Deidre Mussen meets the Auckland woman who is so determined to kill herself when cancer claims her dignity that she’s travelled halfway around the world to buy euthanasia drugs.

DEATH SMUGGLED: A 67-year-old Auckland cancer patient has become the first New Zealander known to travel to Mexico
to buy euthanasia drugs, which she smuggled home to kill herself.

A 67-year-old Auckland cancer patient has become the first New Zealander known to travel to Mexico to buy euthanasia drugs, which she smuggled home to kill herself.

The softly-spoken woman, who declined to be named, flew to the United States in February and took a short bus ride across the border from San Diego to Tijuana to buy a $US25, 100ml bottle of Nembutal, a drug used by vets to euthanase pets.

But the woman, whose cancer is in remission, said it was worth risking any penalties to ensure she died with dignity.

“I don’t want to go into a hospice for those last four weeks, messing the bed and that sort of thing. This business of people saying it’s peaceful (dying in a hospice) – well, it doesn’t look very peaceful to me.

“I know the hospice people do a very good job but I feel I want the choice. I saw my father go through a long process – he had throat cancer. It wasn’t nice.”

Instead, she is comforted by the brown bottle of liquid locked in her bathroom cupboard, ready to end her life if cancer robs her of control over her body’s functions.

Her trip was coordinated by Australian euthanasia advocate Dr Philip Nitschke’s organisation Exit International. At least half a dozen more New Zealanders are expected to join its next trip later this year.

Pentobarbital, the active ingredient of Nembutal, is a barbiturate, which depresses breathing. According to Nitschke, it brings a swift and painless death.

In February, Exit International member Caren Jennings, 74, and Shirley Justins, 58, were charged in Australia with murdering Justins’ partner, former Qantas pilot Graeme Wylie, 71, who had dementia. Police allege the pair killed him in March last year using Nembutal bought in Mexico.

Nembutal is a class C controlled drug under the Misuse of Drugs Act and it is illegal to possess it without a doctor or vet’s prescription. It is also illegal in the United States but can be freely bought in Mexico. Here, anyone who has the drug illegally can be fined up to $500 and jailed for up to three months if they have past convictions. There are no penalties for importing it. The Auckland woman has no criminal record.

She was diagnosed with ovarian cancer 12 years ago and was told two years later she was cancer-free. Two years ago, she developed secondary bowel cancer.

She had surgery and chemotherapy but doctors told her the cancer would return.

“It may not come back for several years, they don’t know,” she said.

She decided euthanasia was a good backstop and planned to stockpile her pills.

In January last year, she attended one of Nitschke’s workshops and became an Exit International member. Two months ago, Nitschke returned to New Zealand to run more workshops and promoted trips to Mexico. He also was selling his new book, The Peaceful Pill Handbook, which was banned in Australia and is awaiting classification by New Zealand censors.

The woman organised her flights to America but once in San Diego, she met Exit’s guide, a former New Zealander, who helped members on the half-hour bus ride into Mexico.

About 15 people were on the trip, mostly Australians and a few Americans, split into smaller groups to cross the border.

“None of us discussed why we were there. We had a lovely time together.”

After stopping for a coffee, the Exit leader guided them to vet shops down some side streets to buy the drug. The Auckland woman went into the shop alone but had photocopies of the drug from Nitschke’s book to show.

“We were told to check its expiry date, that the lid hadn’t been tampered with and that it was pentobarbital.”

Afterwards, the group went shopping, then drank tequilas for courage before heading back into America. None of her group was caught.

“We were a bit nervous but we thought the worst they would do is take the stuff – that would have made me a bit cross.”

She had removed her bottle’s label and hidden it in her toiletry bag.

Aware of New Zealand Health Ministry warnings that Customs would confiscate any Nembutal brought into the country, she pasted a mouthwash label on the bottle to disguise it, but abandoned plans to stick another lid on using chewing gum because it looked too fake. Her jitters worsened before Customs when a loudspeaker announcement said people could be fined $200,000 for bringing in something they hadn’t declared.

“I thought `Oh, that’s the pension, that’s everything’.”

She passed through Customs without a hitch.

