Papst Franziskus ist gegen Lebensverkürzung und für eine bessere Palliativversorgung

WMA-Kongreß zu Fragen des Lebensendes
WMA-Kongreß zu Fragen des Lebensendes

Am ver­gan­ge­nen 16./17. Novem­ber fand auf Ein­la­dung der Päpst­li­chen Aka­de­mie für das Leben im Vati­kan ein Kon­greß der World Medi­cal Asso­cia­ti­on (WMA) zu Fra­gen des Lebens­en­des statt. Katholisches.info berich­te­te im Vor­feld und danach: Päpst­li­che Aka­de­mie für das Leben lädt Eutha­na­sie-Befür­wor­ter ein, Papst Fran­zis­kus und sei­ne „Hei­li­gen Wor­te“ über die Eutha­na­sie und Papst für akti­ve Ster­be­hil­fe?
Dazu ging uns fol­gen­de Stel­lung­nah­me vom Vor­stands­vor­sit­zen­den der Deut­schen Pal­lia­tiv­Stif­tung, dem Pal­lia­tiv­me­di­zi­ner Tho­mas Sit­te, zu. Dr. Sit­te war selbst Teil­neh­mer des Kon­gres­ses.

Deutsche PalliativStiftung
Deut­sche Pal­lia­tiv­Stif­tung

Sehr geehr­ter Herr Schnei­der,

Zu glau­ben Papst Fran­zis­kus sei ähn­lich wie ein bel­gi­scher Orden für Eutha­na­sie ist absurd.

Ger­ne stel­le ich Ihnen für Ihr Nach­rich­ten­por­tal kurz die Fak­ten zum WMA-Kon­gress über “end of life que­sti­ons” zusam­men. Es war anders als bei Ihnen berich­tet, kei­ne Ver­an­stal­tung der Katho­li­schen Kir­che, son­dern des Welt­ärz­te­bun­des mit Unter­stüt­zung der Kir­che. Übri­gens kann Ihr Leser auf der Sei­te des Vati­kans sel­ber die Bot­schaft des Pap­stes zum Kon­gress nach­le­sen. Es wird also nicht vom Vati­kan tot­ge­schwie­gen …

Es soll­te beim Kon­gress das brei­te Bild der ethi­schen Ein­stel­lun­gen in Euro­pa nach­ge­zeich­net und dis­ku­tiert wer­den. Es war nie­mals geplant, z. B. bereits ein The­sen­pa­pier für die Öffent­lich­keit dar­aus zu ent­wickeln. U. a. des­halb nicht, da die­ser Kon­gress einer von meh­re­ren auf der Welt war, auch in Nord- und Süd­ame­ri­ka, in Afri­ka und Asi­en wer­den par­al­le­le Ver­an­stal­tun­gen des WMA statt­fin­den. Aus mei­ner Sicht war der euro­päi­sche Kon­gress gera­de durch den Ort in der Aula vec­chio des Vati­kans und die so kla­re Bot­schaft des Pap­stes eine etwas ande­re und sehr gelun­ge­ne Ver­an­stal­tung. Sehr kon­tro­vers, den­noch weit­ge­hend sach­lich. Es gab auch völ­lig anders, als bei Ihnen berich­tet ein sehr kla­res Votum am Ende gegen jede Lebens­ver­kür­zung durch Ärz­te.

Es mag sein, dass eini­ge Ihrer Autoren oder Leser die Auf­fas­sung ver­tre­ten, dass bereits jede Form des Ster­ben Zulas­sens Eutha­na­sie sei. Die­se Auf­fas­sung darf man in einer plu­ra­len Gesell­schaft haben, eben­so, wie eine glück­li­cher­wei­se klei­ne Min­der­heit von Ärz­ten die Auf­fas­sung ver­tre­ten darf, die Gesell­schaft brau­che orga­ni­sier­ten (ärzt­lich) assi­stier­ten Sui­zid und Tötung auf Ver­lan­gen. Wer jedoch in der Ret­tungs­me­di­zin, auf der Inten­siv­sta­ti­on oder eben gera­de auch in der Pal­lia­tiv­ver­sor­gung eini­ge tau­send Men­schen bis zum Tod beglei­tet hat, der weiß, dass immer die­se Fra­gen am Lebens­en­de gestellt wer­den müs­sen. Und, sie müs­sen Ant­wor­ten bekom­men, die umge­setzt wer­den.

