The Church offers beautiful teachings to assist us in making difficult medical decisions
By Bishop Richard F. Stika
How precious in the eyes of the Lord is the death of His faithful. –Psalm 116:15
“The person in affliction is sacred.” This ancient proverb speaks to a beautiful truth that the sanctity and dignity of a person is most evident when we are weakest and suffering. Far from stripping us of our dignity, suffering actually reveals our sacredness even more.
Unfortunately, the sacred character of life at its very beginning and at the approach of its earthly end is no longer respected as such. With the growing acceptance and promotion of euthanasia and assisted suicide under the banner of “death with dignity,” it is more important than ever to understand the great beauty and comfort to be found in the Church’s teaching on the mystery of suffering and on medical treatment, particularly at the end of life.
Death is inevitable, and the fear and suffering that accompany its approach is a mystery that can easily overwhelm us. I write as one who has twice stood at death’s door and been exposed to many sufferings and fears related to various medical conditions and hospitalizations.
But during these times I have been uplifted by a truth expressed by the Second Vatican Council: “Through Christ and in Christ, the riddles of sorrow and death grow meaningful. Apart from His Gospel, they overwhelm us.” By suffering His Passion and cross, Christ not only redeemed us from eternal death, but gave divine meaning and purpose to suffering.
Sacrifice is a word that has lost its true meaning in a secular world that ignores the spiritual. But in its Latin meaning, to sacrifice something means to make it sacred. So when we “offer up” our sufferings in union with the redemptive sufferings of Jesus upon the cross, our sacrifice becomes pleasing to the Lord as a sharing in Christ’s work of salvation for the good of souls.
In other words, our sufferings become redemptive, and with Christ we are helping to save souls! As Christ united the poor offering of the Good Thief to His offertory upon Calvary, so Christ unites our poor offering to His in every Mass.
But we live in a society that is spiritually sick and blind, where the culture of death has even succeeded in having abortion, euthanasia, and assisted suicide accepted as “health care.” How, then, are we to approach the difficult medical decisions we can be faced with, particularly at the end of life?
Fortunately, the Church has never ceased to reflect upon this question and to minister to the seriously ill and dying who need the special help of God’s grace in their time of great need.
To assist the U.S. bishops in our continuing reflection upon the dignity of the human person in health care and the life sciences, the National Catholic Bioethics Center (NCBC) was established in 1972. Staffed with leading experts on bioethics, they provide a wealth of information and resources on key bioethics topics. I encourage clergy and laity alike to familiarize yourselves with their website at https://www.ncbc.org and to avail yourselves of the information they offer.
One four-page document the NCBC offers that I highly recommend is “A Catholic Guide to End-of-Life Decisions.” It also includes an “Advance Care Plan” (Catholic Living Will) and “Appointment of Healthcare Agent” (someone who makes medical decisions for you when you are consciously not able to). These two documents are essential and satisfy the requirements of hospitals for such and I highly recommend their use in place of living wills that often contain options that are contrary to the Church’s moral teaching.
Another very short document that can be easily googled and read online is the U.S. Conference of Catholic Bishops document, “Ethical and Religious Directives for Catholic Health Care Services, Sixth Edition” (ERD).
I encourage everyone to read its preamble and introduction (about three pages in length), along with part five, “Issues in Care for the Seriously Ill and Dying” (also three pages in length). For within these few pages you will find the guiding principles needed to help you when faced with difficult treatment options. Part five contains a short introduction and 12 directives, each of only one to four sentences in length. Six of these short directives (ERD Nos. 56 – 61) are of particular importance in helping us in our difficult medical decisions.
Treatment options can be categorized between those we should accept as “ordinary/proportionate” and those that are optional or “extraordinary/disproportionate.” These are explained in ERD nos. 56 and 57.
Unfortunately, there is no black and white list of what treatments are obligatory or optional. Sometimes we can be faced with a very large gray area of questions and only a fringe of what is clear regarding treatment choices. Treatments that we should accept or that might be considered optional can be different based upon a person’s age or the changing circumstances of one’s condition during the course of treatment. In Catholic teaching, there is no obligation to continue a treatment if the benefits erode or the burdens prove too great.