“I’m a bit naughty, really, but I don’t have any qualms about what I’ve done. If I’d been bringing back several bottles and distributing it around the neighbourhood, that would be different. I think I should be able to have the choice.”

The woman has never married and has no children, nor any relations in New Zealand.

“It does make it easier because I have no one I’m responsible for and I’m not beholden to anyone. If I had family, it might be different.”

She has told two close friends who accept her decision.

She is physically well but “I know how quickly you can go down.

“I hope I stay well and healthy past this bottle’s (August 2008) expiry date. If I am, I’ll have to do another trip to Mexico,” she says, laughing.

Draft Bill on Euthanasia Questioned

By Galina Stolyarova, Staff Writer

Sixty-year-old Valentina is gradually dying. She has Hepatitis C. But this St. Petersburg pensioner is not receiving treatment for her condition. Doctors have told her that the available medications would in fact serve to hasten her end.

Valentina shrugs her shoulders? at the news that Russia s Federation Council has come up with a draft bill that, if passed, would legalize euthanasia in exceptional cases. She believes that many doctors in Russia are already leaving some patients to die when they should be providing medication and care that would allow them to live longer. The law would only formalize a situation that already exists in practice.

At least, there is no more hypocrisy. My doctors have essentially left me to die, she said. In theory, Russians should be getting free medical treatment from the state but I have to pay for every single thing, even blood tests to evaluate the quantity of the virus in my blood. Doctors are writing me off as though I had already died.

For Valentina, euthanasia is not an option. It is getting more and more difficult for me to look after my two grandchildren, she said.

But I immensely value every single extra moment of life that I can afford, even if I got so weak that I could only manage to look at my nearest and dearest.

The brains behind the draft law which is being debated by the Federation Council this month are members of the upper house of parliament s social affairs committee. The head of the committee, Valentina Petrenko, argues that euthanasia, if introduced, will not be widely applied.

The law, however, does not restrict the use of euthanasia to a specific number of cases per year. It also stops short of setting more detailed limitations on its implementation, other than listing requirements for a patient s consent, the verdict of a medical consultation and a subsequent review by an expert panel selected by a local municipality.

Euthanasia has been allowed in the Netherlands since 2001. Doctors in Belgium, Switzerland and the U.S. state of Oregon are also permitted to terminate the lives of their patients on their request and under specific conditions.

In France, the U.K. and Australia passive euthanasia , where terminally ill patients are granted the right to refuse treatment, is allowed.

Euthanasia is meant as a possible solution for those patients who suffer from excruciating pain or live with the severest disabilities and just cannot bear it anymore, said Valentina Petrenko. We would like to make it possible for the gravely ill, who are begging their doctors for help, to be relieved of this nightmare of a life they are enduring.

Valentina, for one, does not believe that good intentions were what drove the parliamentarians to come up with this controversial plan.
Rather, she argues, a lack of resources and cynicism are what lie behind it. She cites an old Chinese proverb which says that reforms start when the money has run out.

It looks to me as if the state cannot cope with masses of sick and feeble people. And so it is cynically hoping to reduce their numbers by offering to help them commit painless suicide, as opposed to granting them a course of therapy to ease the pain, a psychotherapist and plenty of medication to improve the quality of their last days, Valentina said. That would certainly be a great bargain for the state.

Yabloko politician Natalya Yevdokimova, who chaired the Social Issues Commission at the St. Petersburg Legislative Assembly from 1998 to March 2007, supports the introduction of euthanasia, though she has expressed fears that the law, if it is written vaguely and contains loopholes, could lead to an increase in medical corruption.

I am convinced that people need to feel free to end their sufferings, she said. It so happens that at the moment one of my closest friends is fatally ill and this person s condition is rapidly deteriorating. This patient is in a clear state of mind but absolutely helpless, and is undergoing a rapid physical decline. I think everyone in such a condition should have the right to decide for themselves. It is the only merciful way.

But the expert goes on to warn that in Russia, where corruption is rife, the trend towards shadowy deals between doctors and relatives of terminally ill patients would be marked.

In countries where euthanasia is permitted, there is legislation to protect the patient and to make sure that the medical profession has made every effort on behalf of the patient. Only after all that is the door left open for euthanasia, Yevdokimova added. It has to be a last resort.

