End of Life Decisions, Palliative Care and Growing in Spirituality

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Hospital patient's hands folded in lap, close-up

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We at Peace and Freedom became students of “end of life decisions” and palliative care when a friend asked us to accompany him on his final efforts to stay alive after he was diagnosed with stage IV lung Cancer.

Palliative care is a kind of specialized medical care for people with serious illness. In addition to the purely medical role, palliative care focuses on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.

My experience with my first dying friend started with making sure he was able to get to all of his medical appointments and to assist in exhausting every opportunity to reverse the cancer by medical means.

A woman who we often saw as we were with doctors in or at treatment, including chemo and radiation,  finished all of her treatments “cancer free.” Everyone had been expecting her to die. But God gave her more time.

Good Samaritan by Walter Rane. We are all called to be The Good Samaritan — but many are “too busy.” Plus, one man told me, “there’s no money in it.”

Traveling the last mile on this Earth, especially with a person with a belief in God, often involves spiritual assistance, prayer, confession, the Eucharist (Holy Communion) and also can delve into legal issues such as closing bank accounts, dealing with the will and last wishes plus a whole host of other requirements.

In our society today, the sanctity of human life is often neglected or ignored. Because of the great financial expense of end of life care, there is a tendency for individuals, even doctors and family members, to “just move things along a little,” which is a nice way of sometimes saying euthanasia.

On one occasion, a doctor came into the ICU while I was knelling and praying with a friend. I overheard the doctor telling the man’s wife, “It is time to let your husband go. His brain is no longer functioning.”

I thought about taking the easy way out and staying silent. But my friend had just been holding my hand and we had said the Lord’s Prayer together. I heard him speak every word.

Fortunately, the man’s wife started to resist the doctors lie. Her husband was in fact speaking to us and was in full command of his faculties. So I asked my friend to write down the names of his grandchildren — which he did.

That doctor never came back. My friend lived another year. But my friend did encounter much more pain and suffering during that last year of his life. Yet he thanked me and prayed with me and said he appreciated the extra time to see all his relatives, to make a more complete confession and to deal with some issues before he was ushered out the door.

He taught me how to really pray. And I also learned about the salvific value of suffering (see below).

We are called to love one another — as Jesus loves us.

The Catholic Church teaching on these subjects is below. Each person and family have to make their own decisions, and answer to God, when its all over.

In a nutshell, the Catholic Church pretty much says our lives have a sanctity from God, and we are to always choose life and allow God to decide how it ends.

Once families and doctors start killing people off thinking they know better than God, it seems to me we are entering an area that is God’s alone. Our job is to support life. God will do the rest.

One last thought. I went to the hospital one time to see an old friend after he had a stroke. Everyone thought he was a “goner.” But he just kept slowly getting better. When he came out of a coma, he reached out, grabbed my arm and said, “You are my Simon of Cyrene.”

I did get an opportunity to carry his cross — and not by my own choosing. I did not seek this out. God’s will was pretty clear: he wanted me to provide love, help and prayer — not a pillow over the face.

He taught me how important our loving service can be. That man who nearly died is still alive — almost ten years after he assigned me the role of Simon of Cyrene, which I am still thankfully able to provide to others who are suffering — even despite a progressive neurological condition now slowing robbing me of many skills.

I tell people now, if you want to progress spiritually, if you want to be found by the Holy Spirit, do it God’s way. If you do it any other way, you may never forgive yourself. Plus you won’t nourish your spirituality — you may lose it. If you ever had any.

John Francis Carey
Peace and Freedom

PS: Just last week a priest came over to my house to ask a favor of me. He wanted me to seek out and talk to a young man, in his late thirties, who had just had a stroke, lost his job, girlfriend and everything else he values, so he decide to start thinking about suicide.

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I went, with a friend, and we spent some time with this guy. He seemed like a wonderful guy. I’ll be honest, I always over react at the sound of the word suicide. I told the man, “Whatever cards God gives us, we have to play those cards. We can’t always just walk away or ask for a new deal.”

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I think he won’t commit suicide. But not because of me. I think we left the Holy Spirit with him and he’ll be OK. But I’ll check on him again for sure. Every life has more value in God’s eyes than we’ll ever know. And if He is kind enough to keep us alive, we should pay Him back by serving Him better.

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Simon of Cyrene carries the cross of Jesus

Related:

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The Catholic Church’s Teaching on Euthanasia

ISSUE: What is euthanasia? Why does the Church forbid its practice?

