Mitt Romney, Catholicism, & Death Panels

Which religious tradition (or non-religious tradition) do you want used to legally define suicide? Or to set the legal standard for how much freedom you have to decline medical treatments?

Last week, the New York Times' Bill Keller and I both did columns suggesting that presidential candidates be closely questioned about how their faith might influence their governance. (Keller's column somehow attracted more attention than mine.)

And then into my e-box popped a perfect example for why he and I are right. The missive from the Culture of Life Foundation is one of many regular digital blasts I check out. This one was titled "Legalizing Euthanasia by Omission - And Making It a Doctor's Order."

The point of the column was to argue against a Colorado law concerning a medical directive called variously by the acronyms MOST, POLST, PORT and MOLST. Whatever it's called, it packs together living wills, do-not-resuscitate orders, durable powers of attorney for health care, default surrogate provisions, and guardianship provisions. It provides a list of what a patient wants followed if he or she is unable to directly express a preference. It's signed by a doctor, therefore it carries the potent legal force of any other doctor's order.

Culture of Life says it presents "the truths about the human person at all stages of life and in all conditions." The column in question was picked up from Zenit, a non-profit Catholic news aggregator whose motto is "the world as seen from Rome." This particular piece is by E. Christian Brugger, an impressively credentialed professor at St. John Vianney Theological Seminary in Denver, Colorado.

So we're clear about the POV being expressed: Intelligently informed by Catholic teachings and doctrine.

Brugger has a powerful beef with the Colorado law, and all such laws authorizing these documents. He says that they allow for the possibility of patients to decline treatment that could save their lives.

"Without using the term, the new law authorizes euthanasia," he writes.

And he suggests that concerned citizens contact their state legislatures to weigh in on the topic. Brugger was kind enough to engage me in an email back-and-forth where it became clear that the column I saw was an abbreviated version of a much longer analysis that appeared in the journal of the Catholic Medical Assoiation, which he sent me.

Here's the legal and moral snarl this question raises: The U.S. Supreme Court has ruled that anybody has the Constitutional right to refuse any treatment. Whether the treatment is the removal of a hangnail or the removal of life support. But the Supremes and various lower federal courts have made it clear that the right is not absolute. A series of rulings concerning patients with names familiar and less so - Quinlan, Bouvia, Perlmutter, Saikewicz, Cruzan - have drawn not-always-consistent lines identifying the limits of that right.

In most of these cases, the patient was clearly dying. In other cases, notably those involving Jehovah's Witnesses, a religious prohibition against a particular treatment (blood transfusion) was the key issue. Many of the arguments boil down to a definition of suicide, and how that definition affects a doctor's legal obligations.

From Brugger's perspective, intent draws a bright line. If someone refuses treatment with the primary intent to die, that's suicide and a doctor who complies would be assisting suicide. If the primary intent of the refusal is to halt an unusually burdensome treatment of limited efficacy, and the inevitable side effect is death, that's OK. There's a philosophical concept called the Principle of Double Effect that is deeply embedded in Catholic teachings.

Brugger has a particular objection to the Colorado legislation. Like some other similar laws, Colorado does not require that a patient be terminally ill before the MOST provisions kick in. And that, he says, is a full step closer to legalizing euthanasia: "Since the introduction of the MOST paradigm, Colorado law has empowered physicians to carry out medical procedures with the aim of bringing about the death of patients. Prescribing a lethal dose of meds is no more than carrying out a medical procedure with the aim of bringing about the death of patients; therefore, ..."

Which to me has a logical flaw -- can not carrying out a medical procedure really be considered the carrying out of a medical procedure? And runs into the fallacy of the infinitely slippery slope Brugger acknowledges that "to stigmatize the new law as euthanasia-friendly is to characterize a complex piece of legislation in relation to an interpretation that very few people are likely to give to it."

Which doesn't stop him from doing so.

I am, inevitably, giving very short shrift to Brugger's arguments. I commend the links to both the shorter and longer versions to your attention. While detailed, even the long piece is not so academic that a lay reader could not benefit from reading it.

But here's my bottom line: Who should decide what your intent might be if you decline a treatment? How involved do you want the government to be in deciding what your medical treatments should or should not be? How much do you want a judge or legislature to determine your intent as to accepting or rejecting health care?

The GOP canard about "death panels" during the heath care reform debate had traction because it artificially invoked a real public policy worry about the appropriateness of outside intrusion into these deeply personal decisions.

I happen to think that Brugger is wrong on many of the merits of his argument. Having experienced some of these issues firsthand through the death of my dad, I've come to have a healthy respect for having the law tilted on the side of informed autonomy. But I could not agree more that this is an issue that needs full public and political airing.

Not all faith traditions approach the question in the same way as Catholicism. And even candidates who belong to a particular tradition may not agree with all the teachings of that faith. That's why it is important to grill top-tier candidates who make their faith a centerpiece of their public, political identities about how their understanding of that faith would inform their governance.

Gov. Perry, Rep. Bachmann, Gov. Romney, and yes, President Obama: How do you understand your church teachings on this issue? Do those teachings inform your views?