Advent is nearly upon us and with it come many special Community activities. Notable is an upcoming talk by George Eppley about which I received two unsolicited articles. Quantity doesn’t always mean quality, but I think this is one case where it does. Read on and try to be there.

It’s with sadness that we mark the passing of Cardinal Bernardin. I only knew him from his press clippings, but from what I read, he struck me as a very great individual, the kind of leader our Church needs many more of. It’s an appropriate time, I think, to run a long article on physician-assisted suicide from America, that Barbara Lohn sent me a couple of months back. I highly recommend this thought-provoking piece to you. Thanks to Pat Willis for typing it.

On the E-mail front, I recently added the Juno service to my computer and have been very pleased with how it works. Juno is a free E-mail system with an easy-to-use interface. One negative is that it can not yet handle "attached files," but is good for the simple E-mail messages most people send and receive. Call 1-800-654-JUNO to obtain the start-up disk. System requirements are a 386 PC, using Windows 3.1 or higher, 4MB RAM, 10MB free hard drive space, a 3.5-in. floppy drive, VGA or SVGA monitor and at least a 9,600 baud modem. Most computers bought in the last 2-3 years have all this. (Note: to reach me by E-mail, please keep using 73511.3222@compuserve.com.)

Thanks to Jane Smith, Mary Englert, Kim Langley and Paul Kunkel for writing articles this time.

According to my dictionary, there are two definitions for advent, one could be secular, the other is clearly spiritual. Fortunately for Christians, both definitions can have a spiritual meaning, if we let them.

This Advent season will begin for Christians in just seven days. We’ll start planning the festivities for Christmas. We’ll hope to start our shopping soon. And before we know it, we’ll be so busy, we may hardly enjoy what Christmas was meant to be.

Fortunately, we are blessed with an opportunity to slow down, to come together as a community and to listen to George Eppley as he shares our Advent reflection with us.Thoughts to carry us through this holiday in a deeper way as only George can.

For those of you who know George, you know what I mean. For those who don’t, you have a special gift waiting for you if you join us Tuesday, Dec. 3 for an Advent Evening Reflection at 7 p.m. in the church, with soup and salad supper at 6 p.m. in the school hall.

George is a gifted teacher both in academia and the church and his work has been published across the country. He has the ability to help people to see that scripture is as meaningful today as it was thousands of years ago. I believe George Eppley is one of the prophets of our time, a person who calls us out of ourselves and into relationship with our God and our community. I hope you take this opportunity to join us.

George Eppley, familiar to the Malachi scene for some 25 years, currently is "making the scene" twice over.

As was announced in our last newsletter, he will be presenter for our Advent Evening Reflection set for Tuesday, Dec. 3. The evening will include a 6 p.m. supper, followed by George’s talk, a reflection and prayer service. Jane Smith, spiritual development chair, is having flyers out and about with the details.

Another flyer to be seen here and there announces that Malachi Center and the Malachi Food Fund will benefit from the sale of George’s new audio-cassette program, "Looking Back and Learning from Three Score and Ten."

Educator, author and master story-teller that he is, George inspires and entertains listeners with experiences from his own life. Topics are wide-ranged: Greta Garbo, the Beanfield War, James Thurber, the Del Mar Racetrack, etc.

George believes that society — and even seniors themselves — overlook their value as wisdom figures. So he challenges seniors to get in touch with their feelings and memories of persons, places and events that have shaped their lives and values. He does it with humor, and with messages appealing to all ages.

(Eppley, who retired from Cuyahoga Community College a year ago, has had opinion pieces published frequently in the Plain Dealer, as well as in The New York Times, Newsday and professional journals. For the past 15 years, he has written a column for the Retired Senior Volunteer Program (RSVP) newsletter. He and his spouse, Anita Dixon Eppley, another familiar face at St. Malachi, have co-authored three college textbooks on writing. She teaches at CSU.)

"Looking Back and Learning" is a three-tape audio-cassette program. Total program cost is $29.95, including Ohio sales tax, handling and shipping. For each sold through the Community of St. Malachi, St. Malachi Parish, Malachi Center or Malachi House, $4 will be donated to the Malachi Center or Malachi Food Fund. You get to pick which. The address: E & D Productions, P.O. Box 771392, Lakewood, OH 44107; phone: 521-0114.