RESPONSE: The glossary in the Catechism of the Catholic Church defines euthanasia as “an act or omission which, of itself or by intention, causes the death of handicapped, sick, or dying persons—sometimes with an attempt to justify the act as a means of eliminating suffering.”

Euthanasia is a form of murder and thus is prohibited by the Fifth Commandment. It is a grave offense against the dignity of the human person and also against God, the Author of human life. While motives and circumstances can mitigate one’s culpability, they do not change the nature of this murderous act, which must be forbidden (Catechism, no. 2277).

The Church affirms the right to life of all persons, from conception to natural death. The Church encourages those with terminal illness to unite their sufferings with those of Jesus Christ, for the sake of His body, the Church (cf. Col. 1:24). The Church also encourages caregivers and family members to treat sick or handicapped persons with “special respect” (Catechism, no. 2276).

DISCUSSION: Death is part of the human condition. While everyone is well aware of this reality, the presence of terminal or severe illness requires us to look more closely at this reality. As we approach death, we confront our own beliefs about the meaning of life, the value of suffering, and the prospect of life after death. In other words, the experience of our own mortality is a pivotal moment in our pilgrimage of faith (cf. Catechism, no. 1501). How we approach death is of utmost importance to the individual and to society. Further, the way we treat those in need, the least of our brethren (cf. Mt. 25:31-46), speaks volumes about who we are as a people.

In his encyclical letter on the “Gospel of Life” (Evangelium Vitae, “EV”), Pope John Paul II identifies several cultural factors that have contributed to the spread of euthanasia. He says that in today’s society we are increasingly unable to face and accept suffering, so we are increasingly tempted to eliminate it at the root by hastening the moment of death (cf. EV, no. 15). This points to the “crisis of faith” in the West, where the physical evil of suffering is considered to be “the epitome of evil, to be eliminated at all costs” (ibid.). The Pope points out several other factors, including modern man’s desire to control life and death and an assessment of human value based on medical costs, self-sufficiency, and societal “burden.”

We saw in the 20th century how Planned Parenthood and the little-known radical views of its founder, Margaret Sanger, subtly imposed its contraceptive, anti-natalist, racist, and eugenic agenda on the world. The result has been that conduct once considered unspeakably evil—the killing of unborn or even partially born children—is not only accepted but enshrined as an inalienable right. Less people, however, are aware that a similar effort is well under way to legitimize the killing of our elderly and sick citizens.

Palliative care - file picture

Credit: AMELIE-BENOIST / BSIP/SPL

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In 1938, Dr. Foster Kennedy, president of the Euthanasia Society of America (ESA), announced his organization’s support of legislation to legalize the killing of “defective” or “incurable” human beings—with or without their consent. Back then, such legislation was utterly intolerable to most people, so the ESA took a more strategic, incremental approach, employing deceptive language such as “death with dignity” and building upon the utilitarianism (“quality of life”) and radical autonomy (“right to choose”) championed by secular society and, unfortunately, the U.S. Supreme Court. Many now see euthanasia as a topic of political discussion, not an abomination.

God’s Timeless and Timely Word

It would not be realistic to expect Sacred Scripture to address contemporary issues regarding care for the dying. Even so, the biblical message—amplified by Church Tradition and definitively expounded by the Magisterium—is firmly and unequivocally on the side of life. Some relevant biblical themes include:

The value and dignity of human life.

The Bible begins with the creation narrative, which provides that man has been specially created in the image and likeness of God (cf. Gen. 1:26-27). The rest of the Bible is the story of God’s fatherly plan to draw all people to Himself. This plan culminates in the Incarnation of Christ. By becoming one like us, God amazingly demonstrates His solidarity with the human family and affirms the value and dignity of human life. Pope John Paul II connects the dots for us, telling us that a rejection of human life is really a rejection of Christ (EV, no. 104).

Prohibition of murder.

The Fifth Commandment expressly forbids taking another’s life (cf. Ex. 20:13). Jesus not only affirms the necessity of this commandment for eternal life (cf. Mt. 19:16-22), but actually tightens its requirements (cf. Mt. 5:21-26). He also roots the commandment in the positive requirement to love one’s neighbor “as one’s self” (cf. Mt. 22:34-40). This positive command presupposes a legitimate love of self that would exclude the rejection of the fundamental gift of life.

Respect for advanced age.

