International Colloquium: Globalization and the Culture of Life : Care of the Frail Elderly and the Dying
Issue 10, August 2003
July 29-August 3, 2003
Recently Father Michael McCabe, Director of The Nathaniel Centre attended the inaugural Colloquium for Catholic Bioethicists in Toronto, Canada. The Colloquium was organised by the Canadian Catholic Bioethics Centre and sponsored by the Knights of Malta. Bioethicists and moral theologians from over 20 countries considered the care of the frail elderly and the dying from the perspective of globalization.
A growing proportion of the world's population is ageing, but few resources are available to meet this looming crisis. Elderly people face challenges that increase over time. Great disparities exist within and among nations, however, in providing health care and social and spiritual supports for the elderly, particularly those frail elderly who have complex and multiple needs. At the same time, increasingly the legalization of euthanasia is seen as a 'solution' to ageing and dying around the world.
The following "Consensus Statement" was drawn up by participants at the Colloquium.
Globalization refers to the historical process of transformation by which the nations and peoples of the world become more closely connected through the mediums of markets, banking, international business and trade, travel, telecommunications, transportation and other technologies. This process, like technology, holds the promise of good and the threat of what is harmful. The good effects relate to better knowledge of, and a greater exchange of knowledge from, other lands, cultures and traditions, and in the opportunities to share in the benefits of health care, industrial development and wealth. It also involves the commitment of a high percentage of nations and peoples to the Universal Declaration of Human Rights which transcends national boundaries and cultures. The harmful effects relate to consumerism, the degradation of cultures, political and economic control, and exploitation of the poor. Care must be taken to recognize and respect not only the values which all share in common, but also the diversity of cultures. 
The adverse consequences of globalization, according to a United Nations report on human rights, can be serious and extensive:
The negative impact of globalisation- especially on vulnerable sections of the community - results in the violation of a plethora of rights guaranteed by the Covenants. In particular, the enjoyment of fundamental aspects of the right to life, freedom from cruel, inhuman or degrading treatment, freedom from servitude, the right to equality and non-discrimination, the right to an adequate standard of living (including the right to adequate food, clothing and housing), the right to maintain a high standard of physical and mental health, and the right to work accompanied by the right to just and fair conditions of labour, freedom of association and assembly and the right to collective bargaining, have been severely impaired. 
Globalization has effected the perception of self as belonging not only to family and local communities, but also to the world community. Crucial to a sound understanding of the human community is respect for the inviolability, purposefulness, and inestimable worth of each human being and of the relationships between human persons.
The Catholic social justice tradition has foundational principles that can be used as tools of analysis to offer valuable direction for those immense issues that face a global world. These principles and tools of analysis include solidarity, subsidiarity, the common good, and the preferential option for the poor. Solidarity includes the responsibility of the community for itself and its members at every one of its levels. Particular concerns are the exploitation of the poor in all nations as the subjects of medical research, and the setting of priorities in health care and social support. Subsidiarity entails that community responsibility is to be exercised at the individual and local levels where the effects are felt, and where those levels are capable of exercising that responsibility. A commitment to the common good involves the collaboration of all members of society to assist its members to realize those goods that human beings need in order to flourish. Some examples are water supply, police force, and an education system. In applying the principle of the common good to the development of new technologies and research priorities, the needs of the less affluent are to be given priority.
It follows that the world community has responsibility for the protection and promotion of human life in its biological, intellectual, social, moral, and spiritual dimensions.
Promoting a Culture in which Human Beings Flourish
A culture where human beings flourish is a culture of life. That culture is achieved by enhancing what promotes human flourishing and avoiding what is restrictive of human flourishing or what causes human decline. The meaning of life is found in giving and receiving love. Love gives meaning to suffering and death. Suffering and death are a mystery, but the process of illness and dying is an opportunity for growth in understanding and love. Science and technology should always be at the service of humanity and the development and flourishing of each person in a way that is consistent with the Christian tradition. More particularly, science and technology ought to enhance the formation of relationships that support and sustain a person in love and empathy. 
Bioethical Issues near the End of Life
1. We must regain an understanding of the mystery of death in order to understand the ethics of dying.
2. For the frail elderly and dying this has particular meaning for the application of technology in a way that defends and promotes the inherent dignity and intrinsic value of each person, particularly their need for meaning and hope.
