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{
Are
these End-of-Life misconception issues in my weekly parish bulletin,
correct? }
Richard
replied:
Hi, Mike —
Yes, all of those statements deviate
in some way from Church teaching,
so they are misconceptions.
When faced with natural death,
one must seek and accept all
life-support measures.
[ top ]
The first one is definitely
erroneous. Evangelium Vitaeparagraph 65 has
a useful explanation
of what constitutes euthanasia,
what distinguishes euthanasia
from a decision to forego
aggressive medical treatment,
and why it is not mandatory
to pursue all forms of
life support:
65. For a correct
moral judgment on
euthanasia, in the
first place a clear
definition is required.
Euthanasia in the
strict sense is understood
to be an action or
omission which of
itself and by intention
causes death, with
the purpose of eliminating
all suffering. "Euthanasia's terms
of reference,
therefore, are to
be found in
the intention of the
will and in the methods
used".[76]
Euthanasia must be
distinguished from
the decision to forego
so-called "aggressive
medical treatment",
in other words, medical
procedures which no
longer correspond
to the real situation
of the patient, either
because they are by
now disproportionate
to any expected results
or because they impose
an excessive burden
on the patient and
his family. In such
situations, when death
is clearly imminent
and inevitable, one
can in conscience refuse
forms of treatment
that would only secure
a precarious and burdensome
prolongation of life,
so long as the normal
care due to the sick
person in similar
cases is not interrupted. [77]
Certainly there is
a moral obligation
to care for oneself
and to allow oneself
to be cared for, but
this duty must take
account of concrete
circumstances. It
needs to be determined
whether the means
of treatment available
are objectively proportionate
to the prospects for
improvement.
To
forego extraordinary
or disproportionate
means is not the equivalent
of suicide or euthanasia;
it rather expresses
acceptance of the
human condition in
the face of death.[78]
So Catholic ethics
do not require anyone
to seek and accept
all life-saving measures. This
question is also addressed
at length by the Declaration
on Euthanasia:
Everyone has the duty
to care for his or
her own health or
to seek such care
from others. Those
whose task it is to
care for the sick
must do so conscientiously
and administer the
remedies that seem
necessary or useful.
However, is it necessary
in all circumstances
to have recourse to
all possible remedies?
In the past, moralists
replied that one is
never obliged to use extraordinary means.
This reply, which
as a principle still
holds good, is perhaps
less clear today,
by reason of the imprecision
of the term and the
rapid progress made
in the treatment of
sickness. Thus, some
people prefer to speak
of proportionate and disproportionate means.
In any case, it will
be possible to make
a correct judgment
as to the means, by
studying the type
of treatment to be
used, its degree of
complexity or risk,
its cost and the possibilities
of using it, and comparing
these elements with
the result that can
be expected, taking
into account the state
of the sick person
and his or her physical
and moral resources.
In order to facilitate
the application of
these general principles, the following clarifications
can be added:
If there
are no other sufficient
remedies, it is permitted,
with the patient's
consent, to have recourse
to the means provided
by the most advanced
medical techniques,
even if these means
are still at the experimental
stage and are not
without a certain
risk. By accepting
them, the patient
can even show generosity
in the service of
humanity.
It is
also permitted, with
the patient's consent,
to interrupt these
means, where the results
fall short of expectations.
But for such a decision
to be made, account
will have to be taken
of the reasonable
wishes of the patient
and the patient's
family, as also of
the advice of the
doctors who are specially
competent in the matter.
The latter may in
particular judge that
the investment in
instruments and personnel
is disproportionate
to the results foreseen;
they may also judge
that the techniques
applied impose on
the patient strain
or suffering out of
proportion with the
benefits which he
or she may gain from
such techniques.
It is
also permissible to
make do with the normal
means that medicine
can offer. Therefore
one cannot impose
on anyone the obligation
to have recourse to
a technique which
is already in use
but which carries
a risk or is burdensome. Such
a refusal is not the
equivalent of suicide;
on the contrary, it
should be considered
as an acceptance of
the human condition,
or a wish to avoid
the application of
a medical procedure
disproportionate to
the results that can
be expected,
or a desire not to
impose excessive expense
on the family or the
community.
When
inevitable death is
imminent in spite
of the means used,
it is permitted in
conscience to take
the decision to refuse
forms of treatment
that would only secure
a precarious and burdensome
prolongation of life,
so long as the normal
care due to the sick
person in similar
cases is not interrupted. In
such circumstances,
the doctor has no
reason to reproach
himself with failing
to help the person
in danger.
Once a life-saving technique
has been started, it can never
be shut off. [ top ]
The Catechism addresses
this point. Paragraph
2278 affirms that, in
certain circumstances,
it is permissible to
discontinue life-sustaining
treatment:
Euthanasia
.
.
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 Vatican has an office
for medical ethics issues,
called the Pontifical
Council for Pastoral
Assistance to Health
Care Workers. While the
Council does not exercise
teaching authority, it
does give helpful moral
guidance and explanation
for the Catholic position
on this question in its Charter for Health Care Workers [119].
