SPECIAL UPDATE: The priest has answered my queries by email, and the story is even more horrifying than I had imagined. Readers can find out the latest news by scrolling to the end of my OP.
STOP PRESS: I have just been sent a copy (which I won’t be publishing, for privacy-related reasons) of the complaint filed by the wife. The priest’s story is true. Readers can find out more in the comments section.
People have various opinions about end-of-life decisions. The issues are complex, and reasonable-sounding arguments can be marshaled on both sides. However, few people would deny that a doctor who not only refuses to treat a patient with a life-threatening condition, despite his and his family’s explicit request for treatment, but administers a lethal dose of a drug to the patient, with the intention of hastening the patient’s death, is morally guilty of murder. Recently, I read of a case in Canada which might fit this description, if the account given is accurate. In this case, the account comes from the blog of a Catholic priest, Fr. X, a parish priest in Quebec. Catholic writer and social activist George Weigel, author of a best-selling biography of Pope John Paul II who also happens to be a member of Fr. X’s congregation during the summer months, has written an article in the religious journal First Things which discusses the case (It’s a Culture War, Stupid, August 22, 2017). Here’s an excerpt from Fr. X’s blog entry. I would invite readers to weigh in with their opinions on whether this case is morally equivalent to murder:
Tonight I am preparing to celebrate a funeral for someone (let’s call him ‘H’ to protect his privacy) who, while suffering from cancer, was admitted to hospital with an unrelated problem, a bladder infection. H’s family had him admitted to the hospital earlier in the week under the assumption that the doctors there would treat the infection and then he would be able to return home. To their shock and horror, they discovered that the attending physician had indeed made the decision NOT to treat the infection. When they demanded that he change his course of (in)action, he refused, stating that it would be better if ‘H’ died of this infection now rather than let cancer take its course and kill him later. Despite their demands and pleadings, the doctor would not budge from his decision. In fact, he deliberately hastened ‘H’s end by ordering large amounts of morphine ‘to control pain’ which resulted in him losing consciousness as his lungs filled up with fluid. In less than 24 hrs., ‘H’ was dead.…
Again let me make this point abundantly clear: It was the express desire of both the patient and his spouse that the doctor treat the infection. This wish was ignored by a doctor who believed he alone and not his patient possessed the authority to determine whether or not he deserved to live or die.
Fr. X supplies a few personal details about the patient:
Let me tell you a bit about ‘H’. He was 63 years old. He leaves behind a wife and two daughters who are both currently working in universities towards their undergraduate degrees. We are not talking here about someone who was advanced in years and rapidly failing due to the exigencies of old age. We are talking about a man who was undergoing ongoing chemotherapy and radiation treatments. We are talking about a man who still held on to hope that perhaps he might defy the odds long enough to see his daughters graduate. Evidently and tragically, in the eyes of the physician tasked with providing the care needed to beat back the infection, that hope was not worth pursuing.
Let us assume that the patient was slowly dying of cancer, and that his cancer treatment would have at best delayed his death. A doctor’s deliberate refusal to treat a man who is slowly dying of one disease, and who has suddenly fallen ill with another disease which will kill him quickly if left untreated, could certainly qualify as murder, if the doctor thereby intends to bring about the death of an innocent human being. But if the doctor’s refusal of treatment is motivated instead by a desire to direct scarce hospital resources (staff, equipment, money etc.) at those patients who are most likely to benefit from medical treatment, then one might sympathize with the doctor’s plight, and it would be inaccurate to describe his/her behavior as murder.
