by Diane Rehm
That was always a challenge: How can I say “no” to my patient? If they were not in our institution, they were certainly free to pursue that route. But we wanted to know that they were doing it, in case we could help them first. Again, it’s not anyone’s first choice, and most people were very open to sharing their concerns.
D: Did you ever have a situation where a patient in hospice under your care said, “I want to do this”?
FR. T: Yes. Yes. And in fact, sometimes that’s the great courteousness of the patient, informing the hospice nurse; they say, “Don’t come tomorrow, because I know this would make you uncomfortable. I know Providence’s teachings on this, so just to give you a heads-up.” It is very nice, that they would be concerned about the conscience of their caregivers as well. And it never became a challenge. People didn’t leave our hospice because of our beliefs, nor did we ever discharge anyone because of their beliefs.
D: I see. In the case of an individual who says, “Don’t come tomorrow,” would you as a Roman Catholic priest be willing to offer that person last rites?
FR. T: That is a very good question. Pretty much, the consensus is no, we couldn’t, because last rites carries with it the sacrament of reconciliation. If the person is conscious, they actually go to confession, as it were. If they’re unconscious, the forgiveness of sin happens as well. And you can’t forgive something that hasn’t happened yet. So if I knew you were going to take the medication, last rites would not be particularly meaningful because you haven’t yet done anything for which you need absolution. And of course, once you take the pills, you’ve kind of moved beyond. So I can’t absolve you from something you haven’t done yet.
D: But the intention is there and the intention has been verbalized.
FR. T: If you were a Catholic and you wanted to be anointed, you could be anointed, but you wouldn’t receive the last rites, because they carry the sacrament of reconciliation. You could be anointed during your illness. Last rites are the very last time you’d be anointed. So while you could have been anointed frequently during your illness, you wouldn’t receive that final anointing.
D: That seems so sad, especially for one who perhaps has been a lifelong and faithful Roman Catholic.
FR. T: This sounds very unpastoral, but certainly we would say, “Trust yourself to the mercy of your God.” And perhaps I could say, “I’m sorry, I can’t anoint you, but we can pray together and entrust yourself to God’s mercy,” And that is so we don’t abandon the patient.
D: In the faith practice then, if one dies without having been given last rites, what happens to the soul?
FR. T: That’s entirely up to the mercy of God. Last rites is not a requirement, just as baptism’s not a requirement for salvation. Whether you were anointed or not anointed, you’re in the hands of God at that point, so that decision would have no impact, from our perspective. You could have a Catholic funeral as well. You would not be denied.
D: You could have a Roman Catholic funeral if you had taken the pills?
FR. T: Yes. And even, completely outside of this context, if you struggled with mental illness and you took your own life, you could still have a Catholic funeral. The Church would say that it’s unfortunate that the person felt that this was his or her only option, but we trust in the mercy of God, and the person would get the rituals to which you’re entitled as a Catholic.
D: For you, Father Tuohey, what would be a good death?
FR. T: For me, I think I’d like to know that it was coming. If I can get personal for a minute, a few years ago I was diagnosed with metastatic liver cancer. We were talking months to live, and obviously that was not the case, but having those few weeks of not knowing gave me a real appreciation for the preparedness of knowing what’s coming. And the fear of the unknown.
I’d like to know what was coming, so I could prepare myself for it. Now, if I die in my sleep, I’m not going to argue. But I think I would like to know in advance so that I would be prepared. There are still things I would like to do.
D: And who or what would you like to have around you?
FR. T: Oh, my family. That’s one of the reasons I moved back to Massachusetts, to be close to family. That would be the most important.
D: And that is what so many people who choose medical aid in dying talk about. They say, “When I die, I’d like to have my family with me. I’d like to do it at a time when I can still speak with them, when I can express my love for them. And have them express their love for me in ways I can hear.” Many would say that this is part of the justification for choosing medical aid in dying. And I gather you’d like to have the same thing?
FR. T: Absolutely. The difficulty would be that you can’t always get what you want. We had some real tragic cases where people were adamant to die at home and they died in the ambulance because there was no one home to unlock the door. You can’t always get what you want.
D: A number of times, you’ve used the word anointed. Explain the difference between anointing and last rites.
FR. T: Anointing is the sacrament of anointing of the sick using oils. Essentially, it’s a prayer asking for the Lord’s healing comfort, whether that be a miracle of a physical nature or praying for the person, the peace of the patient and their comfort, consolation. The last rites would be the anointing you receive for the last time, and it’s still anointing with oils, but the prayers are formulated in such a way that we are commending you to the mercy of God.
If I were to go in the hospital for an operation, I would be anointed, asking for the Lord’s grace, for my recovery, and so forth. If I were on my deathbed, the prayers would be worded differently: “We commend you to the mercy of God.” It’s still the anointing with oil, but the phrasing recognizes the finality, if you will, of the situation.