Critics of the draft law also warn that the introduction of euthanasia would ultimately relieve doctors of responsibility for saving the lives of their patients.

Professor Georgy Novikov, head of the Russian nationwide movement Medicine For the Quality of Life called the plan destructive and said the law would only serve to encourage suicide attempts.

Only someone who is not receiving adequate medical care can express a strong desire to end his or her life, he said in an interview with Rosbalt News Agency. It is a shame that our country is looking to euthanasia, rather than developing palliative medicine, as well as better psychotherapeutic treatment, and improving conditions in hospices.

St. Petersburg s chief oncologist Alexei Barchuk also opposes the proposal.

It is too early for euthanasia to be introduced in Russia, he said at a news conference in mid-April. Our medical system is not ready for that. The move, if accepted, would inevitably increase the suicide rate among patients who have lost hope. This death machine would swallow up our weakest and most vulnerable people like a meat-grinder.

Over 100,000 cancer patients are registered in St. Petersburg, and nearly half of them are fatally ill with their cancer in its final stages, said Dr. Barchuk.

The Russian Orthodox Church has condemned the euthanasia plan, calling the initiative absolutely amoral from the religious point of view. The Church also suggested that it should be involved in the debate.

Maria Matskevich, a leading researcher with the Institute of Sociology of the Russian Academy of Sciences, said that the prevalent attitudes towards life and death in Russia do not make for a favorable environment for the introduction of euthanasia, at least for the time being.

While there is massive support for imposing the death penalty on certain criminals, people who commit or attempt suicide are viewed with much compassion, but they are condemned for it, she said. Methods which are considered humane in the West are judged here from the moral rather than humane perspective. Death is seen as punishment or retaliation, not as something that people should be legally allowed to seek themselves. At least that s what most people here think, Matskevich said.

It’s been a good week for death. In Iraq, 200 people were blown to bits in what witnesses called “a swimming pool of blood”. Remember that the dead are only part of the story: add to this war’s hundreds of thousands of civilian corpses all those burned and crippled survivors, breadwinners and babies lost. Few families are untouched by the sheer scale of slaughter.

But it is hard for the media to find new ways to refresh repeat tales of daily carnage. The pictures and the thoughts tell the same story day after day, raising the same terrible questions: what have we unleashed, how can it end? This is our war, our fault, our bloodshed for aiding America’s reckless and incompetent invasion and for failing to stop civil war. But because news needs to be new, Iraqi deaths struggle to stay on front pages.

Nor does the war find a place in the nation’s top concerns: people worry about terrorist attacks more than the war. Perhaps the public’s compassion fatigue is because these deaths are caused mainly by extremist Iraqi sects killing other Iraqis, and many fewer are at the hands of allied soldiers.

Yet more broadly, there is a growing disproportion and incoherence in public attitudes to death, with a curious blend of indifference about deaths that should concern us, prurience about deaths that don’t, and a squeamishness and fear verging on denial about mundane dying.

It was a good week for death, too, on the Virginia Tech campus. Although it was hardly less unpredictable “news” than bombs in Baghdad, there was more press relish. (College kids like ours?) But those deaths follow in a cortege of identical tragedies: as soon as we knew this was just another deranged loner, what more was there to think? It happened in Scotland, Germany, South Korea, Japan, Tasmania and elsewhere.

The collective insanity of Americans about guns is an oft-reprised wonderment to non-Americans.

Then there is the apparent double suicide of the two Victorian schoolgirls in an online pact. This combined the addiction of today’s youth for forming virtual communities with the nascent voyeurism of many cruising the online world.

Attitudes to death and mourning have grown odder the rarer dying young becomes: there is less sense of proportion about the risks of dying, or about the inevitability of death, even when people die in old age. The temptation is to regard every death as avoidable, deny any accident is ever accidental, always find someone to blame, and hunt down that doctor in charge. At the same time, we dare not face up to the reality of the prolonged agony modern medicine imposes on the dying. Until it happens to them or their parents, people fondly imagine morphine or palliative care will always ease the end. That fallacy means many will enter the grave via the torture chamber, for failure to demand the legal right to die at a time of our own choosing.

