Catholic Healthcare Challenged By A Slippery Slope Towards Euthanasia For Mentally Ill

Psychiatrists are warning against the ever-expanding eligibility criteria for physician-assisted suicide/euthanasia (PAS/E), which is often misleadingly labeled “medical aid in dying”(MAID). In a new  paper, they cited the introduction of expanded eligibility criteria in legislation introduced in California, and several cases in which anorexia patients were given lethal prescribed drugs to end their lives. Drs. Mark Komrad, Annette Hanson, and others wrote on June 6 in the Psychiatric Times that PAS is now legal in 11 US jurisdictions. In contrast, they quoted medical ethicist Dr. Leon Kass, who wrote: ‘We must care for the dying, not make them dead.’” The authors also quoted the American Medical Association’s [AMA] position: “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.” This is echoed by the World Medical Association.

“Despite such clear statements, we and others have called attention to the ever-expanding eligibility criteria for PAS/euthanasia (PAS/E), particularly in Canada, Belgium, and the Netherlands. In essence, every one of these foreign jurisdictions that has legalized [physician-assisted suicide/euthanasia] has eventually expanded them—a phenomenon often referred to as ‘the slippery slope,’” the authors wrote.

While involuntary euthanasia is illegal in all 50 states of the United States, physician assisted suicide is legal in the District of Columbia, California, Colorado, Oregon, Vermont, New Mexico, Maine, New Jersey, Hawaii, and Washington. In Montana, the state supreme court has ruled that precedents nor state law prohibit physician assisted suicide. 

The National Catholic Bioethics Center clarifies essential terminology regarding death at the hands of medical personnel or others. “Euthanasia is categorized in different ways…Voluntary euthanasia is when a person wishes to have their life ended and is legal in a growing number of countries. Non-voluntary euthanasia occurs when a patient's consent is unavailable and is legal in some countries…in both active and passive forms. Involuntary euthanasia, which is done without asking for consent or against the patient's will, is illegal in all countries and is usually considered murder,” it states.

The Catechism of the Catholic Church is clear about suicide and murder. It states: “"Intentional euthanasia, whatever its forms or motives, is murder. It is gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator.(2324) Suicide is seriously contrary to justice, hope, and charity. It is forbidden by the fifth commandment. (2325) Scandal is a grave offense when by deed or omission it deliberately leads others to sin gravely. (2326).

In the Psychiatric Times, the authors cite California Senate Bill 1196, the End of Life Option Act, as  “a radical departure from existing California law.” Even some pro-euthanasia groups saw the bill as too radical, and it was withdrawn. The physicians wrote, “However, in our view, the mere fact that SB 1196 was proposed is cause for great concern and a sign of the slippage we have witnessed in other countries.” They wrote that while PAS proponents claim that the slippery slope argument is hypothetical and that it cannot happen in the US, “We respectfully disagree.” 

The psychiatrists also wrote about three cases where patients suffering with anorexia nervosa died during medical care. “Although the angle of the slope is considerably greater in Canada and Belgium, the Netherlands, and Luxembourg than in the US, we find troubling signs of slippage here at home,” the doctors wrote. They argue that the slippery slope is evident in how an eating disorder, anorexia nervosa, was redefined as a terminal illness that permitted three assisted suicide deaths in Colorado. 

Dr. Jennifer Gaudiani, a specialist in eating disorders, published a paper Journal of Eating Disorders in 2022, describing three anorexic patients. One patient was Alyssa Bogetz, who co-authored the paper. Bogetz died of severe malnutrition in 2021 at the age of 3.

According to Gaudiani’s account, “Alyssa had not completed a full residential eating disorder program; never fully restored weight; never tried newer psychedelic options such as ketamine, psilocybin, or MDMA; and hadn’t had a feeding tube. Dr G[audiani] acknowledged that all but the feeding tube might ordinarily be undertaken prior to someone’s seeking end-of-life care for A[lyssa Bogetz]. Yet, [Alyssa] had been suffering for so long, and despite many conversations about all these treatment possibilities, Alyssa would not consent to any of them. Therefore, given her clarity of understanding around these issues and her sense that she could not fight anymore, everyone had to accept that they weren’t meaningful options.”

Gaudiani’s paper called for a definition of terminal anorexia, thereby stirring controversy among psychiatrists and others concerned about the trend towards euthanasia for the mentally ill. Internationally recognized psychiatrist Dr. Angela Guarda, for example, told the Colorado Sun that giving lethal drugs to anorexia patients is “alarming” and “fraught with problems.” Guarda told the Colorado Sun: “It is in direct contradiction to treating mental illness, promoting hope for recovery and improving quality of life for our patients.”

Drs. Komrad, Hanson, et al. gave a full-throated endorsement of Dr. Guarda’s position, writing in the Psychiatric Times that the cases exemplify that there is a “slippery slope” in the US that may allow for PAS/E for mentally ill patients. The idea that treatment is futile is “not supported by current evidence and should not serve as the basis for decision-making in this condition,” the paper contended.

The paper concluded that an increasingly steep and slippery slope, which normalizes even direct killing by physicians, was to be expected. “The more widely these acts are performed, the easier it becomes to mischaracterize them as forms of ‘medical care.’ This is epitomized in the obfuscating euphemism ‘medical aid in dying,’” they wrote. The American College of Physicians, states: “Terms for physician-assisted suicide, such as aid in dying, medical aid in dying, physician-assisted death, and hastened death, lump categories of action together, obscuring the ethics of what is at stake and making meaningful debate difficult.”

Finally, the paper called on the American Psychiatric Association to maintain its opposition to physician assisted suicide/euthanasia, consistent with the Code of Ethics published by the American medical Association. 

The National Catholic Bioethics Center states that current US protocols allow for violating informed consent. This is true, said NCBI, "especially cognitively impaired patients." Hospices have been known to withdraw therapeutic medication, food and water, and give sedation that makes swallowing impossible.What is at stake for Catholic hospitals and professionals, the NCBC says, it that they are “thus facing threats to their religious liberty when they refuse to participate in such legally allowed procedures (Vermont and Canada are examples).”

As euthanasia advances in Europe, where even Christian agencies are forced to participate in  physician-assisted suicide (PSA/E), American healthcare providers who conscientiously object  may see the limited protections eroded, the NCBC warned. “Numerous unanswered questions exist for Catholic health care. It is likely that the challenges to the integrity of Catholic health care posed by physician-assisted suicide, passive euthanasia, and [voluntary stopping eating and drinking] will be similar to the challenges posed by reproductive issues,” it stated. 

Already in Canada, Catholic bishops are being faced with issues such as requests from people seeking physician-assisted suicide for the sacraments and Christian burial: “These are issues about which the Church and Catholic health must be proactive," the NCBC concluded.

Martin Barillas is a retired diplomat, and author of Shaken Earth, available at Amazon.