Throughout Scripture, old age is characterized by dignity and surrounded with reverence. Just one example of the dignity of the elderly can be found in the story of Eleazar, who accepted torture and martyrdom rather than violate God’s law. His heroic action is described as “worthy of his years and the dignity of his old age” (2 Mac. 6:23).

Jesus’ love for the sick.

The Gospels are replete with accounts of Jesus tending to the needs of the sick, handicapped, and dying. Jesus healed the sick and instructed His disciples to do the same (cf. Mt. 10:8). Caring for the sick has always been considered a “corporal work of mercy,” based on Our Lord’s own words in Matthew 25. And in the parable of the Good Samaritan (cf. Lk. 10:29-39), we see the Christian’s obligation to tend to the needs of our “neighbor” despite any perceived inconvenience or cultural bias.

Earthly life is not an absolute.

Scripture says we weren’t created simply for this life but for eternity (cf. Wis. 2:23). We are advised to be concerned most of all about threats to our eternal souls (cf. Mt. 10:28), realizing that while our “outer self” is wasting away, our “inner self” is being renewed each day (cf. 2 Cor. 4:12-5:1).

Trust God in life and death.

Life is a gift from God, and whether we live or die is in His hands (cf. Ps. 16:15). The just man is depicted not as seeking deliverance from the burdens of old age, but as putting his trust in God’s loving providence. The Bible does not teach a mere fatalism or resignation, but elicits faith in God and trust in His mercy and promises.

Salvific value of suffering.

Through dying on the Cross for us, Jesus Christ reveals the life-giving value of suffering. Christ’s sacrifice redeemed the whole world, but in appropriating this redemption for ourselves, we are instructed to follow Jesus’ example and carry our own crosses, laying down our lives for others. All our thoughts, words, and actions, but particularly our sufferings, have salvific value when united with Christ’s sacrifice.

Here we have to understand the distinction between martyrdom, which involves accepting suffering and even death out of love for Christ, and suicide, which involves seeking death for its own sake, i.e., rejecting the good of human life. St. Jerome, a 4th-century Doctor of the Church, expressed the distinction this way: “It is not ours to lay hold of death; but we freely accept it when it is inflicted by others.”

For 2,000 years, the Church’s Tradition has consistently taught the absolute and unchanging value of the commandment, “Thou shall not kill.” Pope John Paul II cites the Didache, the most ancient non-biblical Christian writing, which condemns crimes against human life as being part of the “way of death” that Christians must reject (EV, no. 54).

St. Augustine, writing in the fifth century, made several statements that support the Church’s constant teaching on euthanasia, such as his assertion “that no man should put an end to this life to obtain that better life we look for after death, for those who die by their own hand have no better life after death” (City of God, I, 26).

Magisterial Pronouncements

The Catholic Church has firmly and explicitly confirmed its condemnation of euthanasia in recent decades. Notably, at the Second Vatican Council (1962-65), the universal Church taught:

The varieties of crime are numerous: all offenses against life itself, such as murder, genocide, abortion, euthanasia, and willful suicide . . . are criminal: they poison civilization, and they debase the perpetrators more than the victims and militate against the honor of the Creator (Gaudium et Spes, no. 27, emphasis added).

Even more recently, in response to what he calls the “culture of death,” Pope John Paul II definitively reiterated the Church’s perennial teaching:

In harmony with the Magisterium of my predecessors and in communion with the bishops of the Catholic Church, I confirm that euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person. This doctrine is based upon the natural law and upon the written Word of God, is transmitted by the Church’s Tradition, and taught by the ordinary and universal Magisterium (EV, no. 65).

Guilt by Association?

The patient who requests euthanasia in effect commits suicide, which the Church has always considered a “gravely evil choice” (ibid., no. 66). While suicide in all its forms is an objective violation of the Fifth Commandment, we must recognize that psychological disturbances, anguish, or grave fear of hardship, suffering, or torture can diminish the responsibility of the person who commits suicide (Catechism, no 2282). We cannot know the eternal fate of such a person: “We should not despair of the eternal salvation of persons who have taken their own lives. By ways known to him alone, God can provide the opportunity for salutary repentance. The Church prays for persons who have taken their own lives” (Catechism, no. 2283).

