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Episode Description
As we mark four years since the beginning of the war in Ukraine, we are honored to welcome Bishop Vitaliy Kryvytskyi, Roman Catholic Bishop of Kyiv–Zhytomyr, for a powerful firsthand account of life amid ongoing devastation. Calling the conflict “a war against civilians,” the Bishop describes harsh winter conditions facing Ukrainians as Russia targets electrical infrastructure, leaving families without heat, light, and basic necessities. He speaks about the danger of fatigue and despair – not only among Ukrainians but the global community – and why prayer from Catholics around the world remains one of the greatest sources of strength.
We discuss New York’s newly signed assisted suicide law with Dr. Lydia Dugdale, professor of medicine and director of the Center for Clinical Medical Ethics at Columbia University. Drawing from her book, The Lost Art of Dying, Dr. Dugdale explains why physician-assisted suicide fundamentally alters our culture’s understanding of life and death, why modern palliative care can address nearly all physical pain, and how legalizing suicide risks endangering the most vulnerable.
As we complete our first week of Lent, Monsignor Roger Landry challenges Catholics to embrace bold prayer, serious fasting, and generous almsgiving – not only small sacrifices but also true repentance and deeper conversion. He reminds us that Lent is an invitation to become saints.
Catch the show every Saturday at 7amET/5pmET on EWTN radio!
And don’t forget to subscribe to TCA’s daily media roundup for smart Catholic news and commentary delivered straight to your inbox.
Bios
Bishop Vitaliy Kryvytskyi, S.D.B., is the Roman Catholic Bishop of Kyiv–Zhytomyr in Ukraine, appointed by Pope Francis in 2017. A member of the Salesians of Don Bosco, he grew up in Odesa and began his formation underground through a Salesian priest. He joined the Salesian Society of St. John Bosco in 1990, studied at Kraków Theological Seminary, and was ordained a priest in 1997. He served as parish vicar in Odesa until 2004, then as head of the parish and Salesian community in Korostyshiv. For the next two years he ministered in the Lviv region, and in 2014 was appointed pastor of St. Peter’s Parish. Since the full-scale Russian invasion in 2022, he has led his diocese in providing humanitarian aid, spiritual support, trauma recovery programs for children, and pastoral care for soldiers and civilians. He has become a global witness to faith, endurance, and hope amid war.
Dr. Lydia Dugdale is a physician, medical ethicist, author, and Professor of Medicine at Columbia University, where she serves as Director of the Center for Clinical Medical Ethics. She previously held leadership roles at Yale School of Medicine in biomedical ethics and the intersection of medicine, spirituality, and religion. She is the author of The Lost Art of Dying: Reviving Forgotten Wisdom, which calls for a renewed cultural understanding of mortality, virtue, and preparation for death in modern medical practice. She edited the book, Dying in the Twenty-First Century: Toward a New Ethical Framework for the Art of Dying Well, and is a sought-after public speaker and contributor to outlets on ethics and medicine. Dr. Dugdale earned her medical degree from the University of Chicago, completed her residency at Yale-New Haven Hospital, and holds a Master of Arts in Religion from Yale Divinity School.
Monsignor Roger Landry is a priest of the Diocese of Fall River, Massachusetts. A graduate of Harvard and the Pontifical North American College in Rome, he served as Attaché to the Holy See’s Permanent Observer Mission to the UN in New York. In 2024, he was appointed National Director of the Pontifical Mission Societies in the USA by Pope Francis. He writes for numerous publications, speaks on radio and TV, and served as executive editor for the weekly newspaper of the Diocese of Fall River. He is the author of the book, Plan of Life: Habits to Help You Grow Closer to God, and leads pilgrimages to Rome, the Holy Land, and other sacred destinations. He was an on-site commentator for EWTN’s coverage of the 2013 papal conclave that elected Pope Francis. He is national chaplain for Catholic Voices USA and New York Chaplain for the Leonine Forum. Father Landry traversed the 1500-mile Eucharist Pilgrimage in 2024, which coincided with his 25th year in the priesthood.
The following transcript is machine generated.
