Thanks Mike,

Here is the response I received. Hope it helps others as well.

Dear Mr. Ream: Catholic moral teaching does not require us to use any means necessary to preserve life. It requires only proportionate (aka ordinary) means of treatment. Disproportionate (a.k.a. extraordinary) means are not obligatory (i.e., they are morally optional, not required), and refusing disproportionate treatments is therefore not the moral equivalent of suicide. The assessment of what constitutes a disproportionate means ultimately rests with the patient (or the patient's decision-making proxy, acting on the patient's behalf and reasoning as the patient would reason if competent). Specifically, “disproportionate means are those that in the patient's judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.” USCCB, Ethical and Religious Directives for Catholic Health Care Services, 5th ed., 2009. Refusing a disproportionate means is ethically legitimate. As you can see, the morally important question would be why you “refuse to go that option.” If you refuse because in good conscience you consider dialysis (and everything it entails, weighing the various benefits against burdens) to be an excessive burden to you, recognizing the limits of the human condition, then your refusal is perfectly legitimate. If, on the other hand, you no longer wish to live, you consider your life itself to be a burden, or you refuse the treatment out of despair of hope and life, it may be tantamount to suicide. Your intention is therefore important. I would recommend that you read especially the following two Church documents as you continue thinking about what lies ahead: Congregation for the Doctrine of the Faith, “Declaration on Euthanasia,” 1980 [PDF] USCCB, Ethical and Religious Directives for Catholic Health Care Services, 5th ed., 2009, especially Part V, nos. 55-61 Hopefully you find this helpful. Please feel free to follow up with any additional questions or concerns. Kind regards, John A. DiCamillo, BeL Staff Ethicist The National Catholic Bioethics Center 6399 Drexel Road Philadelphia, PA 19151