People no longer know how to approach death and its rituals. Abandoning religion doesn’t necessarily mean resorting to reason. With no hereafter, body parts are gaining morbid significance in a strange new fetishism, for example, TV forensics dramas featuring pathologists weighing brains on scales and disgorging stomach contents in close-up.

Fading cellophane-wrapped flowers tied to lampposts are a drive-slower salutary reminder the roads killed more than 1600 people in Australia a year. The clear and present danger of the car should raise as much or more public fear than panic over very rare deaths by terrorism. The anxious taste for daily health scares when we have never been healthier or safer is another necro-neurosis.

The real objection is not aesthetic, or distaste for emotional ostentation. It is about a sense of proportion over fear and death. An age of over-individualism is demanding individual recognition for every painful death, me-me mourning regardless of its collective significance. Near-pornographic fascination with the gory details of a meaningless madman’s murders in Virginia was just grisly. The past week’s deaths in Iraq are the ones we should all be contemplating with due solemnity, because they belong to us.

Girls were missing for a week
Both had taken their own lives
Internet may hold clue to deaths

TWO teenage girls missing for a week were found dead in bushland in the Victorian Dandenong Ranges yesterday.

Police said Jodie Gater and Stephanie Gestier, both 16, took their own lives. They were reportedly found hanging from tree branches.

The girls, from Belgrave, had not been seen since they told their parents they were going shopping in Ringwood on Sunday last week.

Their parents had pleaded for the girls, who had known each only for about six months, to return home, but their worst fears became a reality when the two bodies were found in scrub near Walbundry Ave, Ferntree Gully.

Sgt Andrew Herdman, of Belgrave police, said a man found the bodies on his property about 2.45pm.

Father handed out flyers

Hopes were raised a day earlier when Jodie’s father Robert Gater handed out flyers seeking information about the girls outside Melbourne’s Crown casino.

People told him they had seen the girls near the casino about 30 minutes earlier.

But the report proved false with police revealing the girls died several days ago.

Internet may hold clues

Mr Gater went public last week in a desperate plea for his daughter and her friend.

He feared the internet could hold a key to their disappearance.

Jodie’s MySpace site has a heading that reads: “Let Steph n me b free”.

It also has a message written by Jodie to a friend.

“I luv u sooo soo much allan. miss u heaps xoxoxoxo. I will always remember you,” it says.

Jodie last used the site the day before she disappeared. But Mr Gater said she had shown no signs that anything might be wrong.

Mr Gater said Jodie recorded a new voicemail message on her phone after she disappeared, which he described as disturbing.

“It is her speaking. She’d never set it up before so it’s only been set up in the last couple of days,” he said.

Teen suicide pacts “unusual”?

A leading child psychologist said teenager suicide pacts were unusual but did happen.

“I think it is fairly unusual, it’s not a common occurrence for young people to commit suicide together but it does happen,” Dr Joe Tucci said.

“A lot of parents that I talk to have some inkling that something’s going wrong for their kids. They start to see some early signs – they’re not fitting in or that they’re really distressed or that they’re anxious about something.

“Keeping open lines of communication (is important), regardless of how misbehaving your kids are or how difficult they are or challenging they are in terms of what’s going on in your relationship.”

Police will prepare a report for the coroner.

http://www.channel4.com/news/articles/society/health/womans+euthanasia+bid+is+withdrawn/445317

A terminally-ill woman has been forced to abandon a ground-breaking bid to end her own life, it has been announced.

Kelly Taylor, 30, had begun a court case to force doctors to give her a massive morphine dose which would lead to her death, but asked for the case to be postponed while she investigated alternatives.

But medics rejected her bid for a delay, effectively bringing the court case to a halt.

A spokeswoman for the pro-euthanasia group which has supported Mrs Taylor, Dignity in Dying, said Mrs Taylor was “distressed” by the development.

“Kelly Taylor has been told that her request for an adjournment has been rejected out of hand by the defendants,” the spokeswoman said.

