The Right Not to be Forced to Die Alone
The House of the Virgin (1890) Guillaume Dubufe (1853-1909)
As the historic COVID-19 pandemic is intensifying worldwide and draconian emergency measures are being reinstituted in Europe and elsewhere, I see an urgent need to repeat a defense of the right of patients not to be forced to die alone in hospitals or nursing homes. The mission of the National Catholic Bioethics Center (NCBC) has at its core the defense of the dignity of human person. The terribly restrictive visitation and denial of sacramental access policies of many hospitals and other institutions during this pandemic have led to tragedies and violations of human rights.
I believe that two opposing world views and anthropologies are clashing. An extreme secular humanist view sees saving the physical life of a person as the only thing that matters deeply. Frequently this perspective is paired with a utilitarian or consequentialist philosophy that looks to help the largest number, even if some injustices are committed like sacrificing the old, frail, or similarly “less productive” members of society. The Christian perspective on health care recognizes the fundamental importance of spiritual care and the presence of loved ones rather than just treating the body. Caring for a patient’s spiritual and emotional health have strong claims as essential parts of the Catholic vision of health care. The Church has also always strongly rejected any form of “the end justifies the means” reasoning. We may not actively do evil or injustice to achieve a good goal.
In extreme situations like the COVID pandemic, there is a tendency to allow fear to dominate reason. Living a normal human life involves taking risks. There is no zero-risk activity. If you drive a car, there is a small risk of an accident. If you get out of your bed in the morning, you could fall in the bathroom . . .the list is endless. Morally we are called to use ordinary means and reasonable precautions to preserve our lives without ceasing to fulfill our daily responsibilities. I think it is important to reiterate this almost self-evident point because a desire to reduce the risk of disease transmission to almost zero has led to fundamental rights being violated.
At the start of the pandemic we did not know exactly how deadly the disease would be and did not know the best ways to treat it. There was a lack of personal protective equipment (PPE) and a fear that we would run out of ventilators, ICU beds, and so on. This lack of knowledge and preparedness justified extraordinary actions like the lockdowns we experienced and suspension of most gatherings. Over time, however, we have seen that with good treatment people under the age of 70 and without underlying conditions have a much less than 1% chance of dying if they come down with COVID. There has been a steady increase in the availability of PPE and other needed materials over the last few months. Progress has also been quite rapid in developing vaccines, a remarkable achievement because no successful coronavirus vaccine had ever been created in the past.
I mention all this because it points to the current risks faced by the general population and those in hospitals as lower than originally feared. In any case, risk or no risk, we all recognize that essential activities must go on while following all reasonable safety precautions. We must keep in mind that lockdowns and draconian visitation policies don’t just keep people from catching a disease, they have a cost in human lives. Higher unemployment, for instance, leads to documented increases in suicide rates. Isolation is bad for mental health. I was told of several elderly persons in nursing homes who lost the will to live when they could no longer see family members in person due to COVID restrictions. I think we should all keep in mind the basic ethical principle that it is not acceptable for the cure to be worse than the disease.
Our faith teaches us that some things are worse evils than physical death. The glory of the martyrs is that they chose to die rather than to commit sin. Our eternal life matters much more than our physical life. This is a very basic Catholic belief. That is why having a priest come and confer the last rites is more important for a Catholic than minimizing the risk of exposure to COVID by preventing priests from entering hospitals or nursing homes. Yes, they can and should take safety precautions, use PPE, and so on, but they may not be completely barred from going to patients who ask and beg for last rites. The faithful have a right to the sacraments, and religious liberty rights are recognized human rights. We cannot sit back and tolerate policies that violate our human rights. The Office of Civil Rights of Health and Human Services under the Trump administration understood this. It may become a matter for the courts to rule on in a new administration.
It is similarly true that not allowing loved ones to make final goodbyes to patients or to be at their side when they die is a terrible burden to impose. A balanced approach would weigh both the risks and benefits to individuals and patients. We live in an era that values autonomy and informed consent as not unlimited but still key ethical considerations. Patients and their family members should have some say in the matter of restricted visitation. Safety precautions and compassion can be combined to find acceptable compromises. Given the facts of this pandemic, simply denying all visitation is an unreasonable policy. There are very real human and religious values and rights at stake. I would not want to have on my conscience the guilt of having forced a person to die without the presence of family or the benefit of the sacraments.
