|
Letter “Samaritanus bonus” of the Congregation
for the Doctrine of the Faith on the care of
persons in the critical and terminal phases of
life, 22.09.2020
Congregation for the Doctrine of the Faith
Letter
Samaritanus bonus
on the care of persons in the critical and
terminal phases of life
Introduction
The Good Samaritan who goes out of his way to
aid an injured man (cf. Lk 10:30-37)
signifies Jesus Christ who encounters man in
need of salvation and cares for his wounds and
suffering with “the oil of consolation and the
wine of hope”.[1] He
is the physician of souls and bodies, “the
faithful witness” (Rev 3:14) of the
divine salvific presence in the world. How to
make this message concrete today? How to
translate it into a readiness to accompany a
suffering person in the terminal stages of life
in this world, and to offer this assistance in a
way that respects and promotes the intrinsic
human dignity of persons who are ill, their
vocation to holiness, and thus the highest worth
of their existence?
The remarkable progressive development of
biomedical technologies has exponentially
enlarged the clinical proficiency of diagnostic
medicine in patient care and treatment. The
Church regards scientific research and
technology with hope, seeing in them promising
opportunities to serve the integral good of life
and the dignity of every human being.[2] Nonetheless,
advances in medical technology, though precious,
cannot in themselves define the proper meaning
and value of human life. In fact, every
technical advance in healthcare calls for growth
in moral discernment[3] to
avoid an unbalanced and dehumanizing use of the
technologies especially in the critical or
terminal stages of human life.
Moreover, the organizational management and
sophistication, as well as the complexity of
contemporary healthcare delivery, can reduce to
a purely technical and impersonal relationship
the bond of trust between physician and patient.
This danger arises particularly where
governments have enacted legislation to legalize
forms of assisted suicide and voluntary
euthanasia among the most vulnerable of the sick
and infirm. The ethical and legal boundaries
that protect the self-determination of the sick
person are transgressed by such legislation,
and, to a worrying degree, the value of human
life during times of illness, the meaning of
suffering, and the significance of the interval
preceding death are eclipsed. Pain and death do
not constitute the ultimate measures of the
human dignity that is proper to every person by
the very fact that they are “human beings”.
In the face of challenges that affect the very
way we think about medicine, the significance of
the care of the sick, and our social
responsibility toward the most vulnerable, the
present letter seeks to enlighten pastors and
the faithful regarding their questions and
uncertainties about medical care, and their
spiritual and pastoral obligations to the sick
in the critical and terminal stages of life. All
are called to give witness at the side of the
sick person and to become a “healing community”
in order to actualize concretely the desire of
Jesus that, beginning with the most weak and
vulnerable, all may be one flesh.[4] It
is widely recognized that a moral and practical
clarification regarding care of these persons is
needed. In this sensitive area comprising the
most delicate and decisive stages of a person’s
life, a “unity of teaching and practice is
certainly necessary.”[5]
Various Episcopal Conferences around the world
have published pastoral letters and statements
to address the challenges posed to healthcare
professionals and patients especially in
Catholic institutions by the legalization of
assisted suicide and voluntary euthanasia in
some countries. Regarding the celebration of the
Sacraments for those who intend to bring an end
to their own life, the provision of spiritual
assistance in particular situations raises
questions that today require a more clear and
precise intervention on the part of the Church
in order to:
‒ reaffirm the message of the Gospel and its
expression in the basic doctrinal statements of
the Magisterium, and thus to recall the mission
of all who come into contact with the sick at
critical and terminal stages (relatives or legal
guardians, hospital chaplains, extraordinary
ministers of the Eucharist and pastoral workers,
hospital volunteers and healthcare personnel),
as well as the sick themselves; and,
‒ provide precise and concrete pastoral
guidelines to deal with these complex situations
at the local level and to handle them in a way
that fosters the patient’s personal encounter
with the merciful love of God.
I. Care For One’s Neighbor
Despite our best efforts, it is hard to
recognize the profound value of human life when
we see it in its weakness and fragility. Far
from being outside the existential horizon of
the person, suffering always raises limitless
questions about the meaning of life.[6] These
pressing questions cannot be answered solely by
human reflection, because in suffering there is
concealed the immensity of a specific
mystery that can only be disclosed by the
Revelation of God.[7] In
particular, the mission of faithful care of
human life until its natural conclusion[8] is
entrusted to every healthcare worker and is
realized through programs of care that can
restore, even in illness and suffering, a deep
awareness of their existence to every patient.
For this reason we begin with a careful
consideration of the significance of the
specific mission entrusted by God to every
person, healthcare professional and pastoral
worker, as well as to patients and their
families.
The need for medical care is born in the
vulnerability of the human condition in its
finitude and limitations. Each person's
vulnerability is encoded in our nature as a
unity of body and soul: we are materially and
temporally finite, and yet we have a longing for
the infinite and a destiny that is eternal. As
creatures who are by nature finite, yet
nonetheless destined for eternity, we depend on
material goods and on the mutual support of
other persons, and also on our original, deep
connection with God. Our vulnerability forms the
basis for an ethics of care, especially
in the medical field, which is expressed in
concern, dedication, shared participation and
responsibility towards the women and men
entrusted to us for material and spiritual
assistance in their hour of need .
The relationship of care discloses the twofold
dimension of the principle of justice to promote
human life (suum cuique tribuere) and to
avoid harming another (alterum non laedere).
Jesus transformed this principle into the golden
rule “Do unto others whatever you would have
them do to you” (Mt 7:12). This rule is
echoed in the maxim primum non nocere of
traditional medical ethics.
Care for life is therefore the first
responsibility that guides the physician in the
encounter with the sick. Since its
anthropological and moral horizon is broader,
this responsibility exists not only when the
restoration to health is a realistic outcome,
but even when a cure is unlikely or impossible.
Medical and nursing care necessarily attends to
the body’s physiological functions, as well as
to the psychological and spiritual well-being of
the patient who should never be forsaken. Along
with the many sciences upon which it draws,
medicine also possesses the key dimension of a
“therapeutic art,” entailing robust
relationships with the patient, with healthcare
workers, with relatives, and with members of
communities to which the patient is linked. Therapeutic
art, clinical procedures and ongoing
care are inseparably interwoven in the
practice of medicine, especially at the critical
and terminal stages of life.
The Good Samaritan, in fact, “not only draws
nearer to the man he finds half dead; he takes
responsibility for him”.[9] He
invests in him, not only with the funds he has
on hand but also with funds he does not have and
hopes to earn in Jericho: he promises to pay any
additional costs upon his return. Likewise
Christ invites us to trust in his invisible
grace that prompts us to the generosity of
supernatural charity, as we identify with
everyone who is ill: “Amen, I say to you,
whatever you did for one of these least brothers
of mine, you did for me” (Mt 25:40). This
affirmation expresses a moral truth of universal
scope: “we need then to ‘show care’ for
all life and for the life of everyone”[10] and
thus to reveal the original and unconditional
love of God, the source of the meaning of all
life.
To that end, especially in hospitals and clinics
committed to Christian values, it is vital to
create space for relationships built on the
recognition of the fragility and vulnerability of
the sick person. Weakness makes us conscious of
our dependence on God and invites us to respond
with the respect due to our neighbor. Every
individual who cares for the sick (physician,
nurse, relative, volunteer, pastor) has the
moral responsibility to apprehend the
fundamental and inalienable good that is the
human person. They should adhere to the highest
standards of self-respect and respect for others
by embracing, safeguarding and promoting human
life until natural death. At work here is a contemplative
gaze[11] that
beholds in one’s own existence and that of
others a unique and unrepeatable wonder,
received and welcomed as a gift. This is the
gaze of the one who does not pretend to take
possession of the reality of life but welcomes
it as it is, with its difficulties and
sufferings, and, guided by faith, finds in
illness the readiness to abandon oneself to the
Lord of life who is manifest therein.
To be sure, medicine must accept the limit of
death as part of the human condition. The time
comes when it is clear that specific medical
interventions cannot alter the course of an
illness that is recognized to be terminal. It is
a dramatic reality, that must be communicated to
the sick person both with great humanity and
with openness in faith to a supernatural
horizon, aware of the anguish that death
involves especially in a culture that tries to
conceal it. One cannot think of physical life as
something to preserve at all costs –which is
impossible – but as something to live in the
free acceptance of the meaning of bodily
existence: “only in reference to the human
person in his ‘unified totality’, that is as ‘a
soul which expresses itself in a body and a body
informed by an immortal spirit’, can the
specifically human meaning of the body be
grasped”.[12]
The impossibility of a cure where death is
imminent does not entail the cessation of
medical and nursing activity. Responsible
communication with the terminally ill person
should make it clear that care will be provided
until the very end: “to cure if possible,
always to care”.[13] The
obligation always to take care of the sick
provides criteria to assess the actions to be
undertaken in an “incurable” illness: the
judgement that an illness is incurable cannot
mean that care has come at an end. The
contemplative gaze calls for a wider notion of
care. The objective of assistance must take
account of the integrity of the person, and thus
deploy adequate measures to provide the
necessary physical, psychological, social,
familial and religious support to the sick. The
living faith of the persons involved in care
contributes to the authentic theologal life of
the sick person, even if this is not immediately
evident. The pastoral care of all - family,
doctors, nurses, and chaplains - can help the
patient to persevere in sanctifying grace and to
die in charity and the Love of God. Where faith
is absent in the face of the inevitability of
illness, especially when chronic or
degenerative, fear of suffering, death, and the
discomfort they entail is the main factor
driving the attempt to control and manage the
moment of death, and indeed to hasten it through
euthanasia or assisted suicide.