Episode 357 Transcript
| Betsy | Welcome to conversations with consequences now on EWTN radio. I'm your host, Betty Fentress, and we are deeply honored to have a very distinguished guest with us today. Bishop Vitaly Levitsky, Bishop of Kiev, and Jeremy are visiting the United States this month. Welcome, Your Excellency. |
| Bishop Vitaliy Kryvytskyi | Thank you. |
| Betsy | And we're also happy to have with us Father Alejandro Guevara. Thank you so much for translating for us this morning, father. |
| Bishop Vitaliy Kryvytskyi | You're welcome. |
| Betsy | Your Excellency, we're approaching now the fourth anniversary of the crisis in Ukraine. A constant state of war that has affected millions of Ukrainians. What are your greatest concerns as we approach the fourth year of this terrible war? |
| Bishop Vitaliy Kryvytskyi [2] | Not only. I think, like every Ukrainian, one of the things that concerns me the most is the tiredness of our people. Together with Ukraine, also our partners, our friends are tired. We know that to get tired is something natural, but it's also something we have to learn how to overcome. And this winter, as you know, it's one of the worst that we've had in this past, four years and taken advantage of this cold. The enemy is, focusing on destroying our electrical systems. And that's why our pain is so big. Because we see how our people are just freezing to death. And we are here. We came here to also be witnesses, that our people are going through this very big genocide. It's not just a military war. It's, a fight against the civilians. And also, one of my concerns is that people. Because they're tired, obviously, are helping us less. Maybe they're praying for us less. And just like we felt at the beginning of the invasion, all the support and prayer of all the people, of all the people that were very close to us, the same way we are feeling also the this tiredness of the people that, the maybe they've also, stopped praying for us. But, as an answer to this feeling, is that what we've encountered here, so many faithful that are telling us we will never forget about you, you can, since we continue to pray for you and to keep us, to keep you in your in our prayers. |
| Betsy | So what are you doing back in the Ukraine to fight this feeling of despair? Because you said prior to your trip here, when war becomes long, the greatest danger is not only destruction, but despair. How do you fight this despair? |
| Bishop Vitaliy Kryvytskyi [2] | Glenna. Speechless. To you, the only possible movement from last year that I know. During this time of war. We see that as scriptures that speak to us in a very profound way. Because the scriptures I speak about a certain people that they also went through, a lot of despair, a lot of troubling. That is just think of our Lord Jesus Christ. Before he entered into his passion or already the cross, he gave us an example of how in every, moment of troubling or in every despair, how we can learn to turn to the father. And so that is what we're doing. Each one in its place and his position. We are trying to look for this contact with the God, the father. Because we know that it's from him that we find also consolation, that he's the one that gives a meaning to other lives, and especially during these moments of trouble and despair. Prayer is something very important during this time of war. Also, it's it changes in a way, but also the, the individual one and also the, the one in community. And there's people that they find their strength from uniting in prayer and they get stronger. It's very important, the cooperation of the communities of, of the, the pastor with the parishioners and so on. And it is extremely important for us, especially during the bombings, that we're experiencing the bombings when we get messages from different people, like also, for example, from the US, just asking us, how are you? Maybe they don't know, how to help concretely, but the simple fact that they tell us, I'm praying for you, that's already a big support. And they invite also other people to pray for us. And that is actually one of the biggest things that builds us during this time of despair. Or even better said, during the times of when we're going through the the test so that we don't arrive to despair, because despair is already like a position that, you find yourself already with no way out. |
| Betsy | Well, I know that's at your primary job as the shepherd of your diocese. But I wanted to ask you one of your political question before we talk about all the humanitarian works that you're doing and the needs that you have. For what? Of your reasons for coming here was I'm not coming to the United States to speak about politics or numbers, but to bear witness to faith, endurance and hope. So that final political question I wanted to ask you is we heard that there are rumors of peace. Ukrainian President Zelensky met with Pope Leo, and we're just wondering, how do these talks stand now? And are you hopeful? |
| Bishop Vitaliy Kryvytskyi [2] | There was a minister and my witness. President. One thing that we have to understand is that our president, when he goes to the Holy See, one of the things that he for sure is not looking for is military support. We're sure that, whatever he's looking for, that we don't know exactly what, but for sure is in the field of humanitarian aid. Of course, for, from his point of stand, it's things that we can we hear about, but maybe there's also things that he cannot tell us, but for sure, it's about the good of the people. It's a deal for the good of the people. For example, when we speak about the children, that we want to give back to their families, it's, just to think. Or when we speak about, the soldiers are in exile to come back home together. But that's also just think. And there's also many other civilians that also have been captured, and they also have to go back home. We know that the world sees, looks at the Holy See as, as a moral authority to the Holy See, has, a long, apostolic memory. The church also has, very well thought and elaborated doctrine. And even now, during the war, we've had Protestants coming to us, telling us that they've, read the doctrine of the church, and that has helped them as, resources. And we understand what's the cooperation between, peace and justice. So today we find ourselves in a position that we have to go back to the documents of the church to learn about how the peace and justice cooperate, maybe similar subjects. The president goes to the Holy See to ask about. We understand that, his visit to the Holy See, the president's of the Holy See is just, the peak of the iceberg, of so much work. That's around it. |
| Betsy | We're so fortunate, aren't we, in our church, to have all of these rich doctrines. |
| Bishop Vitaliy Kryvytskyi | And one of the things that we have to mention is that the Roman Catholic Church in Ukraine is one of the minorities is 1%, and not even two, a little more than 1%, not even 2%. Yeah, 1% of the population. But, during the time of war, we've understood the the greatness of the universal church that that is with us, that we understand and we see that the prayers of this universal church, it really brings fruits. And that's what we're, giving testimony of. |