Some treatments are obligatory and considered “ordinary” due to the benefit that can be reasonably expected. To help us further clarify what treatments are considered “ordinary,” another word is associated with it — “proportionate” — meaning the benefits of the treatment are proportionate or greater than the burdens that can be expected. Conversely, some medical treatments are not obligatory and can be considered “extraordinary” and therefore optional. Treatments that are optional can be considered such when the benefits hoped for would be “disproportionate” to the burdens.
By “burden” we mean those primarily to the patient that involve great effort (some means of treatment entail great difficulty), severe pain (that which exceeds what a person can bear), repugnance (psychological factors and dread of certain treatments), or even those that would involve great expense to the patient and family.
But as stated by the NCBC, “One must not overstate the burdens of treatment, just as one must avoid an irrational belief in the benefit of a medical intervention.” As with all our moral decisions, the weighing of benefits and burdens requires honest and prayerful discernment and we should invoke the Holy Spirit “who helps us in our weakness.”
Regarding food and water (nutrition and hydration), it must be stated that the Gospel mandate to give food to the hungry and drink to the thirsty exists even in health care. Food and water, even when administered artificially through a tube, are not medical treatments but are to be considered a part of the ordinary care that a person should be given, along with being kept clean and comfortable. ERD No. 58 expresses this principle of basic care, which we should always presume in favor of.
While there may be exceptions when nutrition and hydration are optional — such as when it is “excessively burdensome for the patient or [would] cause significant discomfort,” as when someone is in the imminent stages of dying, we should never withdraw it (as is often done accompanied with terminal sedation). Removal of food and water should never be done to purposely advance or cause one’s death. Please take the time to read this most important ERD.
The question of whether some treatments should be continued or withdrawn can be an agonizing decision. When it becomes clear that life support would not or will not provide any benefit or that the burdens will exceed the few benefits that can be expected, the decision can be made to withhold the treatment or to withdraw it.
The Church affirms that “when death is imminent, in spite of the means used, it is permitted in conscience to make the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care [such as nutrition and hydration] is not interrupted.” ERD No. 59 speaks to this difficult decision.
Unfortunately, fear — of aging, of feeling useless, of suffering, and death — frequently assails us along our earthly journey. Today’s “efficiency culture” contributes much to these fears and to the marginalization of those deemed to be a burden upon society. But we are stewards of God’s gift of life, not its master, and “the task of medicine is to care even when it cannot cure.” ERD No. 60 speaks to this and to the compassion and love that patients need in this most fragile stage of life.
Suffering, especially during the last moments of life, has a special place in God’s saving plan as a sharing in Christ’s redemptive suffering. But this does not mean we must forego pain treatments. The Church in fact teaches that patients should be kept free of pain as possible so as to die comfortably and with dignity.
That said, when at all possible, patients should not be deprived of consciousness without a compelling reason. In some cases, however, one’s pain may be such that to adequately alleviate or suppress it may indirectly shorten the person’s life. Here, the intention is not to hasten one’s death, but to treat the pain. This is explained in ERD No. 61.
Because every illness brings its own particular glimpse of death, we should always seek the sacramental anointing of the sick. For as Scripture reminds us, “Is anyone among you sick? He should summon the presbyters of the church, and they should pray over him and anoint (him) with oil in the name of the Lord, and the prayer of faith will save the sick person, and the Lord will raise him up. If he has committed any sins, he will be forgiven.” (James 5:14-15).
In the darkness of approaching death in the garden of Gethsemane, Peter, who had earlier professed his willingness to die at the side of Christ (cf. Luke 22:33), drew his sword out of fear. Jesus ordered it sheathed, for the sword can never be drawn if death is to be evangelized and the Gospel proclaimed to the dying person.
Every phase of our life, then, should be a meaningful preparation for our death, such that we can say with St. Thérèse of Lisieux, “It is not Death that will come to fetch me, it is the good God.”