It is a common human tendency to ignore our own mortality and pretend that death is something that is “far away” that we don’t have to worry about right now. But the reality for Christians is that death is not the end, but rather the beginning of a new, resurrected life with God almighty. The catechism teaches that our fate after death ultimately hinges on the state of our souls when we die (CCC 1021).
This view of death affects how we as Catholics make decisions regarding care at the end-of-life. For some people, end-of-life care involves the blessings and struggles that accompany old age. For others, it involves medical decisions that must be made without warning as a result of a sudden illness or accident that can afflict people of any age. In these situations patients and their loved ones must decide which course of action, if any, upholds the dignity of the person nearing the end of life. While the Church recognizes, and encourages compassionate care that alleviates the suffering of those who are near death, She also vigorously teaches that immoral means (such as euthanasia or direct killing) may never be used to reduce suffering even if they are used with apparently good intentions.
Q: Does the Church teach that we are obligated to use every possible means to stay alive?
A: No, the Church teaches that it is acceptable at the end of one’s earthly life to let nature “take its course” and refuse advanced medical care if this is in the best interest of the patient. The key to understanding what procedures we are obligated to provide someone comes in an analysis ofordinary means of care and extraordinary means of care. Ordinary means of care involve the basic elements of human survival and comfort that all people, in virtue of being made in the image and likeness of God, have a right to access. Ordinary care includes, food, water, bathing, human contact, and other basic items that respect the dignity of the human person, do not cause the patient an undue burden, and serve the help the person survive. In contrast, extraordinary care involves those medical interventions that provide minimal benefit to the patient and are expensive or very burdensome. For example, a cancer patient may forgo an expensive and physically exhausting procedure that will provide them another six months of life in favor of maintaining their current health and peacefully waiting for their time to be with the Lord.
Q: Does the church permit euthanasia so that people who are suffering can be “put out of their misery”?
A: The Church cares deeply about alleviating the suffering of God’s people in the world. Christ himself said, “”Come to me, all you who labor and are burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am meek and humble of heart; and you will find rest for your selves. For my yoke is easy, and my burden light.” (Matthew 11:28-30) However, she also recognizes that suffering is an inescapable aspect of life and that this suffering ultimately unites us to God and helps us see our sheer dependence on him. C.S. Lewis poignantly wrote in the Problem of Pain that, “God whispers to us in our pleasures, speaks in our conscience, but shouts in our pains: it is his megaphone to rouse a deaf world.”
Some critics allege that the Church is cruel because we put animals like dogs and cats “out of their misery” with euthanasia, but we won’t allow the same thing for suffering humans. But this objection actually strengthens the Church’s teaching that human beings are intrinsically valuable and should not be treated like animals. That is because most animals are euthanized not because they suffer, but because it is considered too costly to treat their suffering. But it is never too expensive to care for human beings who are made in the image and likeness of God. Indeed, this dynamic is already becoming the norm in places where euthanasia and assisted suicide is legal. For example, in Oregon Barbara Wagner received a letter from her health insurance company stating that her cancer treatment was too expensive and could not be covered, but that the company would cover the costs of suicide pills if Mrs. Wagner decided to kill herself instead.
Q: Does the Church believe that if someone is a vegetable (is in a Persistent Vegetative State) they should be kept alive?
A: First, referring to any human being as an inanimate object like a vegetable is offensive and should be treated in the same way racial and ethnic slurs are treated. All human beings, regardless of their age or functional abilities, should be given basic care like food, water, adequate temperature regulation and other things to make them comfortable. A person in a persistent vegetative state (PVS) apparently has no upper brain activity and is not conscious. They are still alive but their actions are merely the result of reflexes and other automatic stimuli responses. The Church teaches that it Is not what we do (acting rational, thinking, moving purposefully) that makes us valuable, but simply that we are human beings made in God’s image that gives us our value. Furthermore, it is very difficult for doctors to diagnose if someone is in a PVS or whether the condition is permanent. Some patients are conscious but cannot communicate with the outside world (locked in syndrome) and others were diagnosed as even being “brain-dead” but eventually regained consciousness (see the case of Jesse Ramirez). In some cases it may be appropriate to take a patient who lacks brain activity off of artificial life sustaining devices that constitute extraordinary care (like a heart lung machine). However, it is not acceptable to deny these patients ordinary care unless administering such care is actually more detrimental to the patient’s well-being than the act of withholding that care.
Q: Why can’t someone choose to end their own life is they desire? Shouldn’t a doctor be allowed to help such a patient end their own life? (i.e. through physician-assisted suicide)
A: The position of the Catholic Church on physician assisted suicide is actually best summarized in the opinions of leading medical associations. For example the American Medical Association states that, “It is understandable, though tragic, that some patients in extreme duress–such as those suffering from a terminal, painful, debilitating illness–may come to decide that death is preferable to life. However, allowing physicians to participate in assisted suicide would cause more harm than good. Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.
Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life. Patients should not be abandoned once it is determined that cure is impossible. Multidisciplinary interventions should be sought including specialty consultation, hospice care, pastoral support, family counseling, and other modalities. Patients near the end of life must continue to receive emotional support, comfort care, adequate pain control, respect for patient autonomy, and good communication.