| Betsy | Do you work with other Christian churches and Christian church leaders in Kiev? To deal with all of these crises. |
| Bishop Vitaliy Kryvytskyi [2] | Talk you most cannot stop. Yes. And I have to say that some of the mechanisms that are working now, are just an effect of something that was already, you know, tested with before, many of, our listeners probably don't know about the fact that in Ukraine, there's, a unique, Council of Religions and Organizations of Ukraine, you know, it's, mainly the, the Christian leaders, the Jewish leaders, and also the, Muslim leaders. We say that it's a community of communities, monotheistic, of the, Abraham, you know, Abraham. Isaac, father. Yeah. So with this communities, before the war and, now, especially during the war, we have been working together in the whole time. We are in communication with the with the government to with our society. And the decisions are taken in the community and the council there always under one census consensus. Sorry that with very small exceptions, God helps us to always arrive to a consensus. And together with, Christian churches, we also pray together, especially for the chaplains. And we pray, different vocations. And also, since the beginning of the war, 2022, we gather every, every year to do a national prayer. This, at the end of this month and together with, the other members of the council, we're going to gather by the walls of our parliament to pray together our priest, not only the ones that are involved with the military, but also many others, are volunteers that go to the frontlines with groups, visiting the soldiers. They go in groups of 3 or 4, together with other Christian denominations, and together they preach, they speak about Christ. The Lord has also given me the opportunity to, twice go to the frontlines together with other church leaders and visit, the soldiers and preach to them about Christ. And together we we go there in the same car, we sleep under the same roof, and together we visit the soldiers and we speak to them in one voice. Together we announce to them, the risen Christ. And now, for example, during the Christmas time about, the Nativity of Christ, it's a sign for the soldiers that, just like our society, supports them. Also, the churches are there support. |
| Betsy | What a beautiful witness. |
| Bishop Vitaliy Kryvytskyi [2] | So we'll try to do that. Because, of course, you know, in this time, the prayer and the unity is very necessary. |
| Betsy | Yes. Let's turn to a minute to the humanitarian aid issue. We know Samaritan's Purse has been on the ground as well as the Knights of Columbus. Is your diocese receiving the support it needs? |
| Bishop Vitaliy Kryvytskyi [2] | That, citizens study? Yes. We receive help from different, sides. Let's look at them. Our autonomy, my, now, let's say, Columba, with, my disco, all. We received from the Knights of Columbus from the Order of Malta. We're grateful that, they themselves analyze the situation and, somehow control this situation. And they already know where, is needed. The most, and they distribute the goods themselves. At the beginning of the war, they were concentrated mainly, bringing, generators, because we had the full blackouts. And then the time came later on when we had to also start working with healing the, the, the wounds and traumas of war. And so, we've seen ourselves that we have to prepare the, the chaplains and also the volunteers, volunteers, chaplains, to go to the frontlines because it's a new thing for the, for us. Right. So that's something that they studied. As you know, one of the biggest challenges today is a cold. People are freezing. So they are also helping us in this, taking care of the people, see, are the ones that are in need of the most. Essential things. And they go they're looking for them and they provide for them also, many of the necessary things. So using this occasion, also, I would like to thank all the people that, help with their donations, that gathered the help that send it. So that Ukraine can receive this help and, so that it can reach the, the most needed. And I can get my witness that your help is actually solving, saving people's lives. |
| Betsy | That's very, very moving. I wanted to focus a little bit on the children as we finish our conversation with a couple of points. You have a very impressive youth program, which includes trauma recovery, especially with your summer programs. Can you share a little bit about those and how they help your young people to heal? |
| Bishop Vitaliy Kryvytskyi [2] | Talks, which I know, just as a motion on a budget necessity. Yes, of course we can share. And thank you for asking, because something that we carry in our hearts. So every people's lives in a different way and has to carry the burden of the traumas that they receive in different ways. And that's something that they carry on a daily basis. So children, it's not like they live it less. The problem is that they simply don't know how to express it or called it. They're not always aware of what they're going through. And they it's harder for them to express how they feel. Already before the war, we already started, summer camps for the, for the child, for the children. And we help them to little by little and develop the programs to, we're looking for the costs, the necessary funds to do the programs. But last summer, we we saw that it was necessary to develop a new program, for children, for a bigger number of children, but not only for the psychologist or the specialists that are that know how to do this. And they can develop this program. But we thought about the program for everyone, also for the priests and also for other people that will want to be engaged in this. So it was after, I came back to Ukraine last year, coming from the US, it was when I funded this, this program for the commission of the youth, for them to start working and start getting this program going. We worked on the biblical side of the program, on the psychological side of the program, we did the big, a became part of the program to, work in teams, and they did a special cartoon for the kids. They did a scenario for the children, so that every day they can be involved in different activities and just stay busy. The first program was based on the figure of King David. It's a figure that also, went through a lot of wars and a lot of troubles. He had friends. Yeah, enemies. And he experienced betrayal. With God's help, he learned how to work with it. He would always find himself in, in situations without a way out. And with God, he would find a way out. So that was last year's program. This year, we're trying to, even make it better. And we're still working on the one for the for the next summer camp. And we're also looking for for help to, to get this program going into to be sure that we're going to have it so that the children of Q that are going through this continuous blackouts, the lack of energy, the lack of heat, so that this summer they can at least leave the city and go somewhere to the summer camp where it could be calm and they can concentrate and, and healing. So last year, throughout the whole summer and all the summer camps, we had more than 1500 children. So the the subject of this program for this year, is Moses and his journey are were is already taking too long. So we need to learn patience and perseverance. |