“She feels she has been forced to withdraw her case by the defendants and wishes to express how distressed she is by their actions. Kelly remains committed to patient choice at the end of life. She will continue to campaign for the rights of terminally ill people to determine when and how they die.”

Mrs Taylor is to experiment with non-drug treatments including physiotherapy. Mrs Taylor, from Bristol, who is frail and endures constant pain, planned to win the legal right to demand potentially lethal doses of drugs. A “living will” would then come into force, asking doctors not to provide artificial food or hydration. Physicians refused to provide the treatment, saying it amounted to euthanasia.

An initial hearing at the High Court in London earlier this year heard Mrs Taylor would also be seeking damages under the Human Rights Act. A full hearing was due next week.

Mrs Taylor attempted to starve herself to death as an act of voluntary euthanasia in July 2005. After 19 days she was in so much pain she decided it was less dignified than her medical condition, and began eating again. She suffers from the heart and lung condition Eisenmenger’s syndrome. She also has a spinal condition, Klippel-fiel syndrome.

http://www.statesman.com/news/content/news/stories/local/04/15/15emilio.html

Hospital installs hotline, guard;
case has international reach

By Mary Ann Roser
AMERICAN-STATESMAN STAFF
Sunday, April 15, 2007

The rhythms of hospital life have been anything but normal since the plight of a 17-month-old boy on life support captivated people across the country and cast a white-hot spotlight on Children’s Hospital of Austin.

The hospital has been so inundated with phone calls ¬ more than 100 a day ¬ that it set up a hot line March 20 to take messages about doctors’ plans to disconnect Emilio Gonzales from his respirator against his family’s wishes. The story has been covered by media outlets across the country as well as in England and Canada.

Hospital officials also have posted an armed guard in the pediatric intensive care unit to deal with unauthorized visitors, including out-of-towners who say they want to visit or pray with Emilio, said Dr. David Anglin,- the chief doctor treating the child. And ICU staff members, known for their high morale, receive group therapy twice a week to cope with the stress, Anglin said.

“This is a once-in-a-lifetime thing,” said Anglin, who is 53 and has been a pediatric intensive care doctor for 25 years. “This has been hard on everyone.”

Although doctors and families sometimes differ over treatment decisions, Emilio’s case has been particularly contentious. And because it’s playing out as end-of-life issues are being debated in the Texas Legislature, Emilio’s case could influence how future cases are handled statewide.

“The fact that it’s a child and it’s getting a lot of media” has made the case all the more compelling, said Robin Chandler, an aide to state Rep. Eddie Rodriguez, D-Austin, co-author of a bill to change state law dealing with decisions on end-of-life care. The other author, Bryan Hughes, R-Mineola, appeared with Emilio’s mother, Catarina Gonzales, in meetings with the hospital’s ethics committee to discuss the child’s case.

Their bill would require doctors to continue treating severely ill patients until another hospital agrees to provide the care.

At issue is a debate over who should have the final say on treatment decisions at life’s end when doctors and family members can’t agree and the patient is too incapacitated ¬ or too young ¬ to express his or her wishes.

Doctors at Children’s diagnosed Emilio with Leigh’s disease, a neurometabolic disorder that causes the central nervous system to collapse. They said Emilio, who has been blind and unable to hear since birth, has no hope of recovering.

An MRI last week showed “his brain is rotting . . . and it’s filled with giant holes,” Anglin said. “He’s as close to brain dead as you can be without being brain dead.He has no control of his bodily functions.

“He’s lost human dignity,” Anglin said.

Under Texas law, doctors who determine that ongoing treatment is futile can start a process that gives a family 10 days to find another facility to care for their loved one or face the withdrawal of treatment.

Doctors planned to disconnect Emilio’s respirator last week, but Travis County Probate Judge Guy Herman extended the time and appointed a lawyer to act as Emilio’s guardian. Herman scheduled another hearing for Thursday, when he will get a report from the guardian and hear witnesses on both sides.

Anglin sat in Herman’s courtroom last week and is watching efforts to change the 10-day rule.

He said he thinks that requiring doctors to treat a patient like Emilio indefinitely denies the person a peaceful, dignified death.

“It’s almost like we’re being asked to become the abusers,” Anglin said, echoing testimony doctors gave on a Senate bill last week that is a companion to the Hughes-Rodriguez bill.