D: So the last rites commend you to the mercy of God, but the anointing of oil leaves out that phrase?
FR. T: Yes. I mean, you’re always at the mercy of God. But commending in the sense of turning you over to God, as opposed to God’s mercy, for your healing. So maybe a better word for last rites would be commendation. We commend you to the Lord as you move forth into eternal life.
The reason we wouldn’t give last rites for someone who is about to voluntarily take his or her own life is that the Church teaches that it would be a sin. As I’ve said, I can’t absolve you of a sin that you intend to commit, and that you haven’t committed. Let’s say you change your mind. Well, you haven’t been absolved, because you didn’t do it, but you can’t absolve someone ahead of time. That would be like asking permission to rob a bank.
D: Right. Suppose, then, that the individual has used some form of voluntary taking of one’s own life, would you come in after the fact to give that person last rites?
FR. T.: I think I would. If somebody called up and asked me to anoint, I think I would not feel comfortable refusing at the last minute. I couldn’t be part of the preparation for the person’s death, but if the family were to call afterward, I would not feel comfortable turning them down. And again, I would anoint with the idea of commending you to the mercy of God. If you called me after the fact, I would come.
D: And would that be a general concept or is that your personal concept?
FR. T: I am not sure that there’s specific directive on that. My pastoral side would say that you don’t deny someone the sacraments, irrespective of how they got there.
D: Going back to the beginning of our conversation, can you give me a really tight, concise statement of the Roman Catholic Church’s position on voluntary dying?
FR. T: Sure. The Creator does not take life, so nor should the creature. And we follow the example of the God who created us.
We are creatures. We have a Creator who creates life and does not take life. Part of that created order is that there is a natural way that we die and return to our Creator. T
hat’s the way the Creator made it to be. And so as his creatures, we shouldn’t take control over the process but let it unfold as nature would have it.
D: As nature or God would have it?
FR. T: Well, God created nature, so yes.
D: If an individual wishes to continue on a path toward voluntarily taking one’s life and not taking medication or continuing with palliative care, I mean what is the difference between not continuing and voluntarily moving toward death?
FR. T: The difference, from the Catholic perspective, would be that one way trusts nature, that God created the world in such a way that when the body can no longer physiologically sustain itself, it passes. The other way means, before that moment has arrived, I’ve decided to step in and choose that moment myself. Our teaching would be that it happens naturally, and we ought not take it over.
D: Does the Church consider the patient and/or the doctor who does move in that direction toward voluntarily taking of one’s life as having committed a sin?
FR. T: Yes, it would be considered a sin in the Catholic teaching, yes.
D: What kind of a sin?
FR. T: A grave sin, because it’s the taking of life. The taking of life, the unjustified taking of life, is probably the worst sin that can be committed. And so it would be grave. Now, there may be a lot of circumstances around it, particularly on the patient’s part, let’s say if they’re in extremis and so forth. So there may be a lot of contingencies for culpability, but yes, the action itself would be considered a grave sin.
D: And what about a certified physician who may help that patient? Is that person also committing a sin?
FR. T: Yes. Yes. The writing of the prescription for that purpose would be considered a sinful act.
D: Do you see any movement within the Roman Catholic Church away from that sort of thinking?
FR. T: Only in the movement away from judgmental thinking. It’s one thing to say that we consider the act sinful. But the Church—which is why I mentioned that if you’re a Roman Catholic and you take aid in dying, the Church would not make judgment upon you but would look beyond the action to the circumstances surrounding it, and you would get a Christian burial. So while it would still consider the act wrong, you would not be denied a right of Christian burial.
D: But what about the doctor or the nurse who might be involved?
FR. T: Well, if they’re Catholic, they always have access to the sacrament of reconciliation if they see the error of their ways, to use the Church’s expression. They always have the sacrament available to them.
D: Tell me about that sacrament of reconciliation. I think we all know about the sacrament of confession, but how does that differ from reconciliation?
FR. T: Oh, it doesn’t. Actually, the name of the sacrament was changed in order to focus on the effect of the sacrament as opposed to the act of confessing my sins, which I do, but the whole point is to be reconciled with God and the community. Calling it the sacrament of reconciliation focuses on why I’m confessing, not just the fact that I’m confessing.
D: If a doctor or a nurse had carried out the patient’s wishes and provided a prescription and was there to help, and went to reconciliation, would that person automatically receive absolution?
FR. T: Yes.
D: And then suppose that person continued in that vein?
FR. T: Well, reconciliation presumes that you are changing your ways. It’s a conversion experience.
D: I see.