| Betsy | Well, it sounds like a beautiful program, and I hope that our listeners hearts and pocketbooks are moved by your story. I want to have one final conversation about the children of Ukraine and the heartbreaking stories that there are many missing children there. And I know that this week, our first lady, Melania Trump, said that she was working on this and that she told EWTN news that, she had spoken with Putin or communicated with him about this. Are there any reports of of success with this, trying to get these children back in this horrifying, horrifying story? |
| Bishop Vitaliy Kryvytskyi [2] | That's about the only solution. In reality, not, included and conversations or, deals that the Holy See has, in regards to this matter. There's certain people that, take care of this subject and, and are working on it and this others that they're just working, from wherever they can. There's the ones that are, working. We can say, silently by praying for these children. But I do know that, during war, the consolidation of the people. And when they gather together, that is actually what pushes the things forward. Such you build it? Not people do. So I am convinced that, when efforts come together, they bring fruit and they will bring fruits also here in this case. So as bishops, as, ministers. Right. Sometimes we serve as the interim mediators, to give certain names, certain, information of soldiers and so many things, that can also help and maybe provide some type of help. |
| Betsy | How can Catholics here in the United States help your people? |
| Bishop Vitaliy Kryvytskyi | So first of all, I would like to thank to the Catholics that are already helping Ukraine. They're helping with their prayers. They're helping with their material help. They're helping, with their taxes, and they're helping to, to stand against this propaganda and their meditations and prayers. They can, find the truth and witness to the truth. The last things I would like to say is just that I thank you and continue asking for your prayers, that we really need them, especially the ones in the frontlines. And we're very grateful, especially for the help that we've received, from the Conference of Bishops of the US. And most of the time is very, fast. The rice was very fast. It's very effective and is help saving a lot of people, during this horrible time of war. What we concentrate in the most is to save people's lives. And now, especially by and keeping them warm. People that are freezing to death. Is still the things that she do. Said she would do in Kyiv. Battle over Covid. But don't give someone you know due to bus or parlor neighbors. Electric car. For example, the the thousands and thousands of of buildings the whole buildings were a part of people live are left with electricity and without heating. It even in their buildings. Forgot to, of course, ensure that the huge to be eradicated. Another few more. Many of these people, they don't have anywhere to go. They just have to confront the these terrible conditions when they. My more sincere. Thanks be to God that during this four years of invasion, we don't have any refugee camps. And, I wouldn't like to say that it is, because of the Ukrainians and their, unity, but mainly is because of God and also because of all the help that we receive from the outside. And I have to say that this help is saving people. We're in need of funds because we want to turn our churches. And so, like this oasis that can provide all the essential needs for the people and give and and, in the suburbs of Kiev, we had to renew the generators and, fix, most of them, many of them that were already, broken after working constantly all these years. But after fixing them, we find ourselves that they need in order for them to produce electricity. They need gasoline for them to to work through somewhere. You can imagine the hospitals, the, the, the tools that they have in order to, to get the hospital going, they need electricity and to have electricity. They need, of course. |
| Betsy | Your Excellency, your courage, your faith. Your witness is so moving and beautiful. It is a reminder of the things that we have that the people of Ukraine don't right now. And it's a reminder for us to be full of gratitude. |
| Bishop Vitaliy Kryvytskyi | Thank you. |
| Betsy | Thank you so much for your time today, Bishop Shepherd of Kiev in the Ukraine. We're grateful for your service and keep you and all Ukrainians in our prayers during this turbulent time. |
| Bishop Vitaliy Kryvytskyi | God bless you. |
| Betsy | Welcome back to conversations with consequences, where I am joined by our TCA chaplain, Monsignor Roger Landry. Monsignor, we I've now started officially the first week of lent. What can we learn this lent, and how can we prepare our hearts in the next six weeks? |
| Msgr Landry | So it's very important for us not to live lent as wimps. Many of us do when we've been trained by church culture and practice over the course of time. To think that the, that all that the Lord is asking of us during the Lenten season is to give up potato chips or chocolate or maybe wine and beer. The Lord is asking us to repent and believe in the gospel. He's asking us to become truly holy in this Lenten season. And I don't know about you, but just given up potato chips probably isn't going to make me the next Saint John Vianney. And so I think that it is important for us to choice test and Ash Wednesday, as we heard when we went to mass. He told us, when you pray, when you fast, when you give alms, he's anticipating that we're going to be doing that rather full time, not just during the Lenten season, but throughout the year, but especially in lent. The church wants us to ponder the what and the why of these three great practices. And so I'd begin by helping us do a little bit of a deeper dive on what he's saying. First, he says, when you pray, don't do it for show. Don't do it for any other reason than for your father. Go to your in a room, which was kind of like, safe in the average Jewish home with no access to the outside so that you do, what? You pray. You pray in secret. It doesn't mean we can't pray in church in the midst of others. It doesn't mean that we can't pray even outdoors. But we're supposed to be doing it for God rather than for ourselves. And, why does God want us to pray? Because a lot of the times, our relationship with God has been disordered through our choices. And when we pray, we say, God, your most important in my life, I'm going to make the time for you. And so we've got to make time in lent for prayer. Many of us don't pray enough. If that's the case, we add practices of prayer, whether that be daily mass, whether that be reading over the gospel readings, whether that be going to the stations of the cross, whether that means the Rosary, whether that means a holy half hour, a holy hour of mental prayer, whatever it be, we would need to start or add something for those who are already praying quite a bit. It could mean just praying with, Lenten flavor that we begin to pray just the sorrowful