But advocates for the disabled, family caregivers and others say doctors are not infallible and have too much power under current law.

“Let us err on the side of life,” said state Sen. Bob Deuell, R-Greenville, a doctor sponsoring the Senate bill.

Gonzales, Emilio’s 23-year-old single mother, told the senators at Thursday’s hearing she wants everything possible done to keep her son alive, and said she believes that’s what Emilio wants and what God wants.

Emilio’s care is being covered by taxpayers through the government-sponsored Medicare and Medicaid programs.

The case has weighed heavily on the hospital staff, Anglin said. Attempts to transfer the child haven’t worked, despite contacting more than 30 other facilities over two months. All have refused because they can offer nothing more to Emilio, said Michael Regier, general counsel for the Seton Family of Hospitals, which runs Children’s.

Gov. Rick Perry, who has no authority in Emilio’s case but could sign the proposed legislation into law if it passes, has received more than 200 e-mails and letters in the Gonzales case ¬ the vast majority from out-of-state writers. Most urge Perry to save Emilio, but Perry has not publicly taken a position.

“This is a heartbreaking tragedy and a very difficult situation and certainly the governor’s heart goes out to Emilio’s family,” Perry spokeswoman Krista Moody said.

Much of the mail to Perry’s office has been fueled by organizations involved in the case, including the disability rights group Not Dead Yet and right-to-lifegroups, which oppose abortion and euthanasia. They are posting media reports from national and regional news outlets on the Internet along with comments from their members, bloggers and others who believe Emilio should be kept alive.

Anglin said he and the medical staff have been advised not to read the commentary. Although some have praised the doctors’ stance, “some incredibly hateful things have been said” by those who disagree with the doctors, Anglin said.

“We do the best we can,”but not every life can be saved, he said.

“This is not a natural death,” Anglin said. “It’s prolonging death and preventing a natural death.”

In the1970s, doctors had too much power to make treatment decisions, he said. Now, the pendulum has swung the other way, Anglin said, and families can force treatment on loved ones that is painful, not beneficial and prolongs the process.

Gonzales, who has admitted calling staff members murderers, has been verbally abusive to the staff, Anglin said, and that is stressful.

“There are nurses who asked to not be on this case,” he said.

Gonzales, who has said she can’t have more children because of complications during childbirth, said all she wants is for her son to receive a tracheostomy, a hole made in his windpipe so he can breathe without a machine,and a feeding tube in his stomach so he has a better chance of being accepted by a long-term care facility. Anglin and other doctors said his lungs are too weak to be weaned from a respirator and he needs the intensive care of a hospital to survive.

http://www.statesman.com/news/content/news/stories/local/04/15/15bioethics.html

In Gonzales case, church teachings are interpreted differently

By Eileen E. Flynn
AMERICAN-STATESMAN STAFF
Sunday, April 15, 2007

The mother says it’s murder. The doctors call it mercy. Each claims that Catholic teachings on end-of-life care support their positions.

In the case of Emilio Gonzales, the 17-month-old boy with a terminal disease at Children’s Hospital of Austin, the decision over whether to remove him from a respirator has been steeped in legal maneuverings and court rulings.

But because both Emilio’s mother, Catarina Gonzales, and the Seton Family of Hospitals rely on the Roman Catholic Church for guidance, theological questions on the boy’s care have generated another layer of debate over Catholic doctrine that permits ending medical care for dying patients.

Gonzales brought her son to the Seton-run Children’s Hospital with a collapsed lung on Dec. 27.

Emilio was put on life support in the pediatric intensive care unit the next day, then doctors told her that Emilio suffered from a rare, incurable disorder that causes the central nervous system to break down.

Since then Gonzales, doctors and hospital officials have clashed over how to care for Emilio, with Gonzales seeking more aggressive treatment and doctors recommending withdrawal of life support.

In trying to weigh the sanctity of life against the desire for a dignified death, Bishop Gregory Aymond supports the doctors’ decision.

“It is my responsibility as a shepherd to make sure we are respecting human life and that we are not in any way carelessly taking human life or not respecting the dignity of human life,” he said.

