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What the Catholic Church teaches about death with dignity

“Death with dignity” laws are both sensible and compassionate; religious prohibitions of suicide are both emotional and cruel.     

Too often, that’s how the narrative goes when we discuss end-of-life issues and the laws surrounding them. Secular folks claim that, when people of faith protest against legalized suicide and euthanasia, our arguments are based in emotion, passion, or even a sadistic appetite for pain and suffering.

On the contrary, the Catholic Church’s teachings are both consistent and compassionate.

In light of recent discussions of Supreme Court nominee Neil Gorsuch and his views on assisted suicide and euthanasia, and in light of the story of a Dutch doctor who directed family members to hold down a struggling old woman so he could carry out her “assisted suicide,” I’m sharing again this article from 2013. The research I did for it corrected many of my own misconceptions about what it means to be pro-life at the end of life.

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“Technology runs amok without ethics,” says Tammy Ruiz, a Catholic nurse who provides end-of-life care for newborns. “Making sure ethics keeps up with technology is one of the major focuses of my world.”

How do Catholics like Ruiz honor the life and dignity of patients, without playing God—either by giving too much care, or not enough?

Cathy Adamkiewicz had to find that balance when she signed the papers to remove her four-month-old daughter from life support. The child’s bodily systems were failing, and she would not have survived the heart transplant she needed. She had been sedated and on a respirator for most of her life. Off the machines, Adamkiewicz says, “She died peacefully in my husband’s arms. It was a joyful day.”

“To be pro-life,” Adamkiewicz explains, “does not mean you have to extend life forever, push it, or give every type of treatment.”

Many believe that the Church teaches we must prolong human life by any means available, but this is not so. According to the Catechism of the Catholic ChurchDiscontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of “over-zealous” treatment” (CCC, 2278).

Does this mean that the Church accepts euthanasia or physician-assisted suicide—that we may end a life to relieve suffering or because we think someone’s “quality of life” is too poor? No. The Catechism continues: “One does not will to cause death; one’s inability to impede it is merely accepted” (CCC, 2278).

Richard Doerflinger, associate director of Pro-Life Activities at the USCCB, explains that caregivers must ask, “What good can this treatment do for this person I love? What harm can it do to him or her? This is what Catholic theology calls ‘weighing the benefits and burdens of a treatment.’ If the benefit outweighs the burden, in your judgment, you should request the treatment; otherwise, it would be seen as morally optional.”

Palliative care is also legitimate, even if it may hasten death—as long as the goal is to alleviate suffering.

But how are we to judge when the burdens outweigh the benefits?

Some decisions are black and white: We must not do anything, or fail to do anything, with the goal of bringing about or hastening death. “An act or omission which, of itself or by intention, causes death in order to eliminate suffering 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).

The dehydration death of Terry Schiavo in 2005 was murder, because Schiavo was not dying. Withdrawing food and water had the direct goal of killing her.

But if a man is dying of inoperable cancer and no longer wishes to eat or drink, or his body can no longer process nutrition, withdrawing food and water from him might be ethical and merciful. He is already moving toward death, and there is no reason to prolong his suffering.

Moral Obligations

Our moral obligations are not always obvious. Laura Malnight struggled with doubt and fear as she contemplated the future of her tiny newborn quadruplets. Two of them had pneumonia.

“It was horrible to watch them go through what they had to go through to live, being resuscitated over and over again,” Malnight says.

One baby was especially sick and had suffered brain damage. The doctors who had pushed her to do “selective reduction” while she was pregnant now urged her to stop trying to keep her son alive. “They said we were making a horrible mistake, and they painted a terrible picture of what his life would be like in an institution,” Malnight says.

Exhausted and overwhelmed, Malnight was not able to get a clear answer about the most ethical choice for her children.

Everyone told her, “The baby will declare himself,” signaling whether he’s meant to live or die. “But,” says Malnight, “my only experience with motherhood was with these babies, in their isolettes. The thing was, we would put our hands over our son and he would open his eyes, his breathing would calm.”

“We just kind of muddled through,” she says. Her quadruplets are now 13 years old, and her son, while blind and brain-damaged, is a delightful and irreplaceable child.