mysteries, getting more deeply into each of those mysteries. It can mean that we, take the stations of the cross one a day for two weeks to our mental prayer. Whatever e we're supposed to pray as if our life depends on it, because our life and many others lives do depend on it. Second, Jesus says, when you fast. A lot of the times Catholics approach lent, saying that they're just really going too fast. On Ash Wednesday and Good Friday, they'll give up meat on Fridays of Lent, which we call apps and it's. But they weren't really fast. And some times when they fast, even on Ash Wednesday and Good Friday, they know the teaching of the church that, they're supposed they can have one meal and the two other smaller, meals that they have can't equal a second meal, but some will push the real limit like of 1.9999 meals, because they don't really want to fast. They're a little wimpish when it. I'm not talking about people with eating disorders or diabetics who are in different categories, but for most of us, so can we really fast. And how hard are we going to work so that we can align our hunger to God's hungers? He'll talk about those hungers in mass today through Isaiah 58, in which he said, his real fasting that he wants is for us to care for those who are need not to turn our back on our own. Lots of these corporal works of mercy, we could say. And that leads us to the third point, which is about our almsgiving and hungering for what God hungers for the care of everybody else, for their salvation, for ours. Leads us to almsgiving. Because the Lord really wants us to become great in charity. Everything else is secondary to the love that we have for God and others. And sometimes in lent, we might write a check to one organization. Once we might give a little bit more in the basket on Sundays, but it won't really impact us so that our life will be defined by charity. Jesus ultimately wants our life to become commentaries in the words of consecration that just as he said, this is my body given for you. This is my blood poured out for you. He wants us to be all in and give even our life, not just what's left over, but what's right to people. And the need out there is such is so great. That's why Jesus says, when you give alms, he wants us to be doing it ultimately for our father, because our father has given us the capacity to give alms. As Saint John Vianney, the patron saint, a priest, once said, everything we've received is just a divine depository in our hands. God has placed a deposit like we place a deposit in a bank so that we have the dignity of making those withdrawals and giving them to people who need those divine gifts way more than we do. And so I just encourage everybody during this Lenten season not to be wimps, but to be bold, to ed, to really work on prayer, really work on fasting, really work on charity, because that's when we're going to become way more like Christ, whose prayer, fasting, and giving him himself to the last drop of his blood we enter into every lent. |
| Betsy | Thank you, Monsignor Landry. |
| Msgr Landry | You're welcome. Betsy. Happy lent. |
| Betsy | Welcome to conversations with consequences. Now on EWTN radio. I'm your host, Betsy Fentress. And today, I'm delighted to be joined by Doctor Lydia Dugdale, professor of medicine and director of the center for Clinical Medical Ethics at Columbia University. Prior to her 2019 move to Columbia, she was associate director of the program for Biomedical Ethics and founding co-director of the program for medicine, spirituality, and Religion at Yale School of Medicine. She's also the author of the fantastic book The Lost Art of Dying Reviving Forgotten Wisdom. |
| Dr. Lydia Dugdale | Welcome, Lydia. Thanks so much for having me, Betsy. |
| Betsy | So there's so much to talk about related to your specialty of medical ethics designer babies, gene editing, organ harvesting, redefining death, or expanding the definition of death. But the big news that we're going to start with, the big news is that the state of New York just legalized physician assisted suicide. And what what's your reaction to this and how does it change your day to day medical practice? |
| Dr. Lydia Dugdale | Well, thanks for having me. And thanks for starting with that question. Yes. So just several days ago, Governor Hochul of New York signed the amendments which she had pushed for. So initially signed the legislation in December of 25. But ask for amendments to to, you know, quote, make it safer. And, you know, there are amendments. So now there's a requirement that there's AA5 day waiting period. There's an amendment that requires all people seeking physician assisted suicide to have an evaluation by a psychologist or a psychiatrist. And that's really important, because we know that the same group of people who tend to seek, to hasten their deaths through legally assisted means often is the same group that suffers at high rates from from major depressive disorder. So, of course, we want to be finding cases of depression and treating them, especially if it means people won't be inclined to hasten their death. So I'm grateful for the amendment, but we know that amendments, or any sorts of restrictions in the name of safety quickly become impediments to access. And we've seen time and time again that subsequent rounds of legislation tend to try to get rid of these so-called safeguards or make them more lax so that people can have more, more access. What this means for me personally, as a physician practicing in New York State, New York City and New York State, is that, we have six months to try to figure out how our health care system is going to participate in accordance with the law, and how we will also give carve outs to clinicians who don't want to participate, because it matters of conscience and also how my my hospital in particular, cares for a largely marginalized, vulnerable patient population. How do we make legal the hastening of death in a way that does not feel coercive to people who might feel that their life isn't worth living, or feel the pressure from society to hasten death and just, just kind of go on and get out of the way. Because they are a burden to the system. So these things make me very concerned. I am a part of the, the committee that is trying to figure out what implementation will mean for our whole health system. And so more to come on that. But yeah, creates more work. And then I think also ultimately is going to change the climate when when you live in a society that normalizes the taking of human life, it changes our society. And I don't think it changes our society for the better at all. So I'm I'm not excited to see what that becomes. |
| Betsy | You know, the Catholic bishops have been outspoken on this, and I wanted to get your reaction to a quote from them. They said, how can any society have credibility to tell young people or people with depression that suicide is never the answer, while at the same time telling elderly and sick people that it is a compassionate choice to be celebrated? |