Then there is the physician and others who help to bring about the patient’s death, including those who provide lethal drugs or other means of enabling a patient to commit the form of euthanasia commonly known as “assisted suicide.” All those who knowingly and willingly perform or assist in carrying out the act of terminating the patient’s life have committed murder (cf. Catechism, no. 2277). While there may be mitigating factors in a particular case, especially when it comes to family members who are coping with a loved one’s catastrophic illness, the act nonetheless is seriously wrong, even when the patient requests it. “True ‘compassion’ leads to sharing another’s pain; it does not kill the person whose suffering we cannot bear” (EV, no. 66).

Finally, there are those public officials who pass laws legalizing euthanasia in their jurisdiction. A law that tolerates—or even requires—the killing of the innocent is unjust, non-binding, and brings about the obligation to oppose it by means of conscientious objection (ibid., no. 73). The fact that civil laws allow an evil or that there is a diversity of views on the subject does not alter this requirement, which the Holy Father summarizes:

In the case of an intrinsically unjust law, such as a law permitting abortion or euthanasia, it is therefore never licit to obey it, or to take part in a propaganda campaign in favor of such a law, or vote for it (ibid.).

The Problem of Pain

In discussing the topic of euthanasia, some further distinctions need to be made. First, the Church recognizes the legitimacy of palliative care, which involves making suffering more bearable in the final stage of illness and ensuring that the patient is supported and accompanied throughout his or her ordeal (cf. EV, no. 65).

Surely, Christians are called to find in their suffering and pain a unique opportunity to participate in Our Lord’s Passion. Excessive pain, however, brings the prospect of draining a patient’s moral resources, interfering with his spiritual well-being, and even tempting him to consider euthanasia. Therefore, the patient’s request for pain relief should be respected; those who cannot express their wishes can generally be assured to want such relief.[1]

In treating some serious illnesses such as cancer or AIDS, the doses of narcotics needed to effect adequate pain management can bring about a foreseeable risk of shortening the patient’s life. Pope Pius XII taught in a 1957 address that it is permitted to relieve pain with narcotics, even when the result is decreased consciousness and a shortening of life, “if no other means exist, and if, in the given circumstances, this does not prevent the carrying out of other religious and moral duties.”

The Church has subsequently reaffirmed the moral liceity of authentic palliative care, so long as the medicines are not taken or prescribed with the intention of bringing about the patient’s death. The Catechism calls palliative care a special form of charity which should be encouraged (no. 2279).

It Is Finished

A second issue arises as to what measures must be taken to preserve life. Patients, family members, and health care providers are not morally obligated to pursue every possible avenue of extending human life. Instead, “it needs to be determined whether the means of available treatment are objectively proportionate to the prospects for improvement” (EV, no. 65).

The Church has distinguished between “extraordinary” and “ordinary” care, with only the latter being morally obligatory:

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 (Catechism, no. 2278).

Even when death is considered imminent, patients by virtue of their human dignity should continue to receive “ordinary” care. The Charter for Health Care Workers (Pontifical Council for Pastoral Assistance for Health Care Workers, 1995) says that such care includes nursing care, hygiene, and palliative care. It also involves nutrition and hydration, orally or with artificial assistance (i.e., a feeding tube), if this will support the patient’s life without imposing serious burdens on the patient.

Allowing the patient to die a natural death with dignity is not euthanasia. While it is not permissible and indeed reprehensible to cause a patient’s death through starvation or dehydration, in the case of a patient in the final stages of the dying process, where providing him with food or water would cause greater hardship than relief, those tending to the patient may forego such care (cf. National Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, no. 58).

In both the case of palliative care and the case of foregoing “over-zealous” treatment, the goal is not to terminate the life of the patient, but on the contrary to treat the patient with dignity and respect. The patient’s death is accepted without being willed or deliberately accelerated. And in both cases we see the principle of double effect in action. Some forms of treatment may have two effects, one good (e.g. pain relief) and one evil (shortening of patient’s life). In appropriate circumstances, the treatment may be provided because of the intended good effect, despite the possibility of the foreseeable but unintended bad effect (cf. Catechism, no. 1737). The pivotal issue is what one is trying to accomplish through a given medical decision. If the intention is to kill or shorten the patient’s life, then it is not morally justifiable.

Christian Beatitude

Our Lord says, “Blessed are those who mourn, they shall be comforted” (Mt. 5:4). Modern man tends to resist mourning, to resist embracing the reality of human suffering and death, opting instead for a cosmetic, shallow, and ultimately disposable existence. Our Lord does not say that He will take away our temporal pain and anguish, but He does promise to “comfort” us, which literally means that He will be strong with us, through the power of His Holy Spirit.