Rumor has it that another venerable pseudo-senior, Joe Mohar, the well-known business tycoon, will be taking orders during CSM coffee hours. These could solve some of those "what to get ‘em for Christmas" dilemmas and benefit Malachi ministries at the same time. Think about it.

Today we celebrate the feast of Christ the King! Personally, I have often had a difficult time identifying with this feast. A) Being raised in a democratic republic, the notion of monarchy goes against my grain. B) Being a woman, I do not have a strong identification with the term, ‘king.’ However, if one looks at king-ship as about using power and preserving order, then the obvious question is what do the Scriptures tell us about power and order.

Today, Ezekiel portrays God as a shepherd; one who brings back strays and binds the wounds of the injured. This God/shepherd/king preserves order through healing and reconciliation. In Matthew’s Gospel, the king returns for the final judgment and his measuring stick is a curious one. He does not favor those who have used their power to achieve status or wealth. He does not bestow accolades upon the smart, the swift and the strong. Instead, he commends those who have used their influence, large or small, in service to others.

It’s funny that the image of the good guys here should be sheep, because I think that many of us have become numb to the challenges of choosing this brand of power. It’s so hard to break out of the "flock" (herd?) mentality! We listen to the Gospel, dutifully respond with our "Praise to you, Lord Jesus Christ" and put ourselves on automatic pilot for the rest of the Mass. Will this word change our lives?

Carl Jung’s archetypal notion of the job of the king fits well with Ezekiel’s and Matthew’s model of authority granted for the building up of the world. The King dispenses blessing as one of his primary functions, and especially his role is to bless younger persons and mentor the immature. I like this notion of Christ the king. Perhaps this is not what the church had in mind when the feast was created. But an authority who rounds up what is scattered in us, binds up wounds, lays a blessing hand on a woolly head, and is not above giving a goat a good swift kick when needed, appeals to me.

Concerning the call in the gospel today to be among those who align themselves with the hungry, thirsty, naked and ill, let me offer this. For a long time my main reaction to this Gospel was guilt. For 20 years I thought this reading was meant to make me ask the question how much like a goat can I be and still qualify for "sheep-dom"?

Mid-life helps in finding the balance between the worry that I have an underactive conscience, and the angst that comes from energies spread much too thin. The question that interests me at this time is: what is ripe for blessing in my life right now? What can be left to stray a little, and what must be rounded up?

The commitments I’ve made and continue to honor mean that much of the clothing of the naked that I do is simply forgoing new shoes because the kids have outgrown theirs, and helping my spouse to make Halloween costumes. Not exactly the noble stuff of the lives of the saints. But if these readings are all about subjecting oneself to the right kind of authority, then I am not free from the gospel in my domestic life. I must forge a just, compassionate order at home as well as in the world. It is sometimes easier to see the face of Christ in a stranger than to encounter the divine across the breakfast table or at Thanksgiving dinner.

As we pledge as a faith community to bring the world into God’s order, let us begin with our own messy, less than glamorous lives. As we continue to work to bring justice to the poor, may we also be able to see the poor in the eyes of those who can call us by name.

Let’s hear it for...

Chris Keim, who has made it possible for his mother, onetime CSM council president and current FutureChurch co-coordinator Lou Keim, to proudly refer to him as "my son, the lawyer." Chris was a successful survivor of the most recent Ohio State Bar exams in Columbus.

And cheers for a recent union (amalgamation? fusion? consolidation? or maybe in this case, symbiosis?) of two good CSM names on a sign overlooking Center Ridge Road. The sign announces: "Fairview Medical Group Family Practice" with the names John Gerace MD and Charles Garven MD. (Don’t let ‘em fool you. The sign says "Fairview" but the site is in Westlake. No matter. They’ll never get your tonsils and your appendix mixed up.)

And "break a leg" to Peter Toomey, whose role as Uncle Max in "Sound of Music" at the Huntington Playhouse is cleverly described thusly: " ‘Raindrops on roses, and whiskers on kittens’ (and Toomey singin’, goofing around, and generally looking like he’s having the time of his life making a fool out of himself)..."These are a few of my favorite things!" The "literature" also states: "So if you’re silly enough to want to go, Peter’d love to see you there after the show..." The musical is running Thursdays through Sundays until Dec. 8; reserved seats $9, seniors $8; box office: 871-8333.