Ohne die­se Ant­wor­ten kann der Mensch in der heu­ti­gen medi­zi­ni­schen Ver­sor­gung nicht mehr ster­ben. Denn, ob ich eine künst­li­che Ernäh­rung und/oder Flüs­sig­keits­ga­be fort­füh­re, noch Anti­bio­ti­ka gebe, die Nie­ren­funk­ti­on, die Atmung, den Herz­schlag unter­stüt­ze oder auch erset­ze, sind aus ethi­scher Sicht aus­schließ­lich quan­ti­ta­ti­ve Fra­gen. Qua­li­ta­tiv kann ich mit den heu­ti­gen medi­zi­ni­schen Mög­lich­kei­ten fast jede Kör­per­funk­ti­on unter­stüt­zen oder gar erset­zen. Das gilt (lei­der) prin­zi­pi­ell auch in Todes­nä­he und beim Ster­ben­den.

Des­halb tat Klä­rung Not. Und des­halb bin ich auch sehr froh, Teil des PAL-LIFE Pro­jek­tes der Päpst­li­chen Aka­de­mie für das Leben zu sein, die am 28. Febru­ar 2018 mit einem ersten Kon­gress star­ten wird um die pas­sen­den Ant­wor­ten zu suchen und zu fin­den. Eine gute Pal­lia­tiv­ver­sor­gung über­all und für jeden ver­füg­bar ist eine mög­li­che Ant­wort auf den zuneh­men­den Trend zur Bei­hil­fe zur Selbst­tö­tung und Tötung auf Ver­lan­gen. Zum PAL-LIFE Pro­jekt fin­den Sie die Infor­ma­tio­nen hier:

Damit Sie und Ihre Leser nun bes­ser beur­tei­len kön­nen, was beim Kon­gress der WMA geschah, möch­te ich Ihnen die pri­mä­ren Quel­len zur Ver­fü­gung stel­len.

Kar­di­nal Turk­son ver­las die Bot­schaft S.H. Papst Fran­zis­kus, die ich Ihnen hier voll­stän­dig ein­fü­ge. Solch kom­ple­xe Zusam­men­hän­ge soll­te man nicht mit her­aus­ge­ris­se­nen Zita­ten bewer­ten. [Her­vor­he­bun­gen in der Bot­schaft von Dr. Sit­te.]

Pope Francis: not shortening life, not futilely resistence to death

On Novem­ber 16th Car­di­nal Turk­son has read the Pope‘ Mes­sa­ge to the Mee­ting on End-of-Life Que­sti­ons in the Old Syn­od Hall, joint­ly orga­ni­zed by the Pon­ti­fi­cal Aca­de­my for Life, the World Medi­cal Asso­cia­ti­on, the Ger­man Medi­cal Asso­cia­ti­on.

To My Venerable Bro­ther Arch­bi­shop Vin­cen­zo Paglia Pre­si­dent of the Pon­ti­fi­cal Aca­de­my for Life

I extend my cor­di­al gree­tings to you and to all the par­ti­ci­pants in the Euro­pean Regio­nal Mee­ting of the World Medi­cal Asso­cia­ti­on on end-of-life issu­es, held in the Vati­can in con­junc­tion with the Pon­ti­fi­cal Aca­de­my for Life.

Your mee­ting will address que­sti­ons dealing with the end of earth­ly life. They are que­sti­ons that have always chal­len­ged huma­ni­ty, but that today take on new forms by rea­son of incre­a­sed know­ledge and the deve­lo­p­ment of new tech­ni­cal tools. The gro­wing the­ra­peu­tic capa­bi­li­ties of medi­cal sci­ence have made it pos­si­ble to eli­mi­na­te many dis-eases, to impro­ve health and to pro­long people’s life span. While the­se deve­lo­p­ments have pro­ved qui­te posi­ti­ve, it has also beco­me pos­si­ble nowa­days to extend life by means that were incon­ceiva­ble in the past. Sur­ge­ry and other medi­cal inter­ven­ti­ons have beco­me ever more effec­ti­ve, but they are not always bene­fi­cial: they can sustain, or even replace, fai­ling vital func­tions, but that is not the same as pro­mo­ting health. Grea­ter wis­dom is cal­led for today, becau­se of the tempt­ati­on to insist on tre­at­ments that have power­ful effects on the body, yet at times do not ser­ve the inte­gral good of the per­son.