| Dr. Lydia Dugdale | Yeah, so that's a great, great, question comment to put on the table. The advocates of assisted suicide, physician assisted suicide do not use the language. Physician assisted suicide specifically because they want to distance the medically sanctioned act, the state authorized act of hastening death for the terminally ill from conventional suicide. So there's a very deliberate agenda of distancing those two. Having said that, in every jurisdiction where physician assisted suicide or lethal injection, which might be called euthanasia, that's Canada, some countries in Europe, countries in South America, and every jurisdiction where that is legal, there is a concomitant increase in conventional suicide. So it is true that the normalizing of taking life leads to more taking of life, even if we can't say legalizing so-called maid leads to an increase in conventional suicide, there's certainly a strong correlation in every jurisdiction where this is legal. So I appreciate very much the Catholic Church's concern that this feels like a, a paradox. We don't want people to jump off of bridges, but we do want old people to go on and get it over with. And yet at the same time, advocates would say these are two things, that are completely separate, but one, in fact, there are not in many ways. And so I think we need to keep bringing the conversation back to that. But it is hard, to put that conversation on the table when we, when advocates are choosing to redefine the act of taking one's own life as not being suicide. |
| Betsy | So I know that one of a kind of at the heart of this is that people say they don't either want to suffer any more of themselves, or they don't want to see their loved one suffer. But you testified before the UK Parliament regarding the pain endured by people who might want to end their lives. There is your quote. There is almost no pain that our current regimen of palliative care medicines cannot treat. Can you talk about that? And and if that's been true for a long time, why are we still having this problem? |
| Dr. Lydia Dugdale | Well, fear is something that a lot of people experience regardless of how rational it is, right? So I you know, I've spent enough time in the hospital to know that I, I really don't want to die there. And I know that suffering is complicated. So when people think about suffering at the very end of their lives, the easiest name to give to that is pain. It turns out that physical pain, when you look at data, especially data from Oregon, let's just say because Oregon was the first state to legalize. So we have the most data from Oregon. If we're just talking about the American context, only about a quarter of people are actually concerned about physical pain, that kind of suffering that they are most worried about. Some 90% are most worried about not being able to participate in the activities that make life meaningful. That is a different kind of pain, but it's more of an existential suffering. It's suffering of a different caliber. So, yes, modern medicine is extraordinarily good at treating pain. Some of the worst pain we see is when cancer spreads deep into the bones. That can be exquisitely painful. However, for such individuals, we can even deeply sedate people to give them relief. So at our hospital, we say no one should have to die in pain. And in fact, we have some families come in and say, don't get my loved one pain meds. We want to keep her alive so she can sort of participate in the activities of the dying process. Well, okay, fair enough. But if your loved one is writhing in pain, we we won't permit that unless she herself gives permission to accept that pain. But, so we, you know, I think in Western medicine in particular, there's a strong value on treating pain. Is there the risk of over treating pain such that you hasten death? Yes. Although, it does take quite a lot of extra pain medicines to hasten death. So pain medicine is, is given in proportion to pain relief. Then usually you can strike the right balance and you're not hastening death. More to say on that, but, yes. Physical pain is not usually the problem. |
| Betsy | So, you know, C.S. Lewis wrote the book The Problem of Pain. And I wanted to ask you, is it is it hard for you to, in a really secular situation that you're talking in to Parliament or you're at a on a panel for the state of New York to remove that faith component where, you know, in the second Hebrews, we talk about perfection can happen through suffering. How do you balance that as a medical professional and a medical ethicist and a person of faith? |
| Dr. Lydia Dugdale | That's an interesting question and a great transition with course with this book title, I love that. Okay, so yes, Scripture is very clear that there is redemption possible through suffering. Suffering can do all kinds of wonderful things, not least, change our characters, teach us to persevere, teach us to hope. In fact, most people for whom I have cared, who have a redemptive view of suffering on some level, will say something to the effect that I wish I had never gone through that. But having gone through that, I see what I learned from it. It taught me amazing things and so on some level. I'm glad for it though I'm not glad for it kind of thing. So that it's pretty common, even in a secular context, for people who are willing to kind of work with their suffering to see that they have grown through it. Now, of course, in a religious context or an explicitly Christian context, we, we, we have language for all of that. But but there is nothing to my knowledge in Scripture that says, therefore, go try to inflict yourself and bring suffering upon yourself. |
| Betsy | Right? |
| Dr. Lydia Dugdale | It's very clear that to me that medicine is a gift from God. I mean, when you even read the history of medicine and you see, that it was for some of the early discoveries, it was faith commitments that drove people to discover, you it how to care for the sick in a way that was, life giving and godly that, that, that faith commitments drove a lot of early discoveries in health care and medicine. So this is a gift from God to be used. And if some of that gift is to mitigate suffering, then I think we should use that good gift. It's it's a little bit like saying, you know, however you want to make sense of this. God has given us the tools to build houses and stay warm. Therefore, when it's subzero weather, you know we'll grow in our suffering if we just sleep outside. I mean, that's just silly, right? We have the tools to avoid that deep suffering. But I do think to the extent possible, if we can be conscious now, it's not always possible. But if we can be conscious that through illness such that we can sort of participate. I think that's a great goal. But I wouldn't want to suggest that someone in severe agony should forgo pain medication just to remain conscious and be able to pray, or something like that. |
| Betsy | I guess I was just asking, Ken, is it hard to argue all of this against physician is suicide without bringing any of your faith into it? |