As we continue our mission to love others the way we are loved by God, our Community has been involved in the past few weeks in many efforts of bringing comfort to God’s people as we nurture our own personal and spiritual growth.

Bishop Anthony Pilla addressed parish council chairpersons at the Diocesan Pastoral Council’s fall meeting. Bishop Tony spoke of the importance of parish councils today in being committed to listening and studying to understand our people along with their experiences, needs and struggles, hopes and dreams. In so doing, the councils can articulate a meaningful vision and give direction to the parishes. He stressed the collaborative nature of the relationship with the pastor.

He dealt next with the need for improving liturgy and the spiritual development of parish life. His concern is with the drop in Sunday mass attendance. It’s down to about 35% or less — somewhat alarming. He also spoke of the status of the TV mass that was recently discontinued and some solutions to this problem.

The Church in the City effort was also brought up, with reference to the parish partnership programs that are developing. Working with the poor, with whom we should identify, is important. The Sesquicentennial celebration is starting in April 1997 with the theme, "Celebrating God’s Blessings." He also had remarks about the election process and our part in it.

The exchange that followed gave us some insights to Tony Pilla the person and his coping with the responsibilities including his role as president of the NCCB. One quote from Pope John XXIII was particularly noteworthy. Upon retiring, Pope John prayed, "God, it’s your church. I’m going to sleep now. You take care of it!"

Looking at our Community, we can report that we are involved in developing a vision. Council’s Visionaires committee is putting together a pastoral plan. Council is also involved with listening. Last Sunday, council members met with younger members of the Community along with Father Tony in a session to talk about their needs and desires. Spiritual needs, faith involvement, liturgies, sense of belonging, feeling welcome, the poverty of the world and our concept of it, the diverse groups in the Community, and the need to work together were some of the topics discussed. This group will meet again after Jan. 1.

Also, Council members from the Community, representatives from the Parish and the West Side Catholic Center, have also been meeting for a few months to address the financial needs of the neighbors served by the parish, the Community and the St. Malachi Center. Their first task is setting up a liaison with a near West Side credit union. Saving plans, check cashing and financial counseling are aims of the effort. Our Social Action Committee and the others are involved in this work along with the pastor.

It is very encouraging to report that much of what Bishop Pilla encouraged the parish councils to do is already being addressed in several ways at St. Malachi. We do have working partnerships with some of the neighboring parishes in our RCIA program and in our Pentecost Lecture Series. Collaboration with other parishes is also being considered.

(When I was a member of the CSM Council — way back when — I wrote the following for our way-back-then newsletter. I came across it recently and the thought occurs that perhaps it’s as applicable today as it was way back when. It’s intended for the entertainment — if not the edification — and the encouragement of today’s CSM members and council.
— Mary Englert)

This reflection on the Community of St. Malachi Council and its works is, as Gen McCloskey’s mother used to say: "half-joking, full-serious."

The council’s 22 members are divided nicely between both sexes — 11 of each. They come in all sizes and shapes but at this point in time, unfortunately, in only one color. Two or three are Irish.

Some are CSM veterans, some are relatively new, most are in-betweeners. Some council members have long known what others are coming to grasp: a few people have to do all the work.

(This is what happens when you let human beings into your organization. These very same human beings can mess it all up, too. It’s risky.)

In addition to doing the work — shared, of course, with a band of other dedicated folk — council members have to deal with savages from the "Whydiddenyou?" and "Youshoulda" subcultures. Not to mention the won’t-turn-out-for-anything bunch. Morale bashers, all.

Council members also have to deal with one another. This is not always easy.

These 22 individuals persist in being just that when they sit down at the council table. There occasionally have been shocking displays of even longtime and close friends voting on opposite sides of a proposal. (And then going out together to Malley’s or Maria’s, following further serious debate as to whether ice cream or pizza is required to lift the spirits or ease post-meeting weariness.)

As everyone knows, the world is divided into two kinds of people: those who love meetings and those who despise meetings. The CSM is blessed in having representatives from both on its council.

The community is further blessed in having on council enthusiastic and articulate spokespersons for community members’ varied interests. Here again, council members lovingly put up with what could be perceived as one another’s occasional excesses of enthusiasm and articulation.