3. Even at the end of life, there is an obligation to be truthful in communicating a terminal diagnosis. Information may be communicated step by step, without lying or deception, according to the patient's ability to accept it. Securing informed consent or informed refusal of treatment varies according to culture: it is deemed imperative that the patient understands the diagnosis and treatment. The wishes of a suicidal patient, professionally assessed to be so, may be overridden on the grounds that the right to life is inalienable (cannot be given away). Under certain conditions, incompetent patients may, if necessary, be treated in accordance with their best interests, with due regard to their known or presumed wishes.
4. Life is a precious, basic good, but the obligation to preserve life is not absolute and overriding. Withholding or withdrawing measures that are disproportionably burdensome or fail to serve a reasonable purpose may be morally justified. This does not constitute euthanasia, which we understand to be, in the strict sense, "an action or omission which of itself and by intention causes death, with the purpose of eliminating all suffering."  Therefore the term "passive euthanasia" is confusing, ambiguous and misleading. It does not lead to sound moral analysis and should be avoided.
5. The reasons for withholding treatment may also justify withdrawal of that treatment at a later time.
6. This colloquium affirms the Church's traditional position that assisted suicide and euthanasia are morally illicit.
7. The colloquium acknowledged that the World Health Organization defines palliative care as an approach that " intends neither to hasten or postpone death" and that " improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other physical, psychosocial and spiritual problems." 
8. This colloquium asserts that palliative care, properly defined, is the antithesis of euthanasia. In the care of the dying, palliative care is best understood as one aspect of hospice, a profoundly Christian practice, both historically and ethically, that is dedicated to making the last days of a person's life comfortable and meaningful. This is achieved by supporting and sustaining the person, relieving pain and discomfort, and maintaining function in order to assist the patient to live with dying.
9. Catholic bioethics affirms the use of medication, consistent with the rule of double effect, when the dying patient requires doses of medication that might unintentionally hasten death, provided that the intention is only to relieve specific symptoms such as pain or shortness of breath, and the suffering caused by these symptoms is proportionately grave. By definition this is not euthanasia.
10. In regard to medical research, the Church's role is to represent the interests of vulnerable people to prevent all forms of exploitation, particularly those related to research conducted in less affluent societies.
Catholic Social Teaching and Care of the Frail Elderly and the Dying
11. The alleviation of material, social, and spiritual poverty of the frail elderly is a fundamental obligation that Catholic health care and Catholic bioethics must address, according to the preferential option of the poor.
12. Globally, discussions about the care of the frail elderly and the dying must involve the participation of less affluent peoples and societies.
Implications for Catholic Health Care Delivery
13. Decision making and setting organizational priorities in health care require not only sound procedures, but also attention to foundational goals and ends of care which are consistent with human flourishing.
14. Health care workers trained in personalist ethics should promote a culture in which human beings flourish, and collaborate in international outreach programs.
15. Catholic hospitals, to remain Catholic, must abide by Church teaching, and engage staff who agree to practise their profession in accordance with the teachings of the Church.
Implications for Catholic Bioethics Centres and Catholic Bioethicists
16. Bioethics is essentially an interdisciplinary enterprise involving the collaboration of several different competencies, including matters having to do with political and organizational structures.
17. Bioethicists should analyze health care as a necessary antecedent to understanding health-care ethics. We will not understand health care ethics unless we recognize the limits of medicine in treating ills that are moral and spiritual in nature.
18. Interfaith bioethics, which emphasizes dialogue and understanding, is a reflection of the multi-cultural world and needs to be actively fostered.
Morality should be formative of law reform and not determined by it. Critical reflection ensures that foundations and moral sources are as important as the process of decision-making. The moral formation of Catholics involves increasing awareness and understanding of these foundations and sources, and attending to how to be a fully human person, and a true follower of Christ.
 Globalization can also be conceptualized as a transformation of human perception: the compression of the world and the intensification of consciousness of the world as a whole...concrete global interdependence and consciousness of the global whole in the twentieth century (Roland Robertson, Globalization: Social Theory and Global Culture, London: Sage Publications, 1992, p. 8).
 Globalization and Its Impact on the Full Enjoyment of Human Rights. UN Press Release E/CN.4/Sub2/2000/13. June 15, 2000, paragraph 44.
 John Paul II, Evangelium Vitae no.81.
 John Paul II, Evangelium Vitae no. 65.
 World Health Organization, Cancer Pain Relief and Palliative Care. Technical Report Series No. 804 (1990).
The Nathaniel Centre
The New Zealand Catholic Bioethics Centre