FR. T: If you have no intention of changing your behavior, then it nullifies the sacrament. Faith and reason are integral to Catholic teaching. We would ask ourselves if it is good for society that people can voluntarily take their lives. We know that the death penalty does not reduce crime, and we know that aid in dying does not help the medical profession because the reason people are choosing it is not pain, or dismay. It’s usually because of a lack of sense of dignity. We would ask ourselves if it is good for society to just say that when you feel like you’re dependent on your family, it’s okay to move on. Is it really good for society to affirm that it’s okay, even when you feel you’re helpless? Do we want to affirm that, as a society?
It’s really the ultimate act of selfishness, because the family may disagree, but the person gets to do it anyway. So we would ask whether it is a good public policy to have voluntary taking of life.
D: In the long run, what kind of effect do you believe that medical aid in dying could have on society at large?
FR. T: We did see this when I was in Oregon, talking to legislators, because it results in ill people being pitted against each other. If I have cancer and I’m dying, I can do it. But if I have ALS and I have all my faculties but I don’t have motor control, I can’t. Yet we’re both dying. If I’m dying of dementia, I have the physical ability to take the pills, but I’m no longer competent in making those decisions. So it begins to open up the question: Well, if them, why not us, and if them, why not me? Where do you decide that the voluntary taking of life is to be stopped, and where do you put those parameters? Where do you draw the line?
D: And what about the right of the individuals to choose to say they want their lives to end?
FR. T: I think probably a missing point is that it’s not a right, it’s a privilege. In some states, just like a driver’s license, the state gives you the privilege of voluntarily taking your own life, because of your medical condition, and it denies that privilege to other people. All of us have the right to say, “I’ve had enough, no more interventions.” If it were a right, then any of us could do it, all the time. And it’s a privilege that a cancer patient has but that an ALS patient does not have.
D: Oregon is working on that very issue.
FR. T: Right. When I was there, we would have these discussions and I would remind them, you know, you promised the citizens of Oregon that this is as far as it would go, it would never go any further. And so they approved it. And that just speaks to my point about public policy. Now that they’ve done it, they want to expand it. There are broken promises to society in some of this legislation.
D: And do you feel that Oregon is now breaking promises by trying to help those who you’ve already said cannot help themselves?
FR. T: If you voted for it because it was restricted to patients who had decision-making capacity and who qualified for hospice, and I voted for it because of the limits to it, then yes, you’ve broken a promise to me because I didn’t want it to go that far, and now you’re saying, “We’ve been doing this for fifteen years, let’s expand it.” I think that’s dangerous.
D: Dangerous how?
FR. T: Because, whom do you trust? You know, you promised to take it only so far, but how can I trust you not to expand it later? And now I can’t take my vote back because if I thought it was going to include these populations, I wouldn’t have voted for it in the first place. I think there’s a public trust issue there.
D: Of course, the Catholic Church has been the most outspoken opponent of these laws around the country and yet, I’m so interested that even when a patient says, “Please don’t come in tomorrow,” that that patient who has taken his or her own life voluntarily is not denied a funeral within the Catholic Church.
FR. T: And that’s how mercy triumphs over all. That’s certainly Pope Francis’s message, but it’s scripture as well. Mercy. In the end, mercy. And if you’ve done it and you were part of the community, then we put our trust in God and we’ll take care of you.
D: So it would not be—
FR. T: It’s a nonjudgmental opposition, maybe we can call it that. Opposed to the action without being judgmental against those who would choose it. I like that expression actually.
D: I do, too.
FR. T: We oppose the action but will not make a judgment upon the person who does it.
William “
Bill” Roberts
A TERMINAL CANCER PATIENT AND FRIEND OF THE AUTHOR’S
Bill Roberts was my high school sweetheart. We “went steady” in our senior year, were voted “the cutest couple in the class,” and attended our senior prom together. He was president of our graduating class and earned a scholarship to American University. Bill is nearly a year older than I am, but we graduated together because he had missed a year due to spinal meningitis, a disease that nearly took his young life and left him totally deaf in one ear. He and his wife, Irene, met at American University, and have been married for sixty years.
Our conversation took place via Skype, on December 11, 2018. He looked pale, but managed to smile and even laugh through the pain he was experiencing from prostate cancer that had metastasized to the bone. Irene was at his side. She was now his primary caregiver, though in the last two weeks of February 2019, nurses were brought in round the clock. I asked Bill how he was feeling, and he said he’d just had a nice breakfast and coffee, felt “perky,” and might get out for a walk. “Every day is a good day,” he said.
Professionally, Bill had been program manager of advanced weapons programs (nuclear weapons) at the Rocky Flats Plant, which no longer exists. He told me, “I retired so many times, but I finally retired in 1995. They kept calling me back and I looked at the checkbook and there wasn’t much money in there, so I went back. I had been a chemist originally, but they take their best technical people and make managers out of them. Sometimes that works. And I hope it worked in my case.”