A mixed blessing is a diversity in philosophies. Answers must be attempted for very real questions, ones which surface and re-surface continuously.

Should the community own anything? Employ anyone? What should be its employment practices? What is its responsibility to the neighborhood? Is it being true to its founders’ principles? What is its relationship to the broader church community; what are its responsibilities as a diocesan parish? Is the community too inwardly focused? (Godforbid, Parochial?) Too outwardly focused? What is its relationship with the territorial parish? What about Sanctuary? Political stances?

These are just a few of the questions. There even must be talk about money. Again, diversity of thought. A mixed blessing.

A major blessing for CSM, however, is that its representatives bring to the council table in common...a love for Jesus and the Gospel message, a love for the Community of St. Malachi as a whole...and for one another. And a pride both in the community and, I think, in their Catholic Christian tradition.

Integral to each council meeting are prayer and laughter. Sometimes silent prayer for laughter. The going can get tough. Prayer and laughter are gifts to and from God.

But to the Community of St. Malachi its council makes a gift not only of love but of concern, talent, dedication, energy, enthusiasm, hope, and that most precious commodity, time. At least 21 members do this rather well. And then there’s the undersigned...

May you live always in gracious wisdom

of the sacred king

selfless, compassionate, and generative.

May you be decisive, daring and disciplined

in the spirit of the warrior,

protecting the boundaries

both within and around.

May the spirit of the magician

also shine forth in your life;

insightful, intuitive, observant, and curious

with at least a dash of the trickster.

Finally, may you have ready access

to the passion and playfulness of the lover,

knowing within you

the artist, the poet and the mystic.

May you have access to these energies

in balance and in peace.

I never imagined, when I entered medical school less than seven years ago, that legal physician-assisted suicide might so soon be a reality in the United States. However, thanks to two recent rulings by Federal Circuit Courts of Appeals, the legal way for assisted suicide has been paved in 12 states and a precedent probably set for the rest of the country as well.

The first of these rulings, Compassion in Dying v. State of Washington, came in March of this year out of the Ninth Circuit Court located in San Francisco, which covers nine Western states. The ruling struck down a Washington State law banning physician-assisted suicide. (Some of the legal and moral implications of this decision have been explored in these pages [of America] by Robert Drinan, SJ, (4/20) and John D. Hagen Jr. (7/20). Only a month later, the Second Circuit Court, which covers Connecticut, New York and Vermont, rendered a similar ruling in Quill v. Vacco, shooting down a New York anti-assisted-suicide law. Of all the states covered by these decisions, Oregon stands to be the most quickly affected, as it previously passed the Death With Dignity Act (November 1994), by a 52% to 48% margin, allowing physicians who follow certain guidelines to prescribe a lethal dose of medication to terminally ill patients. Only a court injunction now stands in the way of the Oregon law taking effect. Many observers expect the Supreme Court to rule on assisted suicide in the near future.

As a young physician just about to finish residency training and enter practice, I find myself forced by these legal decisions to ask some fundamental questions about my profession, primarily about how legal physician-assisted suicide would affect the ethos of medicine. I share my reflections on this question not as an expert in biomedical ethics nor as legal scholar, but rather as one trying to discern how my profession might change if assisted suicide were to become standard practice.

In my view, the recent court rulings on assisted suicide challenge three basic assumptions about the moral core of medicine as a profession. First, the centrality of the axiom Premium non nicer ("First do no harm"). Second, the principle of double effect. And third, the moral distinction between actively taking a life and allowing a person to die by choosing not to employ artificial means of life-support.

From practically their first days in medical school, students are taught one of the central tenets of medical practice: "First do no harm." To nonphysicians, such a dictum may sound at least unnecessary, if not ridiculous. But those who have practiced medicine appreciate the awesome power of medical technology for both benefit and harm. The same medications that alleviate suffering can cause horrific side effects. Practically every medication known, even the most seemingly benign over-the-counter remedy like aspirin, has at one time or another caused irreparable damage. Furthermore, who in today’s technological world does not recognize the tremendous harmful potential of the machines that can sustain life even in the face of overwhelming disease, when the only alternative is further suffering or unconscious life? With this in mind, physicians must learn restraint, always questioning if a given intervention may cause more harm than good. Assisting in a patient’s suicide directly contradicts this life-respecting and humbling assertion that our first duty is to do no harm. It is perhaps the ultimate hubris to assume that physicians can harness the awful power to end life when we so often do harm with our well-intentioned efforts to save life.

