The bitter legacy of the fate of Eluana Englaro

Italy has been torn apart by a debate over whether a woman who had spent 17 years in a deep coma should die.

The death of Eluana Englaro in Italy on February 9 echoed around the world. After a car accident in 1992 she lived for 17 years in a deep coma in a Catholic nursing home. Her father, however, thought that she would be better off dead. After years of legal battles, he won. Italy’s highest court allowed him to withdraw food and water and his daughter died after three days.

The case was incredibly controversial and politically divisive. Here a Catholic theologian in Rome answers questions about its significance.

How should we approach the debate over Eluana Englaro?

When a sick person capable of thinking and wanting -- or his or her relatives or guardian -- refuses medical treatment or ordinary care (feeding, hygiene, etc), this decision has ethical, deontological, legal and political consequences. It is not morally neutral. The choice made on behalf of Eluana Englaro can only be just or unjust – although I must stress that I do not want to pass judgement on particular persons.

Two important things occur to me: 

(a) It is not true that a choice made freely and in good faith is necessarily correct. Nor is it true that it is necessarily wrong. Sincere and free choices can be right or wrong from an ethical point of view. Denying this is simply denying the existence of ethics itself.

(b) We must not assume that those who have opposed the choice made on Eluana’s behalf have pre-judged the case and are harsh, negative and even cruel. The dispute is not over who made decisions.

But how can you deny someone freedom of choice?

First of all, we are all free to refuse burdensome medical treatment. Everybody agrees that there is no sense insisting on futile treatment in the face of the inevitable death of a sick person. We must alleviate suffering and support patients so that his or her last moments can be lived in the best way possible.

Second, the notion of self-determination in relation to medical treatment must be considered in light of the Italian legal system which prohibits suicide and assisting suicide.

So, for example, if a young person with serious diabetes were to refuse to take insulin, we would regard this as tantamount to suicide. No doctor could do that, at least without consulting. The same criteria should hold for a healthy person or a clinically-stable patient (eg, a quadriplegic or a someone in a vegetative state), who cannot feed himself. Without judging people’s intentions or using harsh words like murder or homicide, withdrawal of nutrition and medicine must somehow conflict with the law. The actual or presumed will of the person concerned is irrelevant because the application of the law does not depend on the intentions of the person concerned.

Do we have to rethink the commandment “Thou shalt not kill”?

This is the crux of the problem. There are two fundamental positions:

Some maintain that a living in a clinically-stable situation can be negative and senseless. Intentionally taking away the life of a person in such state is a good and legal action. The life of the sick person is deemed so bad that it justifies the abrogation of the universally-accepted juridical principle “Thou shalt not kill (oneself or another person)” or (“Thou shalt not intentionally take away the life of anyone” or “Thou shalt not program an action or an omission that will cause the death of somebody”).

Others maintain that “Thou shalt not kill” is always and everywhere valid, even if in some painful situations it is not necessary to prolong life with burdensome treatment.

The reason why the case of Eluana Englaro has been so controversial is that the legal system has now set down as a juridical principle that there are exceptions to “Thou shalt not kill”.

For centuries, despite terrible wars, civilisation has been based on the notion that a just resolution of whatever type of conflict has a limit that can never be crossed and that limit is: “Thou shalt not kill”. This has been considered universally valid, always and everywhere, even in extreme conflicts. If the legal system accepts that this principle has exceptions, then other universally accepted principles can also have exceptions, which would vary throughout history.

Where the legal possibility of taking away a person’s life is admitted for those who ask for it in extreme cases, slowly but surely even the lives of those who have not asked for it are taken away. This is a documented fact which is not worth debating here. If situations exist which justify exceptions to this absolute prohibition, every government could create its own ideology.

The person who pursued the decision on Eluana’s behalf has been hailed as an honest man who has tenaciously pursued his case through the legal system. I insist that I am not being critical of individuals. I am just noting the failure of a universally accepted juridical principle.

Will there be political consquences?

I believe so. The modern state is based on the idea that men surrender their own capacity for self-defence and their unfettered self-interest to a government which assumes a monopoly of authority. They believe that in this way, their lives, their freedom and their property are better protected. Governments were created to guarantee life, liberty, equality and health and not to administer death, sickness, or slavery.

In every society there will be murderers. But this sad reality has always been considered contrary to the law. The government and its health system must not offer services which lead to the grave. Exceptional and desperate cases must be considered individually. Certain things cannot be asked from the health system, from doctors or from tribunals of justice.

But isn’t this a case of the Catholic Church interfering?

Invoking the question of secularity of the State just confuses things. The late secular Italian philosopher Norberto Bobbio, who understood the foundation of modern political life, once wrote: “I am stupefied that secularists leave to believers the privilege and honour of affirming that one must not kill”.

Isn’t choosing death the ultimate freedom?

Invoking freedom and right of self-determination is likewise confusing. The modern state exists to defend life and freedom and it cannot admit the freedom to kill or the freedom to be killed. For that matter, neither can it admit a freedom to rob or to rape. A life that is free is the highest form of life that can be enjoyed here on earth. If freedom turns out to be against human life, it contradicts itself, and ceases to be a fundamental principle of social and political life.

Angel Rodríguez Luño is the head of the Faculty of Theology in the Pontifical University of the Holy Cross in Rome. Translated and adapted by Dean Johnpaul Menchavez y Dumlao, a free-lance journalist currently based in Rome.

This article is published by Angel Rodríguez Luño, and MercatorNet.com under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation. Commercial media must contact us for permission and fees. Some articles on this site are published under different terms.