He also tells us that when we care for the sick, the marginalized, and the dying, we are truly caring for Him, such that the late Mother Teresa would often say that she was serving the “hidden Jesus” in the poorest of the poor in Calcutta.

We affirm the Gospel of Life, and in particular the value and dignity of the elderly and ill in our midst, when we tend to their physical, psychological, and spiritual needs. This could involve just sitting with them, offering them reassurance, or making the sacraments available to them—particularly Confession and Anointing of the Sick, the underappreciated “Sacraments of Healing”—as well as the Eucharist, which is called “viaticum” when received in anticipation of passing over to eternal life (cf. Catechism, no. 1517). Thus by our actions as well as by our words, we must be ambassadors of God’s mercy and compassion to those who are dying.

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Recommended Reading:

Holy Bible (Catholic edition)

Catechism of the Catholic Church

Vatican II Documents

Pope John Paul II, Evangelium Vitae

Sacred Congregation for the Doctrine of the Faith, Declaration on Euthanasia

Russell Shaw, ed., Our Sunday Visitor’s Encyclopedia of Catholic Doctrine

William Brennan, Dehumanizing the Vulnerable

 

Other Available FAITH FACTS:

 Organ Donation • Debunking the Overpopulation Myth • Canonical Misconception: Pope Pius IX and the Church’s Teaching on Abortion • The Truth About Birth Control

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Source: http://www.cuf.org/2004/04/true-compassion-for-the-dying-the-churchs-teaching-on-euthanasia/

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From Eternal Word Television (EWTN)

The court-ordered starvation and dehydration of Terri Schiavo in 2005 raised a number of issues—moral, legal and constitutional, about the right to life and the so-called right to die. Most coverage of the case focused on the question of her guardian’s right to decide according to her alleged wishes and the due process of the judicial proceedings. However, at base the question was a moral, not a legal, one: under what conditions, if any, may a patient, a guardian, medical personnel or civil authorities, withhold or withdraw nutrition and hydration?

Catholic Teaching on Extraordinary Means

The natural law and the Fifth Commandment1 requires that all ordinary means be used to preserve life, such as food, water, exercise, and medical care. Since the middle ages, however, Catholic theologians have recognized that human beings are not morally obligated to undergo every possible medical treatment to save their lives. Treatments that are unduly burdensome or sorrowful to a particular patient, such as amputation, or beyond the economic means of the person, or which only prolong the suffering of a dying person, are morallyextraordinary, meaning they are not morally obligatory in a particular case. Medical means may be medically ordinary, but yet morally extraordinary.

The many advances in medicine during recent decades has greatly complicated the decision whether to undergo or forego medical treatment,  since medicine can now save many people who would simply have been allowed to die in the past. Further, having saved them, many people continue to live for long periods in comatose or semi-conscious states, unable to live without technological assistance of one kind or another. The following Questions and Answers will address some of the complexities of this issue.

Q. When may medical therapies, procedures, equipment and the like be withheld or withdrawn from a patient.

A. The Catechism of the Catholic Church states,

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.

The key principle in this statement is that one does not will to cause death. When a person has an underlying terminal disease, or their heart, or some other organ, cannot work without mechanical assistance, or a therapy being proposed is dangerous, or has little chance of success, then not using that machine or that therapy results in the person dying from the disease or organ failure they already have. The omission allows nature to takes its course. It does not directly kill the person, even though it may contribute to the person dying earlier than if aggressive treatment had been done.

Q. Does this also apply to artificially provided nutrition and hydration?

A. Yes, when the moral conditions noted above are met. We must, therefore, ask the question “will the withdrawal of nutrition and hydration allow the person to die, or kill the person?” When it will allow a person to die from an underlying condition, rather than unnecessarily prolonging their suffering, it may be removed. So, for example, in the last hours, even days, of a cancer patient’s life, or if a sick person’s body is no longer able to process food and water, there is no moral obligation to provide nutrition and hydration. The patient will die of their disease or their organ failure before starvation or dehydration could kill them.

However, when the withdrawal of nutrition and hydration is intended to kill the person, or will be the immediate and direct cause of doing so, quite apart from any disease or failure of their bodies, then to withdraw food and water would be an act of euthanasia, a grave sin against the natural law and the law of God.

Q. What about the case of Terri Schiavo?

A. In Terri’s case, while there was some disagreement as to her exact medical condition, she was not dying. Indeed, when the other artificial means were withdrawn she continued to live, so that the withdrawal of her food and water directly caused her death. This was a violation of the natural law and the law of God.