In this case, however, the doctor went further, according to Fr. X’s account. He openly declared that it would be better if the patient died of an infection now, rather than dying of cancer later. In other words, he thought the patient would be better off dead, despite the fact that the patient and his wife vehemently disagreed. (And as far as I can tell, the cost of the treatment, even in the most severe cases, would have been no more than $20,000.) I call that medical arrogance. Even worse, the doctor then proceeded to administer “large amounts of morphine,” which killed the patient within 24 hours. I’ve spoken to nurses about morphine treatments, and believe me, there is a real difference between a dose given to alleviate pain and a massive dose which brings on death quickly. So I have to say that I find it hard to believe that the morphine was administered in order to “control pain,” when I read that the dose was a large one, and that the patient was dead one day later. And for those who are still inclined to doubt, here is what Canadian Virtual Hospice has to say in response to the question, “Does morphine make death come sooner?”:
If a person has never received morphine, the initial doses given are low. They are gradually increased to relieve the person’s level of pain or shortness of breath. After a few days of regular doses, the body adjusts to the morphine…
There is no evidence that opioids such as morphine hasten the dying process when a person receives the right dose to control the symptoms he or she is experiencing…
There’s a difference between natural dying and dying from too much morphine. When someone has received too much morphine, he or she usually can’t be woken up…
In the case described above, Fr. X appears to claim that there was a single, massive dose of morphine, and he adds that the patient lost consciousness and died within 24 hours. What’s more, the doctor who administered the drug had previously declared that the patient would be better off dying quickly of an infection than dying slowly of cancer. If the claim is correct, then it may well be the case that the drug was deliberately administered in order to hasten the patient’s death. What should we call that?
I stated at the beginning of my OP that a doctor who not only refuses to treat a patient with a life-threatening condition, despite his and his family’s explicit request for treatment, but administers a lethal dose of a drug to the patient, with the intention of hastening the patient’s death, is morally guilty of murder. I may be wrong in my facts, but I have to say that if Fr. X’s account is correct, that may well have happened here.
But we shouldn’t just blame the doctor for what happened. Canada’s health care system also has a lot to answer for. “Why so?” you ask. George Weigel explains:
Canada’s vulnerability to the culture of death is exacerbated by Canada’s single-payer, i.e. state-funded and state-run, health care system. And the brutal fact is that it’s more “cost-effective” to euthanize patients than to treat secondary conditions that could turn lethal (like H’s infection) or to provide palliative end-of-life care. Last year, when I asked a leading Canadian Catholic opponent of euthanasia why a rich country like the “True North strong and free” couldn’t provide palliative end-of-life care for all those with terminal illnesses, relieving the fear of agonized and protracted dying that’s one incentive for euthanasia, he told me that only 30 percent of Canadians had access to such care. When I asked why the heck that was the case, he replied that, despite assurances from governments both conservative and liberal that they’d address this shameful situation, the financial calculus had always won out—from a utilitarian point of view, euthanizing H and others like him was the sounder public policy.
(Are the bean-counters right here? For the record, I would like to note that a 2014 Fact Sheet on Hospice Palliative Care in Canada put out by the Canadian Hospice Palliative Care Association states that “[d]epending on the estimate, expanding access to quality palliative care would have saved between 40 dollars and 345.5 million dollars between 2003 and 2011 in the province of Ontario,” adding that “[p]rojected savings from 2012 to 2036 range from just under 247 million dollars to just over 2.1 billion dollars, again depending on the estimate scenario.” The same report also claims: “Hospital-based palliative care reduces the cost of end-of-life care by 50% or more, primarily by reducing the number of ICU admissions, diagnostic testing, interventional procedures and overall hospital length of stay.”)
Weigel makes a telling comment in his final two paragraphs:
To reduce a human being to an object whose value is measured by “utility” is to destroy one of the building blocks of the democratic order — the moral truth that the American Declaration of Independence calls the “inalienable” right to “life.”…
When we lose sight of that, we are lost as a human community, and democracy is lost…
Sadly, that is what seems to have happened here. A health care system regulated by utilitarian bean-counters deemed a 63-year-old man’s life not worth saving, and the doctor then administered the man with a massive dose of a drug, after having declared that he would be better off dying sooner, of a quick death, rather than later, of a slow death. 24 hours later, the man was dead. Were the man’s rights violated? If the evidence presented is correct, it would appear that they were.