Some six­ty years ago, Pope Pius XII, in a memo­r­able address to ana­esthe­sio­lo­gists and inten­si­ve care spe­cia­lists, sta­ted that the­re is no obli­ga­ti­on to have recour­se in all cir-cum­stan­ces to every pos­si­ble reme­dy and that, in some spe­ci­fic cases, it is per­mis­si­ble to refrain from their use (cf. AAS XLIX [1957], 1027–1033). Con­se­quent­ly, it is moral­ly licit to deci­de not to adopt the­ra­peu­tic mea­su­res, or to dis­con­ti­nue them, when their use does not meet that ethi­cal and huma­ni­stic stan­dard that would later be cal­led “due pro­por­ti­on in the use of reme­di­es” (cf. CONGREGATION FOR THE DOCTRINE OF THE FAITH, Decla­ra­ti­on on Eutha­na­sia, 5 May 1980, IV: AAS LXXII [1980], 542–552). The spe­ci­fic ele­ment of this cri­ter­ion is that it con­si­ders “the result that can be expec­ted, taking into account the sta­te of the sick per­son and his or her phy­si­cal and moral resour­ces” (ibid.). It thus makes pos­si­ble a deci­si­on that is moral­ly qua­li­fied as with­dra­wal of “overze­a­l­ous tre­at­ment”.

Such a deci­si­on respon­si­b­ly ack­now­led­ges the limi­ta­ti­ons of our mor­ta­li­ty, once it beco­mes clear that oppo­si­ti­on to it is futi­le. „Here one does not will to cau­se death; one’s ina­bi­li­ty to impe­de it is merely accep­ted“ (Cate­chism of the Catho­lic Church, No. 2278). This dif­fe­rence of per­spec­ti­ve resto­res huma­ni­ty to the accom­p­animent of the dying, while not attemp­t­ing to justi­fy the sup­pres­si­on of the living. It is clear that not adop­ting, or else sus­pen­ding, dis­pro­por­tio­na­te mea­su­res, means avoiding overze­a­l­ous tre­at­ment; from an ethi­cal stand­point, it is com­ple­te­ly dif­fe­rent from eutha­na­sia, which is always wrong, in that the intent of eutha­na­sia is to end life and cau­se death.

Need­less to say, in the face of cri­ti­cal situa­tions and in cli­ni­cal prac­ti­ce, the fac­tors that come into play are often dif­fi­cult to eva­lua­te. To deter­mi­ne whe­ther a cli­ni­cal­ly ap-pro­pria­te medi­cal inter­ven­ti­on is actual­ly pro­por­tio­na­te, the mecha­ni­cal app­li­ca­ti­on of a gene­ral rule is not suf­fi­ci­ent. The­re needs to be a care­ful dis­cern­ment of the moral object, the atten­ding cir­cum­stan­ces, and the inten­ti­ons of tho­se invol­ved. In caring for and ac-com­pany­ing a given pati­ent, the per­so­nal and rela­tio­nal ele­ments in his or her life and death – which is after all the last moment in life – must be given a con­si­de­ra­ti­on befit­ting human digni­ty. In this pro­cess, the pati­ent has the pri­ma­ry role. The Cate­chism of the Catho­lic Church makes this clear: “The deci­si­ons should be made by the pati­ent if he is com­pe­tent and able” (loc. cit.). The pati­ent, first and fore­most, has the right, obvious­ly in dia­lo­gue with medi­cal pro­fes­sio­nals, to eva­lua­te a pro­po­sed tre­at­ment and to judge its ac-tual pro­por­tio­na­li­ty in his or her con­cre­te case, and necessa­ri­ly refu­sing it if such pro­por-tio­na­li­ty is jud­ged lacking. That eva­lua­ti­on is not easy to make in today’s medi­cal con­text, whe­re the doc­tor-pati­ent rela­ti­ons­hip has beco­me incre­a­singly frag­men­ted and medi­cal care invol­ves any num­ber of tech­no­lo­gi­cal and orga­niz­a­tio­nal aspects.