Doerflinger acknowledges Malnight’s struggle: “Often there is no one right or wrong answer, but just an answer you think is best for your loved one in this particular situation, taking into account that patient’s own perspective and his or her ability to tolerate the burdens of treatment.”

The key, says Cathy Adamkiewicz, is “not to put our human parameters on the purpose of a human life.”

When she got her infant daughter’s prognosis from the neurologist, she told him, “You look at her as a dying system. I see a human being. Her life has value, not because of how much she can offer, but there is value in her life.”

“Our value,” Cathy says, “is not in our doing, but in our being. Doerflinger agrees, and emphasizes that “every life is a gift. Particular treatments may be a burden; no one’s life should be dismissed as a burden.”

He says that human life is “a great good, worthy of respect. At the same time, it is not our ultimate good, which lies in our union with God and each other in eternity. We owe to all our loved ones the kind of care that fully respects their dignity as persons, without insisting on every possible means for prolonging life even if it may impose serious risks and burdens on a dying patient. Within these basic guidelines, there is a great deal of room for making personal decisions we think are best for those we love.”

Because of this latitude, a living will is not recommended for Catholics. Legal documents of this kind cannot take into account specific, unpredictable circumstances that may occur. Instead, Catholic ethicists recommend drawing up an advance directive with a durable power of attorney or healthcare proxy. A trusted spokesman is appointed to make medical decisions that adhere to Church teaching.

Caregivers should do their best to get as much information as possible from doctors and consult any priests, ethicists, or theologians available—and then to give over care to the doctors, praying that God will guide their hearts and hands.

Terri Duhon found relief in submitting to the guidance of the Church when a sudden stroke caused her mother to choke. Several delays left her on a ventilator, with no brain activity. My husband and I couldn’t stand the thought of taking her off those machines. We wanted there to be a chance,” she says. But as the night wore on, she says, “We reached a point where it was an affront to her dignity to keep her on the machines.”

Duhon’s words can resonate with caregivers who make the choice either to extend life or to allow it to go: “I felt thankful that even though all of my emotion was against it, I had solid footing from the Church’s moral teaching. At least I wasn’t making the decision on my own.”

Adamkiewicz agrees. “It’s so terrifying and frustrating in a hospital,” she remembers. “I can’t imagine going through it without having our faith as our touchstone during those moments of fear.”

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End of life resources

Ethical and Religious Directives for Catholic Healthcare Services (from the USCCB)

Evangelium Vitae

Pope John Paul II, To the Congress on Life-Sustaining Treatments and Vegetative State, 20 March 2004 

NCBCenter.org provides samples of an advance directive with durable power of attorney or healthcare proxy.

This article was originally published in Catholic Digest in 2013.

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7 thoughts on “What the Catholic Church teaches about death with dignity

  1. Doerflinger has been retired from the USCCB since last year. This article makes it sound like his is still there and those quotes are current from him in support of the USCCB. Where did you get these quotes from? Did you actually speak with Doerflinger?

    Doerflinger is now affiliated with the Notre Dame Center for Ethics and Culture.
    http://ethicscenter.nd.edu/public-policy/richard-doerflinger/

    It looks to me like you simply had to find a topi for the article, found some old quotes to fill out the positioning on it.

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    1. Did you read the opening of this post that includes, “I’m sharing again this article from 2013. The research I did for it corrected many of my own misconceptions about what it means to be pro-life at the end of life.”

      Yes, it is a repost of a 2013 article, as the author states right at the start.

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      1. I’m glad you’ve reposted this, its an important topic and used to put me into a real quandary.

        But In Europe we have recently seen the type of involuntary euthanasia that we were told would NEVER happen. Healthy elderly Lady with mild dementia being sedated by stealth and then held down for the needle as She screamed for mercy.

        Although there will always be exceptions I know my own default position must be to preserve life, not just because the Church says so but because its right.