Meanwhile, Gonzales has said that she’s sought counsel from her Lockhart priest and believes that God will take her son when it’s time. Her conscience tells her to keep fighting to keep Emilio alive until that time comes.And she’s found support from organizations that say Catholic teaching backs her position, not the hospital’s.

The conflict is now before Travis County Probate Judge Guy Herman, who has scheduled a hearing for Thursday to decide whether to require the doctors to continue treating Emilio while his mother looks for another facility that will take him.

As medical technology evolves, the church continually reviews its position on medical ethics, striving to balance the Catholic view that life is sacred with the desire to provide dignity in natural death.

In 1980, the Congregation for the Doctrine of the Faith, the Vatican department that oversees Catholic doctrine, released a declaration on euthanasia that said it’s morally acceptable to discontinue extraordinary, or disproportionate, care when a patient’s death is imminent.

In his 1995 encyclical “The Gospel of Life,” Pope John Paul II wrote that such a step was not equivalent to euthanasia or suicide, that “it rather expresses acceptance of the human condition in the face of death.”

The U.S. Conference of Catholic Bishops echoes those sentiments in its directives for health care services, the guidelines Seton’s ethics committee used in its review.

Abortion, euthanasia and assisted suicide clearly violate Catholic teaching, the document states, but the rules on withdrawing treatment reveal the complexities of weighing medical technology, family desires and what’s best for the patient.

“The use of life-sustaining technology is judged in light of the Christian meaning of life, suffering, and death,” the directives state. “Only in this way are two extremes avoided: on the one hand, an insistence on useless or burdensome technology even when a patient may legitimately wish to forgo it and, on the other hand, the withdrawal of technology with the intention of causing death.”

Determining when not to use available technology is the difficult part, said the Rev. Tadeusz Pacholczyk, a neuroscientist on staff at the National Catholic Bioethics Center in Philadelphia, who has been following the Gonzales case closely.

“There is a clear downward trajectory here,” he said. “This child is dying. The question is what do we have to do in order to provide proper care to a dying individual.”

In cases like these, he said, the church teachings are clear that removing Emilio from life support would be morally acceptable.

Though some have drawn comparisons between Emilio and Terri Schiavo, the brain-damaged Florida woman whose feeding tube was removed in 2005, the church sees the situations as distinctly different, Pacholczyk said.

“Terri Schiavo was not dying of anything,” he said, which is why church leaders rallied to try to prevent ending her care. She was a disabled person who died because she was denied nutrition and hydration, a step the Catholic Church would never sanction, he said.

But that’s what Emilio’s doctors are proposing, argues Burke Balch, director of the Robert Powell Center for Medical Ethics, which handles euthanasia issues. The boy is receiving nutrition and breathing assistance, which he believes the church would consider ordinary care.

“In Catholic teaching, if you omit treatment with the intent of bringing about death, that is considered euthanasia, which is forbidden,” he said. “And in this case, that seems to be the object aimed at.”

On Feb. 19, Emilio’s doctors consulted with the pediatric and neonatal ethics committee, a group of people from the community who review difficult cases and make sure Seton adheres to Catholic teaching in its health care practices.

The hospital was founded by the Daughters of Charity and preserves the mission of those nuns.

The committee first advised doctors to pursue more options for the boy. But the following month, after Emilio’s condition worsened, members determined that continued treatment was futile.

Between meetings with doctors and the Gonzales family, the committee also met with Aymond, said Michael Regier, general counsel for the Seton hospital system.

“We regularly consult with the bishop,” he said, “particularly on issues where we think there may be some likelihood that the issues could be (the topic of) public discussion or debate.”

Aymond turned to national and international bioethicists and theologians and said he tried to weigh the details of Emilio’s situation against the overall philosophy issued from the Vatican.

Aymond said he’s satisfied with the hospital’s conclusion.

“From the documentation I have read from the doctors and the ethics committee,” he said, “the hospital staff and administration have acted responsibly and what they are suggesting to do is in accordance with church teaching.”

But he would not say that Catarina Gonzales is wrong to seek continued treatment, and he said he would like to meet with her to talk about the church’s teachings.