It should also be noted that the­se pro­ces­ses of eva­lua­ti­on are con­di­tio­ned by the gro­wing gap in health­ca­re pos­si­bi­li­ties resul­ting from the com­bi­na­ti­on of tech­ni­cal and sci-enti­fic capa­bi­li­ty and eco­no­mic inte­rests. Incre­a­singly sophi­sti­ca­ted and cost­ly tre­at­ments are avail­ab­le to ever more limi­ted and pri­vi­le­ged seg­ments of the popu­la­ti­on, and this rai­ses que­sti­ons about the sustaina­bi­li­ty of health­ca­re deli­very and about what might be cal­led a systemic ten­den­cy toward gro­wing ine­qua­li­ty in health care. This ten­den­cy is clear­ly visi­ble at a glo­bal level, par­ti­cu­lar­ly when dif­fe­rent con­ti­nents are com­pa­red. But it is also pre­sent wit­hin the more wealt­hy coun­tries, whe­re access to health­ca­re risks being more depen­dent on indi­vi­du­als’ eco­no­mic resour­ces than on their actu­al need for tre­at-ment.

In the com­ple­xi­ty resul­ting from the influ­ence of the­se various fac­tors on cli­ni­cal prac­ti­ce, but also on medi­cal cul­tu­re in gene­ral, the supre­me com­man­dment of respon­si­ble clo­seness, must be kept upper­most in mind, as we see clear­ly from the Gos­pel sto­ry of the Good Sama­ri­tan (cf. Lk 10:25–37). It could be said that the cate­go­ri­cal impe­ra­ti­ve is to never aban­don the sick. The anguish asso­cia­ted with con­di­ti­ons that bring us to the thres­hold of human mor­ta­li­ty, and the dif­fi­cul­ty of the deci­si­on we have to make, may tempt us to step back from the pati­ent. Yet this is whe­re, more than anything else, we are cal­led to show love and clo­seness, reco­gni­zing the limit that we all share and sho­wing our soli­da­ri­ty. Let each of us give love in his or her own way—as a father, a mother, a son, a daugh­ter, a bro­ther or sister, a doc­tor or a nur­se. But give it! And even if we know that we can­not always gua­ran­tee healing or a cure, we can and must always care for the living, without our­sel­ves shor­tening their life, but also without futile­ly resi­sting their death. This approach is reflec­ted in pal­lia­ti­ve care, which is pro­ving most important in our cul­tu­re, as it oppo­ses what makes death most ter­ri­fy­ing and unwelcome—pain and lone­li­ness.

Wit­hin demo­cra­tic socie­ties, the­se sen­si­ti­ve issu­es must be addres­sed calm­ly, serious­ly and thought­ful­ly, in a way open to fin­ding, to the extent pos­si­ble, agreed solu­ti­ons, also on the legal level. On the one hand, the­re is a need to take into account dif­fe­ring world views, ethi­cal con­vic­tions and reli­gious affi­lia­ti­ons, in a cli­ma­te of openness and dia­lo­gue. On the other hand, the sta­te can­not renoun­ce its duty to pro­tect all tho­se invol­ved, defen­ding the fun­da­men­tal equa­li­ty wher­eby ever­yo­ne is reco­gni­zed under law as a human being living with others in socie­ty. Par­ti­cu­lar atten­ti­on must be paid to the most vul­nerable, who need help in defen­ding their own inte­rests. If this core of values essen­ti­al to coexi­stence is wea­ke­ned, the pos­si­bi­li­ty of agre­eing on that reco­gni­ti­on of the other which is the con­di­ti­on for all dia­lo­gue and the very life of socie­ty will also be lost. Legis­la­ti­on on health care also needs this broad visi­on and a com­pre­hen­si­ve view of what most effec-tively pro­mo­tes the com­mon good in each con­cre­te situa­ti­on.
In the hope that the­se reflec­tions may pro­ve hel­pful, I offer you my cor­di­al good wis­hes for a sere­ne and con­struc­ti­ve mee­ting. I also trust that you will find the most ap-pro­pria­te ways of addres­sing the­se deli­ca­te issu­es with a view to the good of all tho­se whom you meet and tho­se with whom you work in your deman­ding pro­fes­si­on.
May the Lord bless you and the Vir­gin Mary pro­tect you.

From the Vati­can, 7 Novem­ber 2017

Fran­cis

Der Link zur WMA-Ver­an­stal­tung mit den Prä­sen­ta­tio­nen zum Down­load.

Die Ärz­te­zei­tung brach­te eine seriö­se, kur­ze Zusam­men­fas­sung des zwei­tä­gi­gen Kon­gres­ses:

 

Mit freund­li­chen Grü­ßen
Dr. med. Tho­mas Sit­te
Vor­stands­vor­sit­zen­der
Deut­sche Pal­lia­tiv­Stif­tung

Bild: WMA/Deutsche Pal­lia­tiv­Stif­tung (Scree­en­shots)