. . .
Contemporary medicine,
in fact, has at its
disposal methods which
artificially delay
death, without any
real benefit to the
patient. It is merely
keeping one alive
or prolonging life
for a time, at the
cost of further, severe
suffering. This is
the so-called therapeutic
tyranny, which
consists in
the use of methods
which are particularly
exhausting and painful
for the patient, condemning
him in fact to an
artificially prolonged
agony.
This is contrary to
the dignity of the
dying person and to
the moral obligation
of accepting death
and allowing it at
last to take its course. "Death
is an inevitable fact
of human life": it cannot be uselessly
delayed, fleeing from
it by every means.
Should a dying person go
into heart failure, Catholics
may not refuse artificial resuscitation
by means of Do Not Resuscitate
(DNR) orders.[ top ]
So far, I have not found any
mention of Do Not Resuscitate (DNR) orders in official Church
documents. However, the explanation
above about foregoing aggressive
medical treatments does seem
to apply to resuscitation.
In situations where a patient's
condition is declining despite
resuscitation, it seems reasonable
to consider the resuscitation
as an unproductive treatment,
and it is permissible to forego
it, if the patient wants.
Catholics may never refuse
artificial nutrition and hydration,
no matter what form it may
take. [ top ]
The Congregation for the
Doctrine of the Faith gave
some clear teaching
on this question at
the request of the U.S.
bishops in 2007:
The administration
of food and water
even by artificial
means is, in principle,
an ordinary and
proportionate means
of preserving life.
It is therefore
obligatory to
the extent to which,
and for
as long as, it
is shown to accomplish
its proper finality, which
is the hydration
and nourishment
of the patient.
In this way suffering
and death by starvation
and dehydration
are prevented.
In short, as long as
food and water help to
keep the patient alive
or comfortable, they
are morally required.
This is the case even
when artificial means
are employed such as
feeding tubes or IV lines.
But if the food and water
are no longer effective
for those purposes, they
may be discontinued.
For further explanation
about this point, you
can see the Commentary
issued by CDF along
with their letter to
the U.S. bishops.
Because pain is a fact of
life and can be offered up
for a religious purpose, good
pain medication practices are
not important. [ top ]
That statement, of course,
expresses a callous attitude
utterly contrary to the
Catholic spirit of Mercy,
which calls on us to comfort
the afflicted.
This question pertaining
to painkillers is also
addressed by the magisterium
in several places, two
of which are in:
in the Declaration on Euthanasia III. The Meaning of Suffering for Christians and the use of Painkillers.
While
it is praiseworthy if
a patient chooses to
voluntarily limit his
use of painkillers in
order to consciously
share in the Lord's sufferings,
he is not required to
do so at all, and we
should assume that patients
want the use of available
painkillers unless they
decide otherwise:
In modern medicine,
increased attention
is being given to
what are called methods
of palliative care,
which seek to make
suffering more bearable
in the final stages
of illness and to
ensure that the patient
is supported and accompanied
in his or her ordeal.
Among the questions
which arise in this
context is that of
the licitness of using
various types of painkillers
and sedatives for
relieving the patient's
pain when this involves
the risk of shortening
life. While praise may be due to the
person who voluntarily
accepts suffering
by forgoing treatment
with pain-killers
in order to remain
fully lucid and, if a believer, to share
consciously in the
Lord's Passion, such heroic behavior
cannot be considered
the duty of everyone.
Pius XII affirmed
that it is licit to
relieve pain by 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" . In
such a case, death
is not willed or sought,
even though for reasonable
motives one runs the
risk of it: there
is simply a desire
to ease pain effectively
by using the analgesics
which medicine provides.
All the same, it
is not right to deprive
the dying person of
consciousness without
a serious reason:
as they approach death
people ought to be
able to satisfy their
moral and family duties,
and above all they
ought to be able to
prepare in a fully
conscious way for
their definitive meeting
with God.
According to Christian
teaching, however,
suffering, especially
suffering during the
last moments of life,
has a special place
in God's saving plan;
it is in fact a sharing
in Christ's passion
and a union with the
redeeming sacrifice
which He offered in
obedience to the Father's
will. Therefore, one
must not be surprised
if some Christians
prefer to moderate
their use of painkillers,
in order to accept
voluntarily at least
a part of their sufferings
and thus associate
themselves in a conscious
way with the sufferings
of Christ crucified
(cf. Matthew 27:34). Nevertheless
it would be imprudent
to impose a heroic
way of acting as a
general rule. On the
contrary, human
and Christian prudence
suggest for the majority
of sick people the
use of medicines capable
of alleviating or
suppressing pain,
even though these
may cause as a secondary
effect semi-consciousness
and reduced lucidity.
As for those who are
not in a state to
express themselves,
one can reasonably
presume that they
wish to take these
painkillers, and have
them administered
according to the doctor's
advice.