WHAT THE CHURCH TEACHES So the sisters sent word to him, saying, “Lord, the one you love is sick.” Jn. 11:3 The End of Life The Catholic Church teaches that all life, from con- ception to natural death, is sacred. However, modern medical advances have made end of life issues increas- ingly difficult to sort out. What is the difference between letting a person die and practicing euthana- sia? Can Catholics have “living wills?” How much treatment must be provided to the sick and dying? This pamphlet gives an overview of these and other important moral issues surrounding life and death. Why should I turn to the Church when a loved one is facing an end of life decision? Since such decisions are often made in times of great stress, talking to a priest can help you and your family understand Church direc- tives, assuring that whatever choices are made are both compassionate and morally ethical. Moreover, the Church offers not only the sacra- ments of Reconciliation and the Eucharist to help those who are sick or dying, but also provides the special graces of the Sacrament of Anointing. The Sacrament of Anointing ful- fills the directives expressed in the Letter of James to pray over those who are sick, to anoint them with oil in the name of the Lord, trusting that “the prayer offered in faith will make the sick person well; the Lord will raise him up” (Jas. 5:15). Although “even the most intense prayers do not always obtain the healing of all illnesses” {Catechism of the Catholic Church, 1508), the Sacrament always provides strength, grace, courage, and the for- giveness of sin. What does the Church teach about the end of life? First, because God is the author of all life, directly putting anyone to death is morally unacceptable. It “constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator” (CCC, 2277). Ending life, even for the best of motives, is always wrong. Second, the Church teaches that life in all its stages is sacred. In fact, according to the catechism, “Those whose lives are diminished or weakened deserve special respect” (CCC, 2276). Third, human beings— regardless of their age, ill- ness, social station, or abilities— are never to be con- sidered less than fully human. Speaking to participants in an international congress. Pope John Paul II explained: “Even our brothers and sisters who find themselves in the clinical condition of a Vegetative state’ retain their human dignity in all its fullness. The loving gaze of God the Eather continues to fall upon them, acknowledging them as his sons and daughters, especially in need of help” (John Paul II, Address, March 20, 2004). Finally, the Church does not say that life must be prolonged at all costs. Patients or their rightfully desig- nated authorities may refuse “over-zealous” treatments that are “burdensome, dangerous, extraordinary, or disproportionate to the expected outcome” (CCC, 2278). In short, only “ordinary means” of prolonging life are morally required in the case of illness and imminent death. What does the Church mean by “ordinary means?” “Ordinary means” refer to “the normal care due to the sick person,” including those remedies “that seem necessary or useful” (Congregation for the Doctrine of the Faith, Declaration on Euthanasia, 1980, part IV). The sick are to be kept clean, warm, and protected from infection and pain as far as possible. They are to be given nutrition and hydration, even when these are pro- vided by artificial means (cf. John Paul II, Address, March 20, 2004, no. 4; Pontifical Council for Pastoral Assistance to Health Care Workers, Charter for Health Care Workers, 1995, no. 120). These “ordinary means” should be distinguished from medical treatments that are overly burdensome, risky, or painful when com- pared to the reasonable benefit they might offer. Practically, this means that a procedure that is experi- mental, offers little hope of success, or is too much to bear is not obligatory. For example, a 93-year-old grandmother who is partially paralyzed by a stroke is diagnosed with breast cancer. She may decide that the risks of a mastectomy coupled with chemotherapy are more than she is willing to endure. For her, the treat- ment would constitute “extraordinary means.” On the other hand, for a 33-year-old mother in otherwise good health, such an operation may be merely the “ordinary” means of dealing with her cancer. Why shouldn’t I rely on medical professionals alone to make these decisions? Medicine is an art as much as a science. Medical pro- fessionals can provide their best guesses as to the out- come of an illness, but ultimately God determines the length and span of our days. After gathering all the medical facts, it is helpful to have the advice of a priest or moral counselor to determine not only what may be considered extraordinary treatment in general, but also what may be considered extraordinary treatment in your particular case. Often, people who are gravely ill become either depressed or panicky and may have a hard time making rational decisions. While physicians can > provide options, a priest or moral theologian can help you and your family make the right decisions. Why is euthanasia wrongP Sometimes, in a misguided attempt to alleviate suffering, people believe that euthanasia, the direct ending of life, is an act of mercy. But according to the teachings of the Church, euthana- sia is a “murderous act” and is always forbidden. However, a dis- tinction must be made between