        Its almost evening here in England and I’m sat with my twelve year old Daughter trying to pick a musical to watch. She is severely autistic and will never talk but she is the happiest person I know. I’m a survivor of major heart problems and some very nasty side effects. If doctors had known our Daughters condition they would have tried to get us to abort her, two years ago they tried to get my wife to “turn me off” as I would never recover from my coma.

        I like to think of us as a perfect pair of arguments for the continuation of life if at all possible.

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  2. Last night my husband and I were reflecting on this topic because of what happened to that poor grandmother in Denmark

    My father was receiving hospice care at home, In his final weeks of cancer. The nurses were giving him a morphine patch to ease his pain, but he didn’t like it because it made him feel too drugged. My mother, being practical, made an error by cutting the patch in half– which had the opposite effect. It nearly killed him because it increased the rate of absorption. Even though he only lived another week or so, he knew it wasn’t his time to go. He fought death, and I saw that the effects of the overdose frightened him. This made such a huge impression on me, because you would think that the extra 10 or so days were just useless suffering. But there was something happening there that we couldn’t see. It reminded me of birth, which is such a distinct process. The last three days of his life were difficult to watch, but he was calm and working towards something. It was like he was on a journey, and if you spoke to him, it almost startled him, but he always made the effort to “come back” to answer. He died peacefully in the earliest hours of the morning. His last words were a sweet and calm, “I love you too.”

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  3. Ms. Fisher:
    Thank you for your post, “What the Catholic Church teaches about death with dignity.”
    When talking about these issues, we need to understand there’s medical treatment – which in certain cases we may refuse – and then there’s minimal, ordinary care, namely food and water – including when provided through a tube – which we may not refuse others or ourselves.
    As Saint Pope John Paul II said, “I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means (italics) of preserving life, not a medical act (italics). Its use, furthermore, should be considered, in principle, ordinary (italics) and proportionate (italics), and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.” (his emphasis)
    Yes, according to the Church, there can be situations in which food and fluids are withheld from a person who is imminently dying – not just “moving toward death” – and whose body cannot process the food.
    But in this age of ageism, function-ism, and Medicare bottom-lines, there are lots of people – like persons who’ve had a stroke or who’ve been battling Alzheimer’s – who are labeled in “the dying process.” How many people know of someone who was deemed dying who didn’t straight-away? Dying can take weeks, months, years. No doctor has a crystal ball.
    One thing’s for sure, being refused food and water will kill the stroke victim or Alzheimer’s patient quick. Well, death by dehydration takes an agonizing week or two.
    One should die of the disease not of starvation and thirst, as Father Tad Pacholczyk of the National Catholic Bioethics Center has explained.
    To date, Alzheimer’s is fatal. Food and water won’t change that. That so many sick people are refused food and water – consumable by spoon or straw or tube – makes one wonder what’s the rush.
    Thank you for encouraging readers not to sign a so-called “Living Will” but have a health care proxy instead. As you said, so-called “Living Wills” “cannot take into account all the future, “specific, unpredictable circumstances that may occur.” But they are dangerous for several other reasons, particularly because they assume the refusal of basic, assisted food and water.
    As National Right to Life Committee explains: “the laws of most states define the medical treatment that is refused by their living wills to include food and water. While a few states at least have a “check-off” so you can choose whether or not to be starved, in the majority you have no indication in the living will you sign that you are agreeing to starvation.” (http://www.nrlc.org/medethics/willtolive/whynotwtl/)
    A health care proxy is empowered to make health care decisions for a person in the event he or she is unable to express them. It needs to be someone – and it doesn’t have to be a family member – who is faithful to Church teaching, including the teaching that food and water – including when delivered by a feeding tube – is a basic human right.
    Patricia Coll Freeman
    Anchorage, Alaska

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  4. I think a lot about this issue around this time of year, because it’s been two years since my mother died. She had Stage IV lung cancer, and refused to be put on a ventilator (she hated it), so she hastened her own death with her choice. But we let her make it. (I say “we,” but I mean my dad — I didn’t get to her side in time.)
    We also essentially Schiavo’d one of my grandmothers who had Alzheimers — she was 90, unable to swallow, and would have lived indefinitely with a feeding tube, but the family & hospice workers decided it was her time.

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