Q. You mention the natural law, what is it?

A. The natural law is morality which reason can determine from the nature of man, without the assistance of God’s revelation. An example is the right to life. Almost all human societies throughout history, both religious and non-religious, have recognized that it is wrong to kill an innocent person. This is a conclusion which reason can easily come to, since all human beings  have an inborn desire to live. From this natural law principle we can easily see that any action that directly and intentionally kills an innocent person is an unjust taking of a human life. Therefore, withdrawing food and and water from anyone who is not about to die and who can still tolerate it, has no other reasonable name than murder.

Q. What does the Church say about this?

A. The Pope addressed this issue in an address to a group of physicians who were in Rome in March 2004 precisely to discuss it.

I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.

The obligation to provide the “normal care due to the sick in such cases” (1) includes, in fact, the use of nutrition and hydration (2). The evaluation of probabilities, founded on waning hopes for recovery when the vegetative state is prolonged beyond a year, cannot ethically justify the cessation or interruption of minimal care for the patient, including nutrition and hydration. Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission.

In this regard, I recall what I wrote in the Encyclical Evangelium Vitae making it clear that “by euthanasia in the true and proper sense must be understood an action or omission which by its very nature and intention brings about death, with the purpose of eliminating all pain”; such an act is always “a serious violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person” (n. 65).  [Pope John Paul II, To the Congress on Life-Sustaining Treatments and Vegetative State, 20 March 2004)

(1) Congregation for the Doctrine of the Faith, Iura et Bona, p. IV

(2) cf. Pontifical Council “Cor Unum”, Dans le Cadre, 2, 4, 4; Pontifical Council for Pastoral Assistance to Health Care Workers,Charter of Health Care Workers, n. 120

In this address the Holy Father draws the following significant conclusions:

1. Food and water are natural means of sustaining life, not medical acts, even if delivered artificially.

2. Nutrition and hydration are ordinary and proportionate means of care.

3. Food and water are morally obligatory unless or until they cannot achieve their finality, which is providing nutrition and hydrating and alleviating suffering.

4. The length of time they are, or will be, used is not grounds for withholding or withdrawing artificially delivered nutrition and hydration.

5. If the result of withholding or withdrawing nutrition and hydration is death by starvation and dehydration, as opposed to an undying disease or dysfunction, it is gravely immorally.

In summary, nutrition and hydration, like bathing and changing the patient’s position to avoid bedsores, is ordinary care that is owed to the patient. This is true even if it is delivered artificially, as when a baby is bottle-fed or a sick person is tube-fed. Nutrition and hydration may only be discontinued when they cannot achieve their natural purposes, such as when the body can no longer process them, or, when during the death process they would only prolong the person’s suffering. If such a case the patient dies of the underlying disease. On the other hand, if starvation and dehydration is the foreseeable cause of death, to withhold or withdrawn nutrition and hydration is gravely immoral.

Q. What can a person do to ensure that their wishes and their religious beliefs are respected by their family, medical personnel and the courts?

A. The best way is by means of an Advance Directive which states the patients wishes with respect to aggressive medical treatment. There are two basic kinds, a Living Will by itself or an Advance Directive with a Durable Power of Attorney (or Proxy) for Health Care Decisions. The merits of each are as follows:

1. Living Will. By this document a person decides completely in advance whether they want to be kept alive by technology. It is a “yes” or “no” statement, which then places the matter in the hands of the medical community. Many Catholic bishops and moralists consider this an unsatisfactory approach, as it does not provide for unforeseen circumstances. Despite the enthusiasm of the media, many medical professionals, and sadly even some Catholic institutions, Living Wills are NOT the way to go!

2. Advance Directive with a Durable Power of Attorney or Health Care Proxy. These documents give to a friend or family member the authority to make health care decisions according to one’s mind as expressed in an Advance Directive. By appointing an agent, or giving someone durable power of attorney, the patient allows for unforeseen circumstances. By stating in an  Advance Directive that one wants Catholic teaching adhered to, one can ensure that neither the agent or the medical institution will disregard that teaching. Together they ensure that a trusted person, rather than strangers, will make circumstantially appropriate decisions, in keeping with the Faith.

The following sample forms are provided through the courtesy of the National Catholic Bioethics Center.

Health Care Proxy               Advance Directive

Adobe 4 or higher is need to read and print these forms.

https://www.ewtn.com/morals/end-of-life.htm

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