Monday, February 20, 2012

End of Life Issues And The Catholic Church

Q - Is it morally justifiable, in the eyes of the Catholic Church, to refuse medication in the hope of dying sooner?

A - Thanks for the question. I know the end-of-life issues can be very hard for those who are suffering as well as friends and family who feel helpless. Even in the midst of these situations, we are called to make the best moral decision we can, even if it is difficult or there is much suffering involved. There are several things we need to explore in order to answer your question and the issues that surround it.

Principle #1 - All human life has dignity.
Each of us is created in the image and likeness of God. This is where we find our identity. We are adopted into the family of God (the Trinity) and made partakers of the divine nature. This means we that our nature is caught up into God, by our participation in God's divine life. A new-found identity in Christ means we can no longer look at ourselves or others in the same way. This is why the John Paul the Great quoted the following verse more than any other from Vatican II:
Christ, the final Adam, by the revelation of the mystery of the Father and His love, fully reveals man to man himself and makes his supreme calling clear. (Gaudium et Spes 22)
If we want to know who we are, who others are, and the answers to the other questions that have been planted deep within us, then we need to understand who Jesus is and who we are in light of Christ. When God became man in the Incarnation, He didn't lower His own divine nature, which is impossible - because God is unchangeable, rather He raise up our human nature higher. Our nature
has been raised up to a divine dignity in our respect too. For by His incarnation the Son of God has united Himself in some fashion with every man.
This is our "supreme calling" - to find who we are in Christ. To live fully in the Fathers' love, truth and grace. This is what we were made for.

We were made to live this way, to find this truth. When we do so, we find what real human "dignity" means.
The truth is that only in the mystery of the incarnate Word does the mystery of man take on light.
The mystery of man and the mystery of God isn't just fun to think about. It is the most important thing to search for. It is what will change us and our culture. It is the answer to the questions of life. As Gaudium et Spes 22 ends it says it all.
Such is the mystery of man, and it is a great one, as seen by believers in the light of Christian revelation. Through Christ and in Christ, the riddles of sorrow and death grow meaningful. Apart from His Gospel, they overwhelm us. Christ has risen, destroying death by His death; He has lavished life upon us so that, as sons in the Son, we can cry out in the Spirit; Abba, Father
Principle #2 - Suffering can be redemptive.
Suffering and physical death are not good, but neither are they evil in and of themselves. In fact, through the cross, suffering and death can be redemptive. That is, they can help us to re-capture some of the purity, love and holiness that we are called to. The cross is God's answer to evil and suffering. In it, He conquers and shows us how to overcome them.

From this, suffering and death can lead to holiness and union with God. Therefore, neither are "evil" if we can redeem them for our the good or ourselves and/or others and God's glory. It is the eternal death of the soul we should be afraid of. All of this perfectly explains the reason St. Paul could write these words to the Romans:
For if, by the transgression of one person, death came to reign through that one, how much more will those who receive the abundance of grace and of the gift of justification come to reign in life through the one person Jesus Christ. In conclusion, just as through one transgression condemnation came upon all, so through one righteous act acquittal and life came to all. For just as through the disobedience of one person the many were made sinners, so through the obedience of one the many will be made righteous. The law entered in so that transgression might increase but, where sin increased, grace overflowed all the more, so that, as sin reigned in death, grace also might reign through justification for eternal life through Jesus Christ our Lord. - Romans 5:17-21
Without Christ's suffering on the Cross, none of use would enjoy God's grace or salvation. Thus, Christ has shown us how suffering can lead to great good.

Principle #3 - We cannot intentionally kill an innocent human being for any reason. 
The fifth Commandment says "thou shall not kill". The commandment is better translated "not murder", that is, not to kill innocents. So, with that distinction we can see that euthanasia is never an option.

Euthanasia treats suffering as the ultimate evil and then a person is murdered or commits suicide in order to "escape" the pain.  The intentional taking of an innocent human life might be intended to achieve a good end (stopping suffering), but that is no justification for the evil means which are used to get there.

As I have explained before, we cannot use evil means to achieve a good end.

It is not "health care" to kill. This is my the Hippocratic Oath states:
I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan
The Catechism says:
2277 Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicapped, sick, or dying persons. It is morally unacceptable.

Thus an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. The error of judgment into which one can fall in good faith does not change the nature of this murderous act, which must always be forbidden and excluded.
Some argue that it is more "dignified" to kill someone or allow them to commit suicide when they are in so much pain. Others say they don't want to "burden" anyone. It is very rare that in today's health care that we cannot help alleviate or at least lessen the pain, which is morally acceptable even if it might shorten someone's life unintentionally. Also, some who are suffering a great deal might be depressed and need psychological help not someone to kill them.

Principle #4 - The sick and dying are not obligated to use extraordinary treatments to treat their sickness, but only ordinary treatments.
This is the area that most people find confusing, so I hope I can help provide some clarity.

We will start with the Catechism:
2278 Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of "over-zealous" treatment. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.
Therefore, when death is imminent, a person can refuse "burdensome, dangerous, extraordinary, or disproportionate" treatments. The ordinary treatments, in contrast, are those that are required to maintain our health.

What exactly are these kind of extraordinary treatments?

We can first answer that nutrition and hydration are ordinary, not extraordinary. Only in a few rare and extreme cases would either fall under the "burdensome" designation (when they no longer help a patient continue to live). The Terri Schiavo case brought this issue to the forefront.

An example of extraordinary treatments would include painful and expensive cancer treatments for a terminally ill cancer patient. But, each case is a different situation. If there is doubt, you should consult with a wise, prudent, and orthodox priest (who knows medical ethics) or a good medical ethicist. If you are having trouble finding one, you could contact the National Catholic Bioethics Center, who does great work.


I don't think I am qualified to answer your specific question, because it all depends on individual circumstances and whether the medicine being given is ordinary or extraordinary, whether death is imminent even with treatment, etc. I know it might not be the easy answer you were looking for, but it is the best I can do at this time.


For more on this issue (and others in health care), see the USCCB's Ethical and Religious Directives for Catholic Health Care Services.
I am in distress; my eyes grow weak with sorrow, my soul and my body with grief. My life is consumed by anguish and my years by groaning; my strength fails because of my affliction, and my bones grow weak." Psalms 31:9-10


AKN said...


I point of clarification if I may. The provision of medically assisted food and water (commonly referred to as artificial nutrition and hydration) is not a medical treatment. Rather providing food and water is considered to be normal comfort care akin to cleaning wounds, moistening lips, and bathing a patient. Provision of food and water by means of a tube to an incapacitated patient is much like feeding an infant with a bottle or spoon. With the incapacited patient, the tube is like a very long spoon. While a medical procedure may be necessary to insert a GI Tube, for example, the actual provision of food and water is not a treatment, but normal comfort care. As you noted, at times it may be necessary to remove food and water because it (not the person) has become too burdensome. For example, if the patient cannot assimilate the food or is aspirating because of it. But in principle, provision of food and water is normally necessary because it is normal comfort care owed to all human beings.
- Arland K. Nichols (2003)

Marcel said...

Thanks. A good clarification and necessary one.