| Dr. Lydia Dugdale | But I think actually. So you know, what is the strongest religious argument? Well, every major world religion has a prohibition on the taking of human life. So you bracket that and say, all right, I'm not religious. What are my strong arguments? I think arguments for the vulnerable, for the elderly, for the poor, for how they will be swept up in this are very compelling. Now, the counter to this is that, you know, advocates say, well, look, there are no examples of abuses in America. As long as we are only prescribing pills and not doing lethal injection like they do in Canada, there won't be abuses. But there was just a case that was written about in the Atlantic very recently, I think, published this month, of a young woman who had a very traumatic upbringing. She's very clever, she's very had a very hard life, and she ended up figuring out how to game the system. She found some advocates who had helped her get this. She, yeah, I think faked a doctor's name or whatever had the prescriptions sent. And anyway, she was able to figure out how to game the system and get access to lethal drugs and and fake a terminal condition that she didn't have such that she could end her life. And this was just just recently a young, very young woman. So, yes, it is highly likely that we will see more and more abuses, especially for vulnerable populations. And I think that's a very strong reason to be opposed. And then the other reason is, which we touched on earlier, is this idea of suicide contagion, that in areas where you normalize the taking up life, you're just seeing more and more taking of life, regardless of whether it is physician assisted suicide or conventional suicide. |
| Betsy | So you wrote in the Free Press in December a piece about the expansion of the definition of death. And can you explain a little bit about that and how that feeds into harvesting organs and the problematic connection between those two things? |
| Dr. Lydia Dugdale | Yeah, that's a that's a really complicated question. Sorry. So transitioning to organ transplantation. There are two ways that we can legally take organs. In all cases in the United States, patients must be dead before we remove their organs. Now, the usual way that people think of death is the heart stops. That's the way people have conceived of death going back to the beginning of the beginning. And we understand that the heart stops, the person stops breathing, or vice versa. And they're dead. They turn cold, they get her. Okay. So in such a situation, you can take out organs. Now, the tricky thing is, is sometimes the heart restarts after it stops. The other tricky thing is we now have machines that can maintain the heart after it stops the pressure. On the whole, organ transplantation industry is to have blood flowing through organs because as long as blood is flowing through organs, those are good organs that have a good chance of transplanting well. But if the heart stops, circulation stops. There's no blood flowing through the organs. So you can see then the pressure to have the heart stop, be able to declare somebody dead, and then to take that same body and restart the heart on advanced life support such that, you know, within five minutes there's blood circulating through all of those organs and they are therefore viable again. So there have been a variety of methods to kind of tinker with this state of the body between life and death, being able to declare death kind of monkey with the body, but then try to ensure brain death because you don't want to bring the person back if you're going to take their organs out. So that's where this whole idea of a new definition of death has snuck in. And that's probably its own conversation, but that's just to highlight it. And then the other piece to it, I said, there are two ways that you can legally be declared dead and have organs removed. The second is brain death. But brain death was is completely a fabricated definition of death that was invented in 1968 by a group of people at Harvard, and their their motivation for doing so was twofold, but one of which was to be able to access organs, brain death, literally means no, no, I mean, it doesn't literally, but we understand it to mean no upper level brain activity. You can't breathe on your own. But if a body who that is brain dead is being maintained on life support, it will look just the same as any other person on life support. Except that there's no upper brain activity. Is that truly death? Well, you know, there's a lot of disagreement about that because it's a fabricated definition of death. We know that patients who have met the definition of brain death and are legally brain dead have often had, have also gone on to go through puberty, get their periods, gestate a baby, etc. so can dead bodies do that? Can dead bodies gestate a baby? If a woman is pregnant and becomes brain dead, we tend to say no, except that they can and still be legally brain dead. So yes, we can remove organs from such individuals. But as I said, this is all really complicated. And then this is all against the backdrop of organ transplantation being incredibly lucrative. And so there's a lot of external pressure to figure out how to get organs in a way where we're not killing people for their organs. But if we can declare them dead in some way and keep those organs going, well, then, then it's the best of all worlds, because we haven't killed anybody for their organs. Because we've declared them dead. And yet the organs are so good. It's very messy. But that's happy to talk further any time about that. |
| Betsy | Well, we just are talking about all these life issues and, you know, how we're interested in the dignity of the human person, you know, on this show especially. So let's talk about the good news, which is your book, which is making people realize that we're all going to die. And you say you have time to prepare for death, and you had best start today. So let's use the remainder of the show to talk about, you know, you saw this, that people were just in denial. Families were in denial. You resuscitated an elderly man, Mr. Turner, three times, and he eventually died, you know, within a matter of hours or a day. Why do doctors not want to talk to people about this? And let's talk about what you do in your practice to get people to understand the natural acceptance that they will die. |
| Dr. Lydia Dugdale | Yeah. So there's a lot packed in there as well. One of the things that hospice and palliative medicine as a discipline, as a specialty within medicine has done, is it has professionalized conversations about death and dying, but it's also segregated them. So in a busy hospital system, if you have a patient who wants to have these end of life conversations rather than you, the treating physician of whatever specialty being the one to do it, you just call the palliative care professionals and you kind of outsource it. And so what is. So I think hospice and palliative medicine has been an enormous gift to patients, to dying patients and their families. But it has meant that that that death talk in medicine has been relegated to a group of professionals. And so everyone else kind of falls on of practice. And you, I say, falls out of practice. But this is superimposed on the reality that medical students only get one hour or so of how to share good news, how to talk to patients about death in their entire training process unless they go into a specialty where patients are likely to die. So not a lot of training to begin with. You add to that the specialists and you're kind of off