II. The Living Experience of the Suffering
Christ
and the Proclamation of Hope
If the figure of the Good Samaritan throws new
light on the provision of healthcare, the
nearness of the God made man is manifest in the
living experience of Christ’s suffering, of his
agony on the Cross and his Resurrection: his
experience of multiple forms of pain and anguish
resonates with the sick and their families
during the long days of infirmity that precede
the end of life.
Not only do the words of the prophet Isaiah
proclaim Christ as one familiar with suffering
and pain (cf. Is 53), but, as we re-read
the pages about his suffering, we also recognize
the experience of incredulity and scorn,
abandonment, and physical pain and anguish.
Christ’s experience resonates with the sick who
are often seen as a burden to society; their
questions are not understood; they often undergo
forms of affective desertion and the loss of
connection with others.
Every sick person has the need not only to be
heard, but to understand that their interlocutor
“knows” what it means to feel alone, neglected,
and tormented by the prospect of physical pain.
Added to this is the suffering caused when
society equates their value as persons to their
quality of life and makes them feel like a
burden to others. In this situation, to turn
one’s gaze to Christ is to turn to him who
experienced in his flesh the pain of the lashes
and nails, the derision of those who scourged
him, and the abandonment and the betrayal of
those closest to him.
In the face of the challenge of illness and the
emotional and spiritual difficulties associated
with pain, one must necessarily know how to
speak a word of comfort drawn from the
compassion of Jesus on the Cross. It is full of
hope - a sincere hope, like Christ’s on the
Cross, capable of facing the moment of trial and
the challenge of death. Ave crux, spes unica,
we sing in the Good Friday liturgy. In the Cross
of Christ are concentrated and recapitulated all
the sickness and suffering of the world: all
the physical suffering, of which the
Cross, that instrument of an infamous and
shameful death, is the symbol; all the psychological
suffering, expressed in the death of Jesus
in the darkest of solitude, abandonment and
betrayal; all the moral suffering,
manifested in the condemnation to death of one
who is innocent; all the spiritual suffering,
displayed in a desolation that seems like the
very silence of God.
Christ is aware of the painful shock of his
Mother and his disciples who “remain” under the
Cross and who, though “remaining”, appear
impotent and resigned, and yet provide the
affective intimacy that allows the God made man
to live through hours that seem meaningless.
Then there is the Cross: an instrument of
torture and execution reserved only for the
lowest, that symbolically looks just like those
afflictions that nail us to a bed, that portend
only death, and that render meaningless time and
its flow. Still, those who “remain” near the
sick not only betoken but also embody
affections, connections, along with a profound
readiness to love. In all this, the suffering
person can discern the human gaze that lends
meaning to the time of illness. For, in the
experience of being loved, all of life finds its
justification. During his passion Christ was
always sustained by his confident trust in the
Father’s love, so evident in the hours of the
Cross, and also in his Mother’s love. The Love
of God always makes itself known in the history
of men and women, thanks to the love of the one
who never deserts us, who “remains,” despite
everything, at our side.
At the end of life, people often harbor worries
about those they leave behind: about their
children, spouses, parents, and friends. This
human element can never be neglected and
requires a sympathetic response.
With the same concern, Christ before his death
thinks of his Mother who will remain alone
within a sorrow that she will have to bear from
now on. In the spare account of the Gospel of
John, Christ turns to his Mother to reassure her
and to entrust her to the care of the beloved
disciple: “Woman, behold your son” (cf. Jn 19:
26-27). The end of life is a time of
relationships, a time when loneliness and
abandonment must be defeated (cf. Mt 27:46
and Mk 15:34) in the confident offering
of one’s life to God (cf. Lk 23:46).
In this perspective, to gaze at the crucifix is
to behold a choral scene, where Christ is at the
center because he recapitulates in his own flesh
and truly transfigures the darkest hours of the
human experience, those in which he silently
faces the possibility of despair. The light of
faith enables us to discern the trinitarian
presence in the brief, supple description
provided by the Gospels, because Christ trusts
in the Father thanks to the Holy Spirit who
sustains his Mother and his disciples. In this
way “they remain” and in their “remaining” at
the foot of the Cross, they participate, with
their human dedication to the Suffering One, in
the mystery of Redemption.
In this manner, although marked by a painful
passing, death can become the occasion of a
greater hope that, thanks to faith, makes us
participants in the redeeming work of Christ.
Pain is existentially bearable only where there
is hope. The hope that Christ communicates to
the sick and the suffering is that of his
presence, of his true nearness. Hope is not only
the expectation of a greater good, but is a gaze
on the present full of significance. In the
Christian faith, the event of the Resurrection
not only reveals eternal life, but it makes
manifest that in history the last word
never belongs to death, pain, betrayal, and
suffering. Christ rises in history, and
in the mystery of the Resurrection the abiding
love of the Father is confirmed.
To contemplate the living experience of Christ’s
suffering is to proclaim to men and women of
today a hope that imparts meaning to the time of
sickness and death. From this hope springs the
love that overcomes the temptation to despair.
While essential and invaluable, palliative care
in itself is not enough unless there is someone
who “remains” at the bedside of the sick to bear
witness to their unique and unrepeatable value.
For the believer, to look upon the Crucified
means to trust in the compassionate love of God.
In a time when autonomy and individualism are
acclaimed, it must be remembered that, while it
is true that everyone lives their own suffering,
their own pain and their own death, these
experiences always transpire in the presence of
others and under their gaze. Nearby the Cross
there are also the functionaries of the Roman
state, there are the curious, there are the
distracted, there are the indifferent and the
resentful: they are at the Cross, but they do
not “remain” with the Crucified.
In intensive care units or centers for chronic
illness care, one can be present merely as a
functionary, or as someone who “remains” with
the sick.
The experience of the Cross enables us to be
present to the suffering person as a genuine
interlocutor with whom to speak a word or
express a thought, or entrust the anguish and
fear one feels. To those who care for the sick,
the scene of the Cross provides a way of
understanding that even when it seems that there
is nothing more to do there remains much to do,
because “remaining” by the side of the sick is a
sign of love and of the hope that it contains.
The proclamation of life after death is not an
illusion nor merely a consolation, but a
certainty lodged at the center of love that
death cannot devour.
III. The Samaritan’s “heart that sees”:
human life is a sacred and inviolable gift
Whatever their physical or psychological
condition, human persons always retain their
original dignity as created in the image of God.
They can live and grow in the divine splendor
because they are called to exist in “the image
and glory of God” (1 Cor11:7; 2 Cor 3:18).
Their dignity lies in this vocation. God became
man to save us, and he promises us salvation and
calls us to communion with Him: here lies the
ultimate foundation of human dignity.[14]
It is proper for the Church to accompany with
mercy the weakest in their journey of suffering,
to preserve them the theologal life, and to
guide them to salvation.[15] The
Church of the Good Samaritan[16] regards
“the service to the sick as an integral part of
its mission”.[17] When
understood in the perspective of communion and
solidarity among human persons, the Church’s
salvific mediation helps to surmount
reductionist and individualistic tendencies.[18]
“A heart that sees” is central to the program of
the Good Samaritan. He “teaches that it is
necessary to convert the gaze of the heart,
because many times the beholder does not see.
Why? Because compassion is lacking […] Without
compassion, people who look do not get involved
with what they observe, and they keep going;
instead people who have a compassionate heart
are touched and engaged, they stop and show
care”.[19] This
heart sees where love is needed and acts
accordingly.[20]These
eyes identify in weakness God’s call to
appreciate that human life is the primary common
good of society.[21] Human
life is a highest good, and society is called to
acknowledge this. Life is a sacred and
inviolable gift[22] and
every human person, created by God, has a
transcendent vocation to a unique relationship
with the One who gives life. “The invisible God
out of the abundance of his love”[23] offers
to each and every human person a plan of
salvation that allows the affirmation that:
“Life is always a good. This is an instinctive
perception and a fact of experience, and man is
called to grasp the profound reason why this is
so”.[24] For
this reason, the Church is always happy to
collaborate with all people of good will, with
believers of other confessions or religions as
well as non-believers, who respect the dignity
of human life, even in the last stages of
suffering and death, and reject any action
contrary to human life.[25] God
the Creator offers life and its dignity to man
as a precious gift to safeguard and nurture, and
ultimately to be accountable to Him.