A second way that assisted suicide alters the ethos of medicine is by undermining the principle of double effect. This principle has been a cornerstone of Catholic ethical tradition at least since Thomas Aquinas. The church’s magisterium has used it routinely in it bioethical arguments. In my professional experience, it also serves as an important guide for action for many physicians, Catholic and non-Catholic alike.

The principle of double effect affirms that an act that has both good and evil consequences is justifiable if it meets all of four conditions. 1) The act itself is either morally good or at least neutral. 2) The person acting intends the good effect and sincerely does not intend the evil effect. 3) The evil effect is not a means to the good effect. And 4) The good effect is proportional to the evil one.

In care for the dying this principle plays a key role. Certain acts necessary to alleviate suffering, particularly the administration of large doses of narcotics and sedatives in many cases hastens death. Practically all physicians caring for terminally-ill patients have hastened death by delivering such medications and have felt justified in doing so because of this principle.

Assisted suicide on the other hand, cannot be justified under the principle of double effect. In assisted suicide, death is the direct, intended result of the act of prescribing the medication, not an unintended by-product. Furthermore, the good of relieving suffering is achieved by means of an evil action, that of assistance in direct killing. With such erosion of double effect, our entire professional role in caring for the dying changes. In practicing assisted suicide, we no longer act primarily as care-givers but rather as arbiters of the value of human life, giving care when the life seems worth it and helping to kill the patient when it does not. The hubris of this position worries me. As physicians, we should commit ourselves to caring for human life, not to deciding when it no longer merits care.

Assisted suicide alters the ethos of medicine in a third way by blurring the distinction between withdrawal of artificial life-support and active killing. Both recent court rulings explicitly argued against such a distinction. In the words of the Second Circuit Court opinion, "Physicians do not fulfill the role of ‘killer’ by prescribing drugs to hasten death any more than they do by disconnecting life-support systems." I find this line of argument astounding. It is one thing to say that assisted suicide is morally acceptable on its own grounds. These courts, however, have argued that assisted suicide is morally equivalent to allowing a patient to die from his or her disease by discontinuing life support when such support can only prolong the dying process. This reasoning not only defies logic but also ignores the ultimate reality of patient care: Every human being dies. Withdrawing life support simply recognizes that the point has been reached when we as care givers can no longer preserve a meaningful life for our patient, at least not without disproportionate suffering. Assisted suicide tries to prevent this point from ever being reached but it does so by means of a moral evil, the active taking of life.

The argument that withdrawal of life support and assisted suicide are morally equivalent show, more than anything else in these opinions, how far short the courts’ understanding falls from the realities of bedside medicine. I have participated a number of times in withdrawal of life support when the conclusion was reached that this support could only prolong the dying process. In no sense did I ever feel as if I were killing the patient. Rather, the disease process had progressed to the point where it was going to take the patient’s life no matter what we as physicians did or where further life-sustaining therapy would be unduly burdensome for the patient. Turning off a ventilator and thus allowing a patient to die simply does not feel like killing. It feels like, and indeed is, submitting to the natural course of life.

Catholic moral teaching has been particularly clear on this point. Traditional church statements relied on the distinction between "ordinary" and "extraordinary" means, and the latter were considered optional. Recent comments have moved away from the ordinary/extraordinary distinction, perhaps because of its vagueness in light of current medical technology, but have confirmed the underlying tenet that biologic life need not be preserved when efforts to do so are futile or require overly burdensome treatments. However, such allowing to die has never been equated with the active taking of life. The church has been strong and consistent in its teaching that the withdrawal of artificial life support is morally acceptable, while assisted suicide and active euthanasia are not.