the hook, and then you add to that the secularization of society. A lot of people haven't really thought about what they think about what happens when you die. Why am I here? What is life for those sorts of existential questions. And that creates generations of people who are just ill prepared because they have not thought about this themselves. When I've had colleagues say as much to me that, you know, I don't really talk about deaths with my patients because I myself don't know what I believe. So that kind of explains the professional side. And I got interested in this question of the the art of dying or the really the art of helping everyone, my patients prepare for death because it struck me that we were really inadequate at it, that patients were dying these terribly medicalized deaths they never wanted. It wasn't at all their vision for how the end of life would go. I'd hear this because I'd hear it from their families after they died, or I'd go to the funerals. And so I started investigating other models, earlier models for how society thought about anticipating death and preparing for it. And that's where I came across the Ars morandi, which was that's Latin for the art of dying, which was just general literature, really, handbooks for the preparation for death that started after the bubonic plague outbreak of the mid 1300s and were really wildly popular in the West for more than 500 years. Initial versions were related to the, to the Western church, but didn't stay within Christendom. Well, with the Protestant Reformation there were Protestant versions, Catholic versions, then Jewish versions, then later secular versions. And so really, this idea that everyone, no matter what your background, your belief system, your cultural values were could think about mortality just as a matter of fact and then give some attention during life to prepare for it. That was part of living well, and it wasn't particularly morbid. It didn't dominate the conversation. But insofar as you learned other kinds of arts, maybe the art of conversation or the art of music or the, you know, the art of table manners or wielding axes, whatever it might be. You also learned this art of dying. And so it really became this lifelong process of maintaining an awareness of mortality, which then helps you live into the fullness of life. Because you and I both know any of our friends or loved ones who have received a bad diagnosis, whether it resulted in a premature death or not, that quickly brings into relief that which matters most for us, right? It really changes the way we value life, and we value our commitments and we value our relationships. Everything is different with that bad news and so keeping the end in mind is an awareness of mortality does help us live into the fullness of life, help us flourish in our relationships and in that which gives us meaning. And and so that's what I've really advocated for, through my work over the last 15 or so years, and then most recently, the last sort of dying, my book to encourage my patients to think along those lines. |
| Betsy | I'm just hoping that this new law that has been enacted will somehow galvanize people to take your message and let people know that there is actually a little handbook for for dealing with these. And what I love about the book, you talk about the five temptations faced by the dying and on the other hand, the five virtues that mitigate those temptations. So impatience, patience, despair, hope, arrogance, humility. Can you give a story where you kind of saw this flesh out in in your practice with maybe a particular patient or a family that, that you actually gave them these tools and they did it. |
| Dr. Lydia Dugdale | Yeah. There was a patient that I was working on, my first book, which is an academic book. When she bursts into my office one day as the new patient and basically says, I'm dying, I know I'm dying. I was given six months to live. I need you to help me through it. And this is our first, like, literally our first meeting ever. And, and I just sort of took a deep breath and ended up walking really closely with her. I told her after listening to her for a really long time, I told her about my work and how I was thinking about the arts more, and I was in the very early days. And it was interesting because she didn't have her own children. She was divorced, and she had she was very close to to some of her family members, nieces and nephews and things. And, she had an amazing community of friends, and she really brought them in, got them on board and started talking with them about the art of dying. And she tried to set things up in a way where she addressed the major, her major concerns, her major fears, the things that seemed to be taking away from her that, this the calm, the peace, the hope that can come from a well-lived life. And she addressed those things head on in the context of her community. She had a pastor with whom she was very close. Her church community was a part of this as well. And and she even set things up so that she could die at home. In the end. She had a really terrible lung disease, and she gave me permission to to write her stories. And I've written her story, various versions of it over the years in different, different ways. But, in the end, she, she couldn't die at home because her lungs were failing so badly. But she was able to spend almost all of her last days at home. And just in the context of everything that she'd been able to set up for herself with the help of community. And walking with her came at a really interesting time for me in thinking about this. And she was someone who really wanted to engage in the work of of living well, to die well. And even though she was only given six months when I first met her, she ended up living five years. So we had this really wonderful season of journeying together, and I was privileged to be invited to, well, notified by the hospital right when she died. So I scooted over to the intensive care unit right away and saw her, just after she died. And then also privileged to be included in the in the funeral memorial services. So. So I've seen it play out in this very intimate walk with a patient. But I have heard many, many other stories of people who have engaged in practicing the art of dying and how it's had an impact, especially relationally. I will often hear from people who have thought about who they want to be with them at the end, assessed the kind of status of those relationships now and said, you know what? I know I want my adult kids at the bedside, or I know I want my, you know, my brother at the bedside. But we're not at a good place right now. So I'm going to invest more in those relationships that matter to me now, because not only will my living be better, but my dying will be better, too. And so I've heard a lot of stories like that over the years, which has been a joy as well. |
| Betsy | Thank you so much for joining us. I encourage everyone to pick up Doctor Lydia, Doug Dell's book, the Art of dying. There's so much in there, especially the importance of community, your ritual, all the things that we talk about on this show. Thank you for joining us. |
| Dr. Lydia Dugdale | My pleasure. Thanks so much for having me. |