The Church affirms that the positive meaning of
human life is something already knowable by
right reason, and in the light of faith is
confirmed and understood in its inalienable
dignity.[26] This
criterion is neither subjective nor arbitrary
but is founded on a natural inviolable dignity.
Life is the first good because it is the basis
for the enjoyment of every other good including
the transcendent vocation to share the
trinitarian love of the living God to which
every human being is called:[27] “The
special love of the Creator for each human being
‘confers upon him or her an infinite dignity’.[28] The
uninfringeable value of life is a fundamental
principle of the natural moral law and an
essential foundation of the legal order. Just as
we cannot make another person our slave, even if
they ask to be, so we cannot directly choose to
take the life of another, even if they request
it. Therefore, to end the life of a sick person
who requests euthanasia is by no means to
acknowledge and respect their autonomy, but on
the contrary to disavow the value of both their
freedom, now under the sway of suffering and
illness, andof their life by excluding
any further possibility of human relationship,
of sensing the meaning of their existence, or of
growth in the theologal life. Moreover, it is to
take the place of God in deciding the moment of
death. For this reason, “abortion, euthanasia
and wilful self-destruction (…) poison human
society, but they do more harm to those who
practice them than those who suffer from the
injury. Moreover, they are a supreme dishonor to
the Creator”.[29]
IV. The Cultural Obstacles
that Obscure the Sacred Value of Every Human
Life
Among the obstacles that diminish our sense of
the profound intrinsic value of every human
life, the first lies in the notion of “dignified
death” as measured by the standard of the
“quality of life,” which a utilitarian
anthropological perspective sees in terms
“primarily related to economic means, to
‘well-being,’ to the beauty and enjoyment of
physical life, forgetting the other, more
profound, interpersonal, spiritual and religious
dimensions of existence”.[30] In
this perspective, life is viewed as worthwhile
only if it has, in the judgment of the
individual or of third parties, an acceptable
degree of quality as measured by the possession
or lack of particular psychological or physical
functions, or sometimes simply by the presence
of psychological discomfort. According to this
view, a life whose quality seems poor does not
deserve to continue. Human life is thus no
longer recognized as a value in itself.
A second obstacle that obscures our recognition
of the sacredness of human life is a false
understanding of “compassion”[31].
In the face of seemingly “unbearable” suffering,
the termination of a patient’s life is justified
in the name of “compassion”. This so-called
“compassionate” euthanasia holds that it is
better to die than to suffer, and that it would
be compassionate to help a patient to die by
means of euthanasia or assisted suicide. In
reality, human compassion consists not in
causing death, but in embracing the sick, in
supporting them in their difficulties, in
offering them affection, attention, and the
means to alleviate the suffering.
A third factor that hinders the recognition of
the value of one’s own life and the lives of
others is a growing individualism within
interpersonal relationships, where the other is
viewed as a limitation or a threat to one’s
freedom. At the root of this attitude is “a neo-pelagianism
in which the individual, radically autonomous,
presumes to save himself, without recognizing
that, at the deepest level of being, he depends
on God and others [...]. On the other hand, a
certain neo-gnosticism, puts forward a model of
salvation that is merely interior, closed off in
its own subjectivism”,[32] that
wishes to free the person from the limitations
of the body, especially when it is fragile and
ill.
Individualism, in particular, is at the root of
what is regarded as the most hidden malady of
our time: solitude or privacy.[33] It
is thematized in some regulatory contexts even
as a “right to solitude”, beginning with the
autonomy of the person and the “principle of
permission-consent” which can, in certain
conditions of discomfort or sickness, be
extended to the choice of whether or not to
continue living. This “right” underlies
euthanasia and assisted suicide. The basic idea
is that those who find themselves in a state of
dependence and unable to realize a perfect
autonomy and reciprocity, come to be cared for
as a favor to them. The concept of the
good is thus reduced to a social accord: each
one receives the treatment and assistance that
autonomy or social and economic utility make
possible or expedient. As a result,
interpersonal relationships are impoverished,
becoming fragile in the absence of supernatural
charity, and of that human solidarity and social
support necessary to face the most difficult
moments and decisions of life.
This way of thinking about human relationships
and the significance of the good cannot but
undermine the very meaning of life, facilitating
its manipulation, even through laws that
legalize euthanistic practices, resulting in the
death of the sick. Such actions deform
relationships and induce a grave insensibility
toward the care of the sick person. In such
circumstances, baseless moral dilemmas arise
regarding what are in reality simply mandatory
elements of basic care, such as feeding and
hydration of terminally ill persons who are not
conscious.
In this connection, Pope Francis has spoken of a
“throw-away culture”[34] where
the victims are the weakest human beings, who
are likely to be “discarded” when the system
aims for efficiency at all costs. This cultural
phenomenon, which is deeply contrary to
solidarity, John Paul II described as a “culture
of death” that gives rise to real “structures of
sin”[35] that
can lead to the performance of actions wrong in
themselves for the sole purpose of “feeling
better” in carrying them out. A confusion
between good and evil materializes in an area
where every personal life should instead be
understood to possess a unique and unrepeatable
value with a promise of and openness to the
transcendent. In this culture of waste and
death, euthanasia and assisted suicide emerge as
erroneous solutions to the challenge of the care
of terminal patients.
V. The Teaching of the Magisterium
1.
The prohibition of euthanasia and assisted
suicide
With her mission to transmit to the faithful the
grace of the Redeemer and the holy law of God
already discernible in the precepts of the
natural moral law, the Church is obliged to
intervene in order to exclude once again all
ambiguity in the teaching of the Magisterium
concerning euthanasia and assisted suicide, even
where these practices have been legalized.
In particular, the dissemination of medical
end-of-life protocols such as the Do Not
Resuscitate Order or the Physician Orders
for Life Sustaining Treatment – with all of
their variations depending on national laws and
contexts – were initially thought of as
instruments to avoid aggressive medical
treatment in the terminal phases of life. Today
these protocols cause serious problems regarding
the duty to protect the life of patients in the
most critical stages of sickness. On the one
hand, medical staff feel increasingly bound by
the self-determination expressed in patient
declarations that deprive physicians of their
freedom and duty to safeguard life even where
they could do so. On the other hand, in some
healthcare settings, concerns have recently
arisen about the widely reported abuse of such
protocols viewed in a euthanistic perspective
with the result that neither patients nor
families are consulted in final decisions about
care. This happens above all in the countries
where, with the legalization of euthanasia, wide
margins of ambiguity are left open in
end-of-life law regarding the meaning of
obligations to provide care.
For these reasons, the Church is convinced of
the necessity to reaffirm as definitive teaching
that euthanasia is a crime against human life because,
in this act, one chooses directly to cause the
death of another innocent human being. The
correct definition of euthanasia depends, not on
a consideration of the goods or values at stake,
but on the moral object properly
specified by the choice of “an action or an
omission which of itself or by intention causes
death, in order that all pain may in this way be
eliminated”.[36] “Euthanasia’s
terms of reference, therefore, are to be found
in the intention of the will and in the methods
used”.[37] The
moral evaluation of euthanasia, and its
consequences does not depend on a balance of
principles that the situation and the pain of
the patient could, according to some, justify
the termination of the sick person. Values of
life, autonomy, and decision-making ability are
not on the same level as the quality of life as
such.
Euthanasia, therefore, is an intrinsically evil
act, in every situation or circumstance. In the
past the Church has already affirmed in a
definitive way “that euthanasia is a grave
violation of the Law of God, since it is the
deliberate and morally unacceptable killing of a
human person. This doctrine is based upon the
natural law and upon the written Word of God, is
transmitted by the Church’s Tradition and taught
by the ordinary and universal Magisterium.
Depending on the circumstances, this practice
involves the malice proper to suicide or
murder”.[38] Any
formal or immediate material cooperation in
such an act is a grave sin against human life:
“No authority can legitimately recommend or
permit such an action. For it is a question of
the violation of the divine law, an offense
against the dignity of the human person, a crime
against life, and an attack on humanity”.[39] Therefore,
euthanasia is an act of homicide that no end can
justify and that does not tolerate any form of
complicity or active or passive collaboration.
Those who approve laws of euthanasia and
assisted suicide, therefore, become accomplices
of a grave sin that others will execute. They
are also guilty of scandal because by such laws
they contribute to the distortion of conscience,
even among the faithful.[40]
Each life has the same value and dignity for
everyone: the respect of the life of another is
the same as the respect owed to one’s own life.
One who choses with full liberty to take one’s
own life breaks one’s relationship with God and
with others, and renounces oneself as a moral
subject. Assisted suicide aggravates the gravity
of this act because it implicates another in
one’s own despair. Another person is led to turn
his will from the mystery of God in the
theological virtue of hope and thus to repudiate
the authentic value of life and to break the
covenant that establishes the human family.