In addition to the three principled objections outlined above, some serious practical matters stand in the way of assisted suicide. First, prescribing a lethal dose of medication for a patient may be much more difficult than it sounds. After the Oregon assisted-suicide law passed, a Dutch physician stated in an interview with The Oregonian newspaper that he has participated in over 100 assisted-suicide cases and that in about 25% of them, the patient did not die from the prescribed overdose within hours or even days, at which point the physician administered a lethal injection to kill the patient. The Hemlock Society, a pro-euthanasia and assisted-suicide group, acknowledges as much in its literature when it suggests that in addition to taking the recommended overdose, patients attempting assisted suicide should secure a plastic bag over their head to ensure death. Both recent Circuit Court rulings do, however, forbid direct euthanasia (such as by lethal injection), thus raising the question of what is to be done when a suicide attempt fails. This practical problem opens the door to the very likely possibility of patients lingering in vegetative states after failed suicide attempts, for whom it would be illegal to give a lethal injection.

Another practical consideration for assisted suicide involves the "slippery slope" argument. That is to say, while the present rulings clearly state that assisted suicide is legal only for terminally ill patients (explicitly those having less than six months to live), will the practice extend to other people who are not terminally ill? For example, what of those who suffer from chronic, painful diseases that are not imminently life-threatening? And what of children born with malformations or diseases that may require a lifetime of care and perhaps involve much suffering? Most terrifying of all is the possibility that the aged or chronically ill will be convinced by others that their lives are no longer worth living. This possibility of coercion should not be overlooked. Ultimately, I fear that assisted suicide could become a matter of convenience for society, ridding us of our burden to care for the sick and helpless, precisely those who most merit our caring.

A third practical argument against assisted suicide involves the dismal state of terminal care in the United States. Study after study has shown that physicians regularly ignore their patients’ wishes about end-of-life medical interventions. The most recent confirmation of this fact came from the SUPPORT study published in The Journal of the American Medical Association in November 1995. This project demonstrated that in five well-respected teaching hospitals, almost half the treating physicians did not know when their patients wished to avoid C.P.R., should they require it; four out of 10 patients who died spent at least 10 days in an intensive care unit prior to death; and, perhaps worst of all, half the conscious patients who died were thought by family members to have suffered moderate to severe pain for over half the time of their hospitalization. These dismal statistics reflect the difficulty that modern hospitals have in switching modes from care aimed at cure to care aimed at a comfortable death. They also reflect the nearly complete lack of training that American physicians receive in managing the dying process. Having just come through medical school and residency training, I can attest to how poorly qualified I feel to help patients die comfortably and well.

Should one wish to remain out of a hospital as death approaches, options may be severely limited. Hospice services can be expensive and difficult to find. Insurance may not cover hospice care (even though hospitalization is much more expensive). And most American physicians do not have the expertise to manage a comfortable and dignified death for their patients. In contrast to ours, the British medical community has taken more seriously their care for the dying. Palliative care is a certified medical specialty in Britain so that well-trained physicians can be consulted to aid in end-of -life care. The hospice system in Britain is also much more developed and accessible to dying patients.

Given this sad state of terminal care in our country, if we truly cared about the suffering of the terminally ill, we would work to improve end-of-life care. We would train our physicians properly in managing death, make hospice care available to all who need it, and rein in the aggressive cure-oriented care that our hospitals seem incapable of not pursuing. In the face of these gross deficiencies in terminal care, assisted suicide can be seen for what it is: a simplistic "quick fix" solution to a deeply complex and systemic problem. Practically speaking, I fear that assisted suicide will serve as another excuse not to provide the care that the terminally ill deserve from our society. To put it more bluntly, why care for the dying when they could just kill themselves and relieve us of the burden?

I know that death is not easy either for the dying or for their care-givers. I have seen enough in both my professional and personal lives to know that the beautiful deathbed scene of the movies, with it perfect lucidity and freedom from pain, is rare, at best. And having recently helped care for my own mother through her terminal illness, I am deeply aware of the pain of watching a loved one suffer and of the indignities that the end of life can bring. But despite all these realities, I cannot help but view the move toward assisted suicide as both a change in the fundamental ethos of my profession and an abdication of our responsibility to care for the dying. No matter what the courts have said or will say, we who practice medicine should stand by the central moral tenets of our profession: to do no harm, to value life as an intrinsic good and to give care always.

THE COMMUNITY OF ST. MALACHI is a lay-directed, non-territorial personal parish of the Diocese of Cleveland. Although separate from the Parish of St. Malachi, we join together for many worthwhile activities. All are welcome to worship at the 11:00 a.m. Community liturgy on Sunday. Community members are expected to actively contribute of their time, talent and treasure.