The debate over assisted suicide, the value of human life at its various stages and the treatment of dying or despondent patients has become more and more heated.   The Catholic Bishops of Florida in 1989 issued a pastoral statement: "Life, Death and the Treatment of Dying Patients."  We present here three articles relating to this subject.  The first is "Questions Regarding the Medical Treatment of the Dying," by Elena Muller-Garcia, a writer for the Florida Catholic.   Her columns have a deep insight into human concerns.  The second article is "Driven by Fear," by Paige Comstock-Cunningham, the President of Americans United for Life.  The third is an article that contains some reflections on human suffering by Father Gerard Murphy.

   Death comes suddenly for some, without warning. For others, it comes after a long, and often painful illness. Whichever way it comes, there is no escaping it. The only thing we know for sure is that someday we will die.

   For decades, no one wanted to talk about death. In recent years, however, we have heard some people talk about a "right-to-die." What has caused this change?

   Perhaps one of the chief reasons is that advances in the field of medicine have made possible, more than ever before, the use of medical procedures that can increasingly prolong a person's life. Our technological progress, however, has in many ways backfired against us, and in prolonging life, what we often encounter is a prolongation of the dying process and the pain and suffering associated with it.

   What once seemed the inevitable end of every life, and which we avoided mentioning because it revealed our total lack of control over our fate, now appears to be taken away from us. So people incorrectly speak of the "right-to-die," when in reality death is not a right, but the inescapable outcome of being alive. The human person, alone among all the creatures on this earth, is aware of death. The natural occurrence of death, however, has never been used as an ethical justification for the act of killing. Every major religious or ethical view has had precepts against the deliberate taking of innocent human life. Killing of the innocent, no matter what the apparent reason, must never be justified.

   The Bishops of Florida, in their pastoral statement of April, 1989, "Life, Death and the Treatment of Dying Patients," dealt with the general principles of Catholic teaching that lead us to find ethical and moral answers to the questions that arise from the available new technologies and current medical practices.

   "Our Judeo-Christian heritage holds that life is the gift of a loving God, and that each human being is made in the image and likeness of God," state the Bishops as the first basic principle. The dignity bestowed on each human being, by the fact that we are the image and likeness of God, is permanent. No circumstance in life, no matter how trying, how painful, how debilitating, ever erases our dignity.

   "Consequently, the deliberate taking of life, even with the intention of ending suffering, is not permissible."

   This does not mean, however, that we are therefore obligated to use every available medical procedure to keep a dying person from dying.

   Perhaps no one has better explained this than Pope Pius XII, who is quoted by the Bishops of Florida in their 1989 statement:

   "But normally one is held to use only ordinary means--according to the circumstances of persons, places, times and culture--that is to say, means that do not involve any grave burden for oneself or another."

   Today the distinction between what are ordinary and extraordinary means is sometimes difficult to determine. This is recognized in the 1980 Vatican Declaration on Euthanasia, and quoted by The Bishops of Florida:

   "Thus some people prefer to speak of "proportionate" and "disproportionate" means. In any case, it will be possible to make a correct judgment as to the means by studying the type of treatment to be used, its degree of complexity or risk, its cost and the possibilities of using it, and comparing these elements with the result that can be expected, taking into account the state of the sick person and his or her physical and moral resources."

   Whether we use the terminology of ordinary-extraordinary, or that of proportionate-disproportionate, one thing must remain clear: the withholding of extraordinary or disproportionate means is not the same as euthanasia or assisted suicide. The two latter terms refer to acts/omissions done with the intention of killing the patient. The withholding or removing of extraordinary or disproportionate means is not done with the intention of causing death but rather simply to let nature take its course without prolonging unnecessarily the inevitable process of dying.

   For those who advocate euthanasia and assisted suicide, there comes a point in a person's life when physical, mental or emotional deterioration makes that person's life not worth living. Catholic belief holds that human life is inherently sacred, regardless of the physical, mental or psychological conditions of the individual. The judgment that life is not worth living rejects this affirmation of the inherent dignity of the human person. For this reason we stand firm in opposition to euthanasia and assisted suicide.

   The decision to withhold or remove extraordinary or disproportionate means of medical intervention is made on the judgment that the treatment itself is excessively burdensome, or that the treatment is useless, and never that the person's life is not worth living. The decision flows from a judgment on the treatment itself, not on the loss of dignity or worth of the patient. Some questions arise regarding the provision of artificial nourishment and hydration. Food and water are necessary for sustaining life, and since their provision by artificial means is normally not burdensome, there should always be a strong presumption in favor of there use. However, when artificial nutrition and hydration cause harm to the patient, become useless because the patient's death is imminent (that is, "the physician can predict that the patient will die of the fatal pathology within a few days or weeks"), or become excessively burdensome, withholding or removing artificial sustenance can be morally justified.

   Answering the following questions will help us determine when a treatment may be withheld or withdrawn:

                o    Is it too painful?

                o    Is it too physically damaging?

                o    Is it psychologically repugnant to the patient?

                o    Does it suppress too greatly the patient's mental capacity?

                o    Is the expense prohibitive?

   If the answer to these questions is "yes" the artificial nourishment and hydration may be withdrawn, providing there is moral certainty that the treatment is excessively burdensome.

  A person who is not terminally ill, but seems permanently unconscious or unaware, must be treated with the same respect and dedication that we give to those who are severely mentally handicapped. As a general rule, artificial sustenance should not be withheld or withdrawn from these patients.

   The Catholic Church is clear in the principles to be used when deciding what medical treatment one is obligated to request. The application of the principles to each particular case is sometimes very difficult. Whenever possible, therefore, one should consult with his or her family, physician, and priest or minister, in making these decisions.