Assisting in a suicide is an unjustified
collaboration in an unlawful act that
contradicts the theologal relationship with God
and the moral relationship that unites us with
others who share the gift of life and the
meaning of existence.
When a request for euthanasia rises from anguish
and despair,[41] “although
in these cases the guilt of the individual may
be reduced, or completely absent, nevertheless
the error of judgment into which the conscience
falls, perhaps in good faith, does not change
the nature of this act of killing, which will
always be in itself something to be rejected”.[42] The
same applies to assisted suicide. Such actions
are never a real service to the patient, but a
help to die.
Euthanasia and assisted suicide are always the
wrong choice: “the medical personnel and the
other health care workers – faithful to the task
‘always to be at the service of life and to
assist it up until the very end’ – cannot give
themselves to any euthanistic practice, neither
at the request of the interested party, and much
less that of the family. In fact, since there is
no right to dispose of one’s life arbitrarily,
no health care worker can be compelled to
execute a non-existent right”.[43]
This is why euthanasia and assisted suicide
are a defeat for those who theorize about
them, who decide upon them, or who practice
them.[44]
For this reason, it is gravely unjust to enact
laws that legalize euthanasia or justify and
support suicide, invoking the false right to
choose a death improperly characterized as
respectable only because it is chosen.[45] Such
laws strike at the foundation of the legal
order: the right to life sustains all other
rights, including the exercise of freedom. The
existence of such laws deeply wound human
relations and justice, and threaten the mutual
trust among human beings. The legitimation of
assisted suicide and euthanasia is a sign of the
degradation of legal systems. Pope Francis
recalls that “the current socio-cultural context
is gradually eroding the awareness of what makes
human life precious. In fact, it is increasingly
valued on the basis of its efficiency and
utility, to the point of considering as
‘discarded lives’ or ‘unworthy lives’ those who
do not meet this criterion. In this situation of
the loss of authentic values, the mandatory
obligations of solidarity and of human and
Christian fraternity also fail. In reality, a
society deserves the status of ‘civil’ if it
develops antibodies against the culture of
waste; if it recognizes the intangible value of
human life; if solidarity is factually practiced
and safeguarded as a foundation for living
together”.[46] In
some countries of the world, tens of thousands
of people have already died by euthanasia, and
many of them because they displayed
psychological suffering or depression.
Physicians themselves report that abuses
frequently occur when the lives of persons who
would never have desired euthanasia are
terminated. The request for death is in many
cases itself a symptom of disease, aggravated by
isolation and discomfort. The Church discerns in
these difficulties an occasion for a spiritual
purification that allows hope to become truly
theological when it is focused on God and only
on God.
Rather than indulging in a spurious
condescension, the Christian must offer to the
sick the help they need to shake off their
despair. The commandment “do not kill” (Ex 20:13; Dt 5:17)
is in fact a yes to life which God
guarantees, and it “becomes a call to attentive
love which protects and promotes the life of
one’s neighbor”.[47] The
Christian therefore knows that earthly life is
not the supreme value. Ultimate happiness is in
heaven. Thus the Christian will not expect
physical life to continue when death is
evidently near. The Christian must help the
dying to break free from despair and to place
their hope in God.
From a clinical perspective, the factors that
largely determine requests for euthanasia and
assisted suicide are unmanaged pain, and the
loss of human and theological hope, provoked by
the often inadequate psychological and spiritual
human assistance provided by those who care for
the sick.[48]
Experience confirms that “the pleas of gravely
ill people who sometimes ask for death are not
to be understood as implying a true desire for
euthanasia; in fact, it is almost always a case
of an anguished plea for help and love. What a
sick person needs, besides medical care, is
love, the human and supernatural warmth with
which sick persons can and ought to be
surrounded by all those close to him or her,
parents and children, doctors and nurses”.[49] A
sick person, surrounded by a loving human and
Christian presence, can overcome all forms of
depression and need not succumb to the anguish
of loneliness and abandonment to suffering and
death.
One experiences pain not just as a biological
fact to be managed in order to make it bearable,
but as the mystery of human vulnerability in the
face of the end of physical life—a difficult
event to endure, given that the unity of the
body and the soul is essential to the human
person.
Therefore, the “end of life”, inevitably
presaged by pain and suffering, can be faced
with dignity only by the re-signification of the
event of death itself—by opening it to the
horizon of eternal life and affirming the
transcendent destiny of each person. In fact,
“suffering is something which is still wider than
sickness, more complex, and at the same time
still more deeply rooted in humanity itself”.[50] With
the help of grace this suffering can, like the
suffering of Christ on the Cross, be animated
from within with divine charity.
Those who assist persons with chronic illnesses
or in the terminal stages of life must be able
to “know how to stay”, to keep vigil, with those
who suffer the anguish of death, “to console”
them, to be with them in their loneliness, to be
an abiding withthat can instil hope.[51] By
means of the faith and charity expressed in the
intimacy of the soul, the caregiver can
experience the pain of another, can be open to a
personal relationship with the weak that expands
the horizons of life beyond death, and thus can
become a presence full of hope.
“Weep with those who weep” (Rm 12:15):
for blessed is the one whose compassion includes
shedding tears with others (cf. Mt 5:4).
Love is made possible and suffering given
meaning in relationships where persons share in
solidarity the human condition and the journey
to God, and are joined in a covenant[52] that
enables them to glimpse the light beyond death.
Medical care occurs within the therapeutic
covenant between the physician and the
patient who are united in the recognition of the
transcendent value of life and the mystical
meaning of suffering. In the light of this
covenant, good medical care can be valued, while
the utilitarian and individualistic vision that
prevails today can be dispelled.
2. The moral
obligation to exclude aggressive medical
treatment
The Magisterium of the Church recalls that, when
one approaches the end of earthly existence, the
dignity of the human person entails the right to
die with the greatest possible serenity and with
one’s proper human and Christian dignity intact.[53]To
precipitate death or delay it through
“aggressive medical treatments” deprives death
of its due dignity.[54] Medicine
today can artificially delay death, often
without real benefit to the patient. When death
is imminent, and without interruption of the
normal care the patient requires in such cases,
it is lawful according to science and conscience
to renounce treatments that provide only a
precarious or painful extension of life.[55] It
is not lawful to suspend treatments that are
required to maintain essential physiological
functions, as long as the body can benefit from
them (such as hydration, nutrition,
thermoregulation, proportionate respiratory
support, and the other types of assistance
needed to maintain bodily homeostasis and manage
systemic and organic pain). The suspension of
futile treatments must not involve the
withdrawal of therapeutic care. This
clarification is now indispensable in light of
the numerous court cases in recent years that
have led to the withdrawal of care from – and to
the early death of–critically but not terminally
ill patients, for whom it was decided to suspend
life-sustaining care which would not improve the
quality of life.
In the specific case of aggressive medical
treatment, it should be repeated that the
renunciation of extraordinary and/or
disproportionate means “is not the equivalent of
suicide or euthanasia; it rather expresses
acceptance of the human condition in the face of
death”[56] or
a deliberate decision to waive disproportionate
medical treatments which have little hope of
positive results. The renunciation of treatments
that would only provide a precarious and painful
prolongation of life can also mean respect for
the will of the dying person as expressed in
advanced directives for treatment, excluding
however every act of a euthanistic or suicidal
nature.[57]
The principle of proportionality refers to the
overall well-being of the sick person. To choose
among values (for example, life versus quality
of life) involves an erroneous moral judgment
when it excludes from consideration the
safeguarding of personal integrity, the good
life, and the true moral object of the act
undertaken.[58] Every
medical action must always have as its
object—intended by the moral agent—the promotion
of life and never the pursuit of death.[59] The
physician is never a mere executor of the will
of patients or their legal representatives, but
retains the right and obligation to withdraw at
will from any course of action contrary to the
moral good discerned by conscience.[60]
3. Basic Care: the requirement of
nutrition and hydration
A fundamental and inescapable principle of the
assistance of the critically or terminally ill
person is the continuity of care for the
essential physiological functions. In
particular, required basic care for each person
includes the administration of the nourishment
and fluids needed to maintain bodily
homeostasis, insofar as and until this
demonstrably attains the purpose of providing
hydration and nutrition for the patient.[61]
When the provision of nutrition and hydration no
longer benefits the patient, because the
patient’s organism either cannot absorb them or
cannot metabolize them, their administration
should be suspended. In this way, one does not
unlawfully hasten death through the deprivation
of the hydration and nutrition vital for bodily
function, but nonetheless respects the natural
course of the critical or terminal illness. The
withdrawal of this sustenance is an unjust
action that can cause great suffering to the one
who has to endure it. Nutrition and hydration do
not constitute medical therapy in a proper
sense, which is intended to counteract the
pathology that afflicts the patient. They are
instead forms of obligatory care of the patient,
representing both a primary clinical and an
unavoidable human response to the sick person.