So I would like to invite my readers to weigh in. Would you call it murder? Why or why not?
I would ask readers on both sides to conduct their debate in a spirit of charity, free from rancor. And above all, I would urge readers to respect the privacy of everyone involved in this sad case – especially the doctor and the patient. When we don’t have all the facts at our disposal, any conclusions we arrive at should be provisional, and whatever our viewpoint may be, we should always acknowledge that we may be mistaken in our judgment of a particular case. And now, over to you.
FEEDBACK FROM READERS (see below for the latest update)
I’d like to summarize readers’ feedback on this story.
(1) A number of readers expressed skepticism as to the veracity of the story, on account of the sources: a Catholic priest and a grieving family, which has chosen not to take the case further. Fair enough. There are two sides to any story, and we’ve only heard one side. And as I said in my OP, “When we don’t have all the facts at our disposal, any conclusions we arrive at should be provisional.”
(2) Speaking purely hypothetically, some readers felt that if the facts as presented were accurate, and if the physician acted against the express wish of the patient, then what he did would be morally equivalent to murder. Others felt that criminal negligence and recklessness, a violation of trust and malpractice would be better ways to characterize the alleged act.
(3) Many readers felt strongly that end-of-life decisions should be left up to the patient. I was going to add “and his/her family,” but Alan Fox’s link to the Guardian article about the death of George V should give us all pause. In any case, this is not a post about voluntary euthanasia. The question at issue here is whether legalizing euthanasia paves the way to other practices which violate the patient’s consent. So far, no proof has been submitted that this actually occurs in Canada.
(4) One reader felt that I should have completely anonymized the story, so out of respect for all parties concerned, the name of the priest in my OP has been suppressed.
SPECIAL UPDATE: News from Fr. X.
Last night, I contacted Fr. X by email, and he responded almost immediately. I had three queries.
First, I asked Fr. X why the family had not made an official complaint. Fr. X told me that the family DID complain as soon as they realized what was going on. It turns out that H (the man who later died) was in hospital with a bladder infection for THREE DAYS before the family finally found out that his infection was not being treated. H’s wife then complained to FOUR different doctors, but none of them was prepared to countermand the order of the physician of record. By the time the family tried to move the complaint to a higher level, H had died. The family has now started going through the official routes for lodging a complaint. However, no response has been received to date, other than an acknowledgement of receipt of the complaint.
Second, I asked Fr. X how much morphine had been given to the patient, and on how many occasions. Fr. X replied that he didn’t know the exact size of the dose, but that ANY dose would have been too large, as the patient was wearing an ALERT BRACELET stating that he was ALLERGIC to morphine.
Finally, I asked Fr. X if there was any INDEPENDENT CORROBORATION for his account. He answered that the family could corroborate his account, and that they had been interviewed earlier this week by a reporter from the Catholic Register. Fr. X added that there had recently been a second, very similar case that resulted in the death of another person last Sunday morning. In that case, Fr. X told me, the wife was so frustrated with the hospital and the doctor for their refusal to treat her husband that she went to the police in an attempt to have them intervene. Eventually a courageous nurse decided to ignore the doctor’s standing order, and she wheeled the patient down to the Emergency/ICU, even though she said it might cost her her job, because she couldn’t accept the morality of not treating him. Sadly, it was too late and the patient died about 12 hours later, as his kidneys had already shut down due to sepsis, which had spread through his body from the untreated bladder infection. And what was the doctor’s excuse? He said that the patient (who was in his late eighties) had been a resident in a nursing home for a few years, and that he wouldn’t have a ‘sufficient quality of life’ if he were to return there. Fr. X tells me that this family has also initiated an official complaint.
To all those readers who were skeptical of my account, and who thought that Fr. X was just making stuff up: I hope this answers your questions. The slippery slope of euthanasia is all too real.