euthanasia and permitting natur- al death. Euthanasia is “an action or an omission which of itself or by intention causes death, in order that all suffering in this way may be eliminated” (Declaration on Euthanasia, part II). It is a deliberate action (e.g. an overdose) or an omission that seeks to end the life. Permitting natural death, on the other hand, means that a person’s life is allowed to take its natural course — which, for all of us, ultimately ends in death. Special consideration must be given to painkillers that could hasten death.The Church teaches that the use of painkillers “can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and toler- ated as inevitable. Palliative care is a special form of disinterested charity. As such it should be encouraged” (CCC, 2279). In any event, the nor- mal care owed to a sick person must be contin- ued. Food and fluids nor- mally should be provided. Pope John Paul II says these are “a natural means of preserving life, not a medical act” and their deliberate withdrawal constitutes murder. “Death by star- vation 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” (john Paul ll,Address, March 20, 2004). I have set before you life and death, blessings and curses. Now choose life, so that you and your children may live. Deut. 30:19 The value of suffering In following the example of Our Lord, the Church has always considered care for the sick and dying an essential part of its ministry. As the American Bishops explain in their Ethical and Religious Directives for Catholic Health Care Services, Catholics are “to see Christian love as the animating principle of health care; to see healing and compassion as a continuation of Christ's mission; to see suffering as a participation in the redemptive power of Christ's passion, death, and resurrection; and to see death, transformed by the res- urrection, as an opportunity for a final act of commu- nion with Christ” (General Introduction to Fourth Edition, 2001). Accepting the suffering that comes with illness, old age, and the process of dying can, in the words of the catechism, “make a person more mature, helping him discern in his life what is not essential so that he can turn toward that which is. Very often illness provokes a search for God and a return to him By his passion and death on the cross Ghrist has given a new meaning to suffer- ing: it can henceforth configure us to him and unite us with his redemptive Passion” (CCC, 1501, 1505). What should I do? What should you do so that others will know your wishes if you are incapacitated and dependent upon them to make decisions for you? According to the Patient Self-Determination Act of 1990, all hospitals and medical care facilities must pro- accept or refuse medical treatment vide written information about the and the right to a “Living Will,” and/or how to designate “Durable j a Power of Attorney.” j |r “Durable Power of Attorney” grants authority to a person you designate, who understands your moral considerations and , wishes, to act as a proxy if you are unable to speak for yourself. A “Living Will” is a signed v-fJTj legal document spelling out what medical treatment and procedures you want or do not want to have done if you become incompe- tent. ' ^ You need to be sure before you sign a “Living Will” that it does not contain actions contrary to Catholic teaching, such as allowing euthanasia or physician- assisted suicide. In addition, it should state that you want a priest called to celebrate the Sacrament of Anointing if you are seriously ill. You should keep a copy of your “Living Will” in a safe place and distribute copies to your doctor and family members. Since individual state laws vary, check with your state to see what is legal and necessary. Many dioceses have “Catholic Living Wills” on their websites that you can download and fill out. Without such advance directives, others may make decisions that do not cor- respond either to your wishes or to Church teaching. Caduceus Photo by Comstock / Prescription (Rx) Background Collage by Brand X / All Other Photos by Our Sunday Visitor For More Information May, William H. Catholic Bioethics ami the Gift of Human Life. Our Sunday Visitor, 2000. rhe National Catholic Bioethics Center; www.ncbcenter.org United States Conference of Catholic Bishops, Inc. Ethical and Religious Directives for Catholic Health Care Services (Fourth Edition), 2001; www.Lisccb.org/bishops/directives.shtml John Paul II. Address to the Participants in the International Congress on “Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas.” 2004; www.vatican.va . Letter to the Elderly. 1999; www.vatican.va For additional Catholic resources or to order bulk copies of this pamphlet Contact OurSundayVisitor 200 Noll Plaza • Fiuntington, IN 46750 1-800-348-2440 • Fax: 1-800-498-6709 • www.osv.com Copyright © 2005 by Our Sunday Visitor, Inc. By Woodeene Koenig-Bricker and Robert Fastiggi, Ph.D. Scripture taken from the Holy Bible, New International Version®. Copyright ® 1973, 1978, 1984 by International Bible Society. Used by permission of Zondervan. All rights reserved. Catechism excerpts are from the English translation of the Catechism of the Catholic Church, Second Edition, for use in the United States of America, copy- right © 1994 and 1997, United States Catholic Conference— Libreria Editrice \'aticana. Used by permission. All rights reserved. Inventory No. P227 US $14.95 XSBN "TPS - X - S'=iB'7l=. - - O