Obligatory nutrition and hydration can at times
be administered artificially,[62] provided
that it does not cause harm or intolerable
suffering to the patient.[63]
4. Palliative care
Continuity of care is
part of the enduring responsibility to
appreciate the needs of the sick person: care
needs, pain relief, and affective and spiritual
needs. As demonstrated by vast clinical
experience, palliative medicine constitutes a
precious and crucial instrument in the care of
patients during the most painful, agonizing,
chronic and terminal stages of illness. Palliative
care is an authentic expression of the human
and Christian activity of providing care, the
tangible symbol of the compassionate “remaining”
at the side of the suffering person. Its goal is
“to alleviate suffering in the final stages of
illness and at the same time to ensure the
patient appropriate human accompaniment”[64] improving
quality of life and overall well-being as much
as possible and in a dignified manner.
Experience teaches us that the employment of
palliative care reduces considerably the number
of persons who request euthanasia. To this end,
a resolute commitment is desirable to extend
palliative treatments to those who need them,
within the limits of what is fiscally possible,
and to assist them in the terminal stages of
life, but as an integrated approach to the
care of existing chronic or degenerative
pathologies involving a complex prognosis that
is unfavorable and painful for the patient and
family.[65]
Palliative care should include spiritual
assistance for patients and their families. Such
assistance inspires faith and hope in God in the
terminally ill as well as their families whom it
helps to accept the death of their loved one. It
is an essential contribution that is offered by
pastoral workers and the whole Christian
community. According to the model of the Good
Samaritan, acceptance overcomes denial, and hope
prevails over anguish,[66] particularly
when, as the end draws near, suffering is
protracted by a worsening pathology. In this
phase, the identification of an effective pain
relief therapy allows the patient to face the
sickness and death without the fear of
undergoing intolerable pain. Such care must be
accompanied by a fraternal support to reduce the
loneliness that patients feel when they are
insufficiently supported or understood in their
difficulties.
Palliative care cannot provide a fundamental
answer to suffering or eradicate it from
people’s lives.[67] To
claim otherwise is to generate a false hope, and
cause even greater despair in the midst of
suffering. Medical science can understand
physical pain better and can deploy the best
technical resources to treat it. But terminal
illness causes a profound suffering in the sick
person, who seeks a level of care beyond the
purely technical. Spe salvi facti sumus:
in hope, theological hope, directed
toward God, we have been saved, says Saint Paul
(Rm 8:24).
“The wine of hope” is the specific contribution
of the Christian faith in the care of the sick
and refers to the way in which God overcomes
evil in the world. In times of suffering, the
human person should be able to experience a
solidarity and a love that takes on the
suffering, offering a sense of life that extends
beyond death. All of this has a great social
importance: “A society unable to accept the
suffering of its members and incapable of
helping to share their suffering, and to bear it
inwardly through ‘com-passion’ is a cruel and
inhuman society”.[68]
It should be recognized, however, that the
definition of palliative care has in recent
years taken on a sometimes equivocal
connotation. In some countries, national laws
regulating palliative care (Palliative Care
Act) as well as the laws on the “end of
life” (End-of-Life Law) provide, along
with palliative treatments, something called
Medical Assistance to the Dying (MAiD) that can
include the possibility of requesting euthanasia
and assisted suicide. Such legal provisions are
a cause of grave cultural confusion: by
including under palliative care the provision of
integrated medical assistance for a voluntary
death, they imply that it would be morally
lawful to request euthanasia or assisted
suicide.
In addition, palliative interventions to reduce
the suffering of gravely or terminally ill
patients in these regulatory contexts can
involve the administration of medications that
intend to hasten death, as well as the
suspension or interruption of hydration and
nutrition even when death is not imminent. In
fact, such practices are equivalent to a direct
action or omission to bring about death and are
therefore unlawful. The growing diffusion of
such legislation and of scientific guidelines of
national and international professional
societies, constitutes a socially irresponsible
threat to many people, including a growing
number of vulnerable persons who needed only to
be better cared for and comforted but are
instead being led to choose euthanasia and
suicide.
5.
The role of the family and hospice
The role of the family is central to the care of
the terminally ill patient.[69] In
the family a person can count on strong
relationships, valued in themselves apart from
their helpfulness or the joy they bring. It is
essential that the sick under care do not feel
themselves to be a burden, but can sense the
intimacy and support of their loved ones. The
family needs help and adequate resources to
fulfil this mission. Recognizing the family’s
primary, fundamental and irreplaceable social
function, governments should undertake to
provide the necessary resources and structures
to support it. In addition, Christian-inspired
health care facilities should not neglect but
instead integrate the family’s human and
spiritual accompaniment in a unified program
of care for the sick person.
Next to the family, hospice centers which
welcome the terminally sick and ensure their
care until the last moment of life provide an
important and valuable service. After all, “the
Christian response to the mystery of death and
suffering is to provide not an explanation but a
Presence”[70] that
shoulders the pain, accompanies it, and opens it
to a trusting hope. These centers are an example
of genuine humanity in society, sanctuaries
where suffering is full of meaning. For this
reason, they must be staffed by qualified
personnel, possess the proper resources, and
always be open to families. “In this regard, I
think about how well hospice does for
palliative care, where terminally ill people are
accompanied with qualified medical,
psychological and spiritual support, so that
they can live with dignity, comforted by the
closeness of loved ones, in the final phase of
their earthly life. I hope that these centers
continue to be places where the ‘therapy of
dignity’ is practiced with commitment, thus
nurturing love and respect for life.”[71] In
these settings, as well as in Catholic
facilities, healthcare workers and pastoral
staff, in addition to being clinically
competent, should also be practicing an
authentic theologal life of faith and hope that
is directed towards God, for this constitutes
the highest form of the humanization of dying.[72]
6. Accompaniment and
care in prenatal and pediatric medicine
Regarding the care of neo-natal infants and
children suffering from terminal
chronic-degenerative diseases, or are in the
terminal stages of life itself, it is necessary
to reaffirm what follows, aware of the need for
first-rate programs that ensure the well-being
of the children and their families.
Beginning at conception, children suffering from
malformation or other pathologies are little
patients whom medicine today can always
assist and accompany in a manner respectful of
life. Their life is sacred, unique,
unrepeatable, and inviolable, exactly like that
of every adult person.
Children suffering from so-called pre-natal
pathologies “incompatible with life” – that will
surely end in death within a short period of
time – and in the absence of fetal or neo-natal
therapies capable of improving their health,
should not be left without assistance, but must
be accompanied like any other patient until they
reach natural death. Prenatal comfort carefavors
a path of integrated assistance involving
the support of medical staff and pastoral care
workers alongside the constant presence of the
family. The child is a special patient and
requires the care of a professional with expert
medical knowledge and affective skills. The
empathetic accompaniment of a child, who is
among the most frail, in the terminal stages of
life, aims to give life to the years of a child
and not years to the child’s life.
Prenatal Hospice Centers, in
particular, provide an essential support to
families who welcome the birth of a child in a
fragile condition. In these centers, competent
medical assistance, spiritual accompaniment, and
the support of other families, who have
undergone the same experience of pain and loss,
constitute an essential resource. It is the
pastoral duty of the Christian-inspired
healthcare workers to make efforts to expand the
accessibility of these centers throughout the
world.
These forms of assistance are particularly
necessary for those children who, given the
current state of scientific knowledge, are
destined to die soon after birth or within a
short period of time. Providing care for these
children helps the parents to handle their grief
and to regard this experience not just as a
loss, but as a moment in the journey of love
which they have travelled together with their
child.
Unfortunately the dominant culture today does
not encourage this approach. The sometimes
obsessive recourse to prenatal diagnosis, along
with the emergence of a culture unfriendly to
disability, often prompts the choice of
abortion, going so far as to portray it as a
kind of “prevention.” Abortion consists in the
deliberate killing of an innocent human life and
as such it is never lawful. The use of prenatal
diagnosis for selective purposes is contrary to
the dignity of the person and gravely unlawful
because it expresses a eugenic mentality. In
other cases, after birth, the same culture
encourages the suspension or non-initiation of
care for the child as soon as it is born because
a disability is present or may develop in the
future. This utilitarian approach—inhumane and
gravely immoral—cannot be countenanced.
The fundamental principle of pediatric care is
that children in the final stages of life have
the right to the respect and care due to
persons. To be avoided are both aggressive
medical treatment and unreasonable tenacity, as
well as intentional hastening of their death.
From a Christian perspective, the pastoral care
of a terminally ill child demands participation
in the divine life in Baptism and in
Confirmation.
It may happen that pharmacological or other
therapies, designed to combat the pathology from
which a child suffers, are suspended during the
terminal stage of an incurable disease. The
attending physician may determine that the
child’s deteriorated clinical condition renders
these therapies either futile or extreme, and
possibly the cause of added suffering.
Nonetheless, in such situations the integral
care of the child, in its various physiological,
psychological, affective, and spiritual
dimensions, must never cease. Care means more
than therapy and healing. When a therapy is
suspended because it no longer benefits an
incurable patient, treatments that support the
essential physiological functions of the child
must continue insofar as the organism can
benefit from them (hydration, nutrition,
thermoregulation, proportionate respiratory
support, and other types of assistance needed to
maintain bodily homeostasis and manage systemic
and organic pain). The desire to abstain from
any overly tenacious administration of
treatments deemed ineffective should not
entail the withdrawal of care.The path of
accompaniment until the moment of death must
remain open. Routine interventions, like
respiratory assistance, can be provided
painlessly and proportionately. Thus appropriate
care must be customized to the personal needs of
the patient, to avoid that a just concern for
life does not contrast with an unjust imposition
of pain that could be avoided.
Evaluation and management of the physical pain
of a new-born or a child show the proper respect
and assistance they deserve during the difficult
stages of their illness. The tender personalized
care that is attested today in clinical
pediatric medicine, sustained by the presence of
the parents, makes possible an integrated
management of care that is more effective than
invasive treatments.
Maintaining the emotional bond between the
parent and the child is an integral part of the
process of care. The connection between
caregiving and parent-child assistance that is
fundamental to the treatment of incurable or
terminal pathologies should be favored as much
as possible. In addition to emotional support,
the spiritual moment must not be overlooked. The
prayer of the people close to the sick child has
a supernatural value that surpasses and deepens
the affective relationship.
The ethical/juridical concept of “the best
interest of the child” – when used in the
cost-benefit calculations of care– can in no way
form the foundation for decisions to shorten
life in order to prevent suffering if these
decisions envision actions or omissions that are
euthanistic by nature or intention. As already
mentioned, the suspension of disproportionate
therapies cannot justify the suspension of the
basic care, including pain relief, necessary to
accompany these little patients to a dignified
natural death, nor to the interruption of that
spiritual care offered for one who will soon
meet God.
7. Analgesic therapy
and loss of consciousness
Some specialized care requires, on the part of
the healthcare workers, a particular attention
and competence to attain the best medical
practice from an ethical point of view, with
attention to people in their concrete situations
of pain.
To mitigate a patient’s pain, analgesic therapy
employs pharmaceutical drugs that can induce
loss of consciousness (sedation). While a deep
religious sense can make it possible for a
patient to live with pain through the lens of
redemption as a special offering to God,[73] the
Church nonetheless affirms the moral liceity of
sedation as part of patient care in order to
ensure that the end of life arrives with the
greatest possible peace and in the best internal
conditions. This holds also for treatments that
hasten the moment of death (deep palliative
sedation in the terminal stage),[74] always,
to the extent possible, with the patient’s
informed consent. From a pastoral point of view,
prior spiritual preparation of the patients
should be provided in order that they may
consciously approach death as an encounter with
God.[75] The
use of analgesics is, therefore, part of the
care of the patient, but any administration that
directly and intentionally causes death is a
euthanistic practice and is unacceptable.[76] The
sedation must exclude, as its direct purpose,
the intention to kill, even though it may
accelerate the inevitable onset of death.[77]
In pediatric settings, when a child (for
example, a new-born) is unable to understand, it
must be stated that it would be a mistake to
suppose that the child can tolerate the pain,
when in fact there are ways to alleviate it.
Caregivers are obliged to alleviate the child’s
suffering as much as possible, so that he or she
can reach a natural death peacefully, while
being able to experience the loving presence of
the medical staff and above all the family.
8. The vegetative
state and the state of minimal consciousness
Other relevant situations are that of the
patient with the persistent lack of
consciousness, the so-called “vegetative state”
or that of the patient in the state of “minimal
consciousness”. It is always completely false to
assume that the vegetative state, and the state
of minimal consciousness, in subjects who can
breathe autonomously, are signs that the patient
has ceased to be a human person with all of the
dignity belonging to persons as such[78].
On the contrary, in these states of greatest
weakness, the person must be acknowledged in
their intrinsic value and assisted with suitable
care. The fact that the sick person can remain
for years in this anguishing situation without
any prospect of recovery undoubtedly entails
suffering for the caregivers.
One must never forget in such painful situations
that the patient in these states has the right
to nutrition and hydration, even administered by
artificial methods that accord with the
principle of ordinary means. In some cases, such
measures can become disproportionate, because
their administration is ineffective, or involves
procedures that create an excessive burden with
negative results that exceed any benefits to the
patient.
In the light of these principles, the obligation
of caregivers includes not just the patient, but
extends to the family or to the person
responsible for the patient’s care, and should
be comprised of adequate pastoral accompaniment.
Adequate support must be provided to the
families who bear the burden of long-term care
for persons in these states. The support should
seek to allay their discouragement and help them
to avoid seeing the cessation of treatment as
their only option. Caregivers must be
sufficiently prepared for such situations, as
family members need to be properly supported.
9. Conscientious
objections on the part of healthcare workers and
of Catholic healthcare institutions
In the face of the legalization of euthanasia or
assisted suicide – even when viewed simply as
another form of medical assistance – formal or
immediate material cooperation must be excluded.
Such situations offer specific occasions for
Christian witness where “we must obey God rather
than men” (Acts 5:29). There is no right
to suicide nor to euthanasia: laws exist, not to
cause death, but to protect life and to
facilitate co-existence among human beings. It
is therefore never morally lawful to collaborate
with such immoral actions or to imply collusion
in word, action or omission. The one authentic
right is that the sick person be accompanied and
cared for with genuine humanity. Only in this
way can the patient’s dignity be preserved until
the moment of natural death. “No health care
worker, therefore, can become the defender of a
non-existing right, even if euthanasia were
requested by the subject in question when he was
fully conscious”.[79]
In this regard, the general principles regarding
cooperation with evil, that is, with unlawful
actions, are thus reaffirmed: “Christians, like
all people of good will, are called, with a
grave obligation of conscience, not to lend
their formal collaboration to those practices
which, although allowed by civil legislation,
are in contrast with the Law of God. In fact,
from the moral point of view, it is never licit
to formally cooperate in evil. This cooperation
occurs when the action taken, either by its very
nature or by the configuration it is assuming in
a concrete context, qualifies as direct
participation in an act against innocent human
life, or as sharing the immoral intention of the
principal agent. This cooperation can never be
justified neither by invoking respect for the
freedom of others, nor by relying on the fact
that civil law provides for it and requires it:
for the acts that each person personally
performs, there is, in fact, a moral
responsibility that no one can ever escape and
on which each one will be judged by God himself
(cf. Rm 2:6; 14:12)”.[80]
Governments must acknowledge the right to
conscientious objection in the medical and
healthcare field, where the principles of the
natural moral law are involved and especially
where in the service to life the voice of
conscience is daily invoked.[81]Where
this is not recognized, one may be confronted
with the obligation to disobey human law, in
order to avoid adding one wrong to another,
thereby conditioning one’s conscience.
Healthcare workers should not hesitate to ask
for this right as a specific contribution to the
common good.
Likewise, healthcare institutions must resist
the strong economic pressures that may sometimes
induce them to accept the practice of
euthanasia. If the difficulty in finding
necessary operating funds creates an enormous
burden for these public institutions, then the
whole society must accept an additional
liability in order to ensure that the incurably
ill are not left to their own or their families’
resources. All of this requires that episcopal
conferences and local churches, as well as
Catholic communities and institutions, adopt a
clear and unified position to safeguard the
right of conscientious objection in regulatory
contexts where euthanasia and suicide are
sanctioned.
Catholic healthcare institutions constitute a
concrete sign of the way in which the ecclesial
community takes care of the sick following the
example of the Good Samaritan. The command of
Jesus to “cure the sick,” (Lk 10:9) is
fulfilled not only by laying hands on them, but
also by rescuing them from the streets,
assisting them in their own homes, and creating
special structures of hospitality and welcome.
Faithful to the command of the Lord, the Church
through the centuries has created various
structures where medical care finds its specific
form in the context of integral service to the
sick person.
Catholic healthcare institutions are called to
witness faithfully to the inalienable commitment
to ethics and to the fundamental human and
Christian values that constitute their identity.
This witness requires that they abstain from
plainly immoral conduct and that they affirm
their formal adherence to the teachings of the
ecclesial Magisterium. Any action that does not
correspond to the purpose and values which
inspire Catholic healthcare institutions is not
morally acceptable and endangers the
identification of the institution itself
as“Catholic.”
Institutional collaboration with other hospital
systems is not morally permissible when it
involves referrals for persons who request
euthanasia. Such choices cannot be morally
accepted or supported in their concrete
realization, even if they are legally
admissible. Indeed, it can rightly be said of
laws that permit euthanasia that “not only do
they create no obligation for the conscience,
but instead there is a grave and clear
obligation to oppose them by conscientious
objection. From the very beginnings of the
Church, the apostolic preaching reminded
Christians of their duty to obey legitimately
constituted public authorities (cf. Rm 13:1-7; 1
Pt 2:13-14), but at the same time firmly
warned that ‘we must obey God rather than men’ (Acts 5:29)”.[82]
The right to conscientious objection does not
mean that Christians reject these laws in virtue
of private religious conviction, but by reason
of an inalienable right essential to the common
good of the whole society. They are in fact laws
contrary to natural law because they undermine
the very foundations of human dignity and human
coexistence rooted in justice.
10. Pastoral
accompaniment and the support of the sacraments
Death is a decisive moment in the human person’s
encounter with God the Savior. The Church is
called to accompany spiritually the faithful in
the situation, offering them the “healing
resources” of prayer and the sacraments. Helping
the Christian to experience this moment with
spiritual assistance is a supreme act of
charity. Because “no believer should die in
loneliness and neglect”,[83] it
encompasses the patient with the solid support
of human, and humanizing, relationships to
accompany them and open them to hope.
The parable of the Good Samaritan shows what the
relationship with the suffering neighbor should
be, what qualities should be avoided –
indifference, apathy, bias, fear of soiling
one’s hands, totally occupied with one’s own
affairs – and what qualities should be embraced
– attention, listening, understanding,
compassion, and discretion.
The invitation to imitate the Samaritan’s
example— “Go and do likewise” (Lk 10:37)—is
an admonition not to underestimate the full
human potential of presence, of availability, of
welcoming, of discernment, and of involvement,
which nearness to one in need demands and which
is essential to the integral care of the sick.
The quality of love and care for persons in
critical and terminal stages of life contributes
to assuaging the terrible, desperate desire to
end one’s life. Only human warmth and
evangelical fraternity can reveal a positive
horizon of support to the sick person in hope
and confident trust.
Such accompaniment is part of the path defined
by palliative care that includes the patients
and their families.
The family has always played an important role
in care, because their presence sustains the
patient, and their love represents an essential
therapeutic factor in the care of the sick
person. Indeed, recalls Pope Francis, the family
“has always been the nearest ‘hospital’ still
today, in so many parts of the world, a hospital
is for the privileged few, and is often far
away. It is the mother, the father, brother,
sisters and godparents who guarantee care and
help one to heal”.[84]
Taking care of others, or providing care for the
suffering of others, is a commitment that
embraces not just a few but the entire Christian
community. Saint Paul affirms that when one
member suffers, it is the whole body that
suffers (cf. 1 Cor12:26) and all bend to
the sick to bring them relief. Everyone, for his
or her part, is called to be a “servant of
consolation” in the face of any human situation
of desolation or discomfort.
Pastoral accompaniment involves the exercise of
the human and Christian virtues of empathy (en-pathos),
of compassion(cum-passio), of
bearing another’s suffering by sharing it, and
of the consolation (cum-solacium),
of entering into the solitude of others to make
them feel loved, accepted, accompanied, and
sustained.
The ministry of listening and of consolation
that the priest is called to offer, which
symbolizes the compassionate solicitude of
Christ and the Church, can and must have a
decisive role. In this essential mission it is
extremely important to bear witness to and unite
truth and charity with which the gaze of the
Good Shepherd never ceases to accompany all of
His children. Given the centrality of the priest
in the pastoral, human and spiritual
accompaniment of the sick at life’s end, it is
necessary that his priestly formation provide an
updated and precise preparation in this area. It
is also important that priests be formed in this
Christian accompaniment. Since there may be
particular circumstances that make it difficult
for a priest to be present at the bedside,
physicians and healthcare workers need this
formation as well.
Being men and women skilled in humanity means
that our way of caring for our suffering
neighbor should favor their encounter with the
Lord of life, who is the only one who can pour,
in an efficacious manner, the oil of consolation
and the wine of hope onto human wounds.
Every person has the natural right to be cared
for, which at this time is the highest
expression of the religion that one professes.
The sacramental moment is always the culmination
of the entire pastoral commitment to care that
precedes and is the source of all that follows.
The Church calls Penance and the Anointing of
the Sick sacraments “of healing”[85],
for they culminate in the Eucharist which is the
“viaticum” for eternal life.[86] Through
the closeness of the Church, the sick person
experiences the nearness of Christ who
accompanies them on their journey to his
Father’s house (cf. Jn 14:6) and helps
the sick to not fall into despair,[87] by
supporting them in hope especially when the
journey becomes exhausting.[88]
11. Pastoral
discernment towards those who request Euthanasia
or Assisted Suicide
The pastoral accompaniment of those who
expressly ask for euthanasia or assisted suicide
today presents a singular moment when a
reaffirmation of the teaching of the Church is
necessary. With respect to the Sacrament of
Penance and Reconciliation, the confessor must
be assured of the presence of the true
contrition necessary for the validity of
absolutionwhich consists in “sorrow of mind
and a detestation for sin committed, with the
purpose of not sinning for the future”.[89] In
this situation, we find ourselves before a
person who, whatever their subjective
dispositions may be, has decided upon a gravely
immoral act and willingly persists in this
decision. Such a state involves a manifest
absence of the proper disposition for the
reception of the Sacraments of Penance, with
absolution,[90] and
Anointing,[91] with
Viaticum.[92] Such
a penitent can receive these sacraments only
when the minister discerns his or her readiness
to take concrete steps that indicate he or she
has modified their decision in this regard. Thus
a person who may be registered in an association
to receive euthanasia or assisted suicide must
manifest the intention of cancelling such a
registration before receiving the sacraments. It
must be recalled that the necessity to postpone
absolution does not imply a judgment on the
imputability of guilt, since personal
responsibility could be diminished or
non-existent.[93] The
priest could administer the sacraments to an
unconscious person sub condicione if, on
the basis of some signal given by the patient
beforehand, he can presume his or her
repentance.
The position of the Church here does not imply a
non-acceptance of the sick person. It must be
accompanied by a willingness to listen and to
help, together with a deeper explanation of the
nature of the sacrament, in order to provide the
opportunity to desire and choose the sacrament
up to the last moment. The Church is careful to
look deeply for adequate signs of conversion, so
that the faithful can reasonably ask for the
reception of the sacraments. To delay absolution
is a medicinal act of the Church, intended not
to condemn, but to lead the sinner to
conversion.
It is necessary to remain close to a person who
may not be in the objective condition to receive
the sacraments, for this nearness is an
invitation to conversion, especially when
euthanasia, requested or accepted, will not take
place immediately or imminently. Here it remains
possible to accompany the person whose hope may
be revived and whose erroneous decision may be
modified, thus opening the way to admission to
the sacraments.
Nevertheless, those who spiritually assist these
persons should avoid any gesture, such as
remaining until the euthanasia is performed,
that could be interpreted as approval of this
action. Such a presence could imply complicity
in this act. This principle applies in a
particular way, but is not limited to, chaplains
in the healthcare systems where euthanasia is
practiced, for they must not give scandal by
behaving in a manner that makes them complicit
in the termination of human life.
12. The reform of the
education and formation of the healthcare
workers
In today’s social and cultural context, with so
many challenges to the protection of human life
in its most critical stages, education has a
critical role to play. Families, schools, other
educational institutions and parochial
communities must work with determination to
awaken and refine that sensitivity toward our
neighbour and their suffering manifested by the
Good Samaritan of the Gospel. [94]
Hospital chaplains should intensify the
spiritual and moral formation of the healthcare
workers, including physicians and nursing staff,
as well as hospital volunteers, in order to
prepare them to provide the human and
psychological assistance necessary in the
terminal stages of life. The psychological and
spiritual care of patients and their families
during the whole course of the illness must be a
priority for the pastoral and healthcare
workers.
Palliative treatments must be disseminated
throughout the world. To this end, it would be
desirable to organize academic courses of study
for the specialized formation of healthcare
workers. Also a priority is the dissemination of
accurate general information on the value of
effective palliative treatments for a dignified
accompaniment of the person until a natural
death. Christian-inspired healthcare
institutions should arrange for guidelines for
the healthcare workers that include suitable
methods for providing psychological, moral, and
spiritual assistance as essential components of
palliative care.
Human and spiritual assistance must again factor
into academic formation of all healthcare
workers as well as in hospital training
programs.
In addition, healthcare and assistance
organizations must arrange for models of
psychological and spiritual aid to healthcare
workers who care for the terminally ill. To
show care for those who care is essential so
that healthcare workers and physicians do not
bear all of the weight of the suffering and of
the death of incurable patients (which can
result in burn out for them). They need
support and therapeutic sessions to process not
only their values and feelings, but also the
anguish they experience as they confront
suffering and death in the context of their
service to life. They need a profound sense of
hope, along with the awareness that their own
mission is a true vocation to accompany the
mystery of life and grace in the painful and
terminal stages of existence. [95]
Conclusion
The mystery of the Redemption of the human
person is in an astonishing way rooted in the
loving involvement of God with human suffering.
That is why we can entrust ourselves to God and
to convey this certainty in faith to the person
who is suffering and fearful of pain and death.
Christian witness demonstrates that hope is
always possible, even within a “throwaway
culture”. “The eloquence of the parable of the
Good Samaritan and of the whole Gospel is
especially this: every individual must feel as
if called personally to bear witness to
love in suffering”.[96]
The Church learns from the Good Samaritan how to
care for the terminally ill, and likewise obeys
the commandment linked to the gift of life: “respect,
defend, love and serve life, every human life!”.[97] The
gospel of life is a gospel of compassion and
mercy directed to actual persons, weak and
sinful, to relieve their suffering, to support
them in the life of grace, and if possible to
heal them from their wounds.
It is not enough, however, to share their pain;
one needs to immerse oneself in the fruits of
the Paschal Mystery of Christ who conquers sin
and death, with the will “to dispel the misery
of another, as if it were his own”.[98] The
greatest misery consists in the loss of hope in
the face of death. This hope is proclaimed by
the Christian witness, which, to be effective,
must be lived in faith and encompass
everyone—families, nurses, and physicians. It
must engage the pastoral resources of the
diocese and of Catholic healthcare centers,
which are called to live with faith the duty
to accompany the sick in all of the stages
of illness, and in particular in the critical
and terminal stages of life as defined in this
letter.
The Good Samaritan, who puts the face of his
brother in difficulty at the center of his
heart, and sees his need, offers him whatever is
required to repair his wound of desolation and
to open his heart to the luminous beams of hope.
The Samaritan’s “willing the good” draws him
near to the injured man not just with words or
conversation, but with concrete actions and in
truth (cf. 1 Jn 3:18). It takes the form
of care in the example of Christ who went about
doing good and healing all (cf. Acts 10:38).
Healed by Jesus, we become men and women called
to proclaim his healing power to love and
provide the care for our neighbors to which He
bore witness.
That the vocation to the love and care of
another[99] brings
with it the rewards of eternity is made explicit
by the Lord of life in the parable of the final
judgment: inherit the kingdom, for I was sick
and you visited me. When did we do this, Lord?
Every time you did it for the least ones, for a
suffering brother or sister, you did it for me
(cf. Mt 25: 31-46).
The Sovereign Pontiff Francis, on 25 June 2020,
approved the present Letter, adopted in the
Plenary Session of this Congregation, the 29th of
January 2020, and ordered its publication.
Rome, from the Offices of the Congregation for
the Doctrine of the Faith, the 14th of
July 2020, liturgical memorial of Saint Camille
de Lellis.
Luis F. Card. LADARIA, S.I.
Prefect
✠ Giacomo
MORANDI
Archbishop tit. of Cerveteri
Secretary
__________________
[1] Messale
Romano, riformato a norma dei decreti del
Concilio Ecumenico Vaticano II, promulgato da
papa Paolo VI e riveduto da papa Giovanni Paolo
II, Conferenza Episcopale Italiana –
Fondazione di Religione Santi Francesco d’Assisi
e Caterina da Siena, Roma 2020, Prefazio comune
VIII, p. 404 (Eng. trans.)
[2] Cf.
Pontifical Council for Pastoral Assistance to
Health Care Workers, New Charter for Health
Care Workers, National Catholic Bioethics
Center, Philadelphia, PA, 2017, n. 6.
[3] Cf.
Benedict XVI, Encyclical Letter Spe salvi (30
November 2007), 22: AAS 99 (2007), 1004.
“If technical progress is not matched by
corresponding progress in man’s ethical
formation, in man’s inner growth (cf. Eph 3:16; 2
Cor 4:16), then it is not progress at all,
but a threat for man and for the world”.
[4] Cfr.
Francesco, Discorso all’Associazione italiana
contro le leucemie-linfomi e mieloma (AIL) (2
marzo 2019): L’Osservatore Romano, 3
marzo 2019, 7.
[5] Francis,
Apostolic Exhortation Amoris laetitia (19
March 2016), 3: AAS 108 (2016), 312.
[6] Cf.
Second Vatican Ecumenical Council, Pastoral
Constitution Gaudium et spes, 10: AAS 58
(1966), 1032-1033.
[7] Cf.
John Paul II, Apostolic Letter Salvifici
doloris (11 February 1984), 4: AAS 76
(1984), 203.
[8] Cf.
Pontifical Council for Pastoral Assistance to
Healthcare Workers, New Charter for
Healthcare Workers, n. 144.
[9] Francis, Message
for the 48th World Communications Day (1
June 2014): AAS 106 (2014), 114.
[10] John
Paul II, Encyclical Letter Evangelium vitae (25
March 1995), 87: AAS 87 (1995), 500.
[11] Cf.
John Paul II, Encyclical Letter Centesimus
annus (1 May 1991), 37: AAS 83
(1991), 840.
[12] John
Paul II, Encyclical Letter Veritatis splendor (6
August 1993), 50: AAS 85 (1993), 1173.
[13] John
Paul II, Address to the participants in the
International Congress “Life sustaining
treatments and vegetative state. Scientific
progress and ethical dilemmas” (20 March
2004), 7: AAS 96 (2004), 489.
[14] Cf.
Congregation for the Doctrine of the Faith,
Letter Placuit Deo (22 February 2018),
6: AAS 110 (2018), 430.
[15] Cf.
Pontifical Council for Pastoral Assistance to
Health Care Workers, New Charter for Health
Care Workers, n. 9.
[16] Cf.
Paul VI, Address during the last general
meeting of the Second Vatican Council (7
December 1965): AAS 58 (1966), 55-56.
[17] Pontifical
Council for Pastoral Assistance to Health Care
Workers, New Charter for Health Care Workers,
n. 9.
[18] Cf.
Congregaton for the Doctrine of the Faith,
Letter Placuit Deo (22 February 2018),
12: AAS 110 (2018), 433-434.
[19] Francis, Address
to the participants of the Plenary Session of
the Congregation for the Doctrine of the Faith (30
January 2020): L’Osservatore Romano, 31
gennaio 2020, 7. (Eng. trans.)
[20] Cf.
Benedict XVI, Encyclical Letter Deus caritas
est (25 December 2005), 31: AAS 98
(2006), 245.
[21] Cf.
Benedict XVI, Encyclical Letter Caritas in
veritate (29 June 2009), 76: AAS 101
(2009), 707.
[22] Cf.
John Paul II, Encyclical Letter Evangelium
vitae (25 March 1995), 49: AAS 87
(1995), 455. “the deepest and most authentic
meaning of life: namely, that of being a gift
which is fully realized in the giving of self ”.
[23] Second
Vatican Ecumenical Council, Dogmatic
Constitution Dei Verbum (8 November
1965), 2: AAS 58 (1966), 818.
[24] John
Paul II, Encyclical Letter Evangelium vitae (25
March 1995), 34: AAS 87 (1995), 438.
[25] Cf. Position
Paper of the Abrahamic Monotheistic Religions on
matters concerning life, Vatican City, 28
October 2019: “ We oppose any form of euthanasia
– that is the direct, deliberate and intentional
act of taking life – as well as physician
assisted suicide – that is the direct,
deliberate and intentional support of committing
suicide – because they fundamentally contradict
the inalienable value of human life, and
therefore are inherently and consequentially
morally and religiously wrong, and should be
forbidden wihout exceptions”.
[26] Cf.
Francis, Address to Participants in the
Commemorative Conference of the Italian Catholic
Physicians’ Association on the occassion of its
70th Anniversary of foundation (15 November
2014): AAS 106 (2014), 976.
[27] Cf.
Pontifical Council for Pastoral Assistance to
Health Care Workers, New Charter for Health
Care Workers, n. 1; Congregation for the
Doctrine of the Faith, Instruction Dignitas
personae (8 September 2008), 8: AAS 100
(2008), 863.
[28] Francis,
Encyclical Letter Laudato si’ (24 May
2015), 65: AAS 107 (2015), 873.
[29] Second
Vatican Ecumenical Council, Pastoral
Constitution Gaudium et spes (7 December
1965), 27: AAS 58 (1966), 1047-1048.
[30] Francis, Address
to Participants in the Commemorative Conference
of the Italian Catholic Physicians’ Association
on the occassion of its 70th Anniversary of
foundation (15 November 2014): AAS 106
(2014), 976.
[31] Cf.
Francis Address to the National Federation of
the Orders of Doctors and Dental Surgeons (20
September 2019):L’Osservatore Romano, 21
settembre 2019, 8: “These are hasty ways of
dealing with choices that are not, as they might
seem, an expression of the person’s freedom,
when they include the discarding of the patient
as a possibility, or false compassion in the
face of the request to be helped to anticipate
death”.
[32] Congregation
for the Doctrine of the Faith, Lettera Placuit
Deo (22 February 2018), 3: AAS 110
(2018), 428-429; Cf. Francis, Encyclical Letter Laudato
si’ (24 May 2015), 162: AAS 107
(2015), 912.
[33] Cf.
Benedict XVI, Encyclical Letter Caritas in
veritate (29 June 2009), 53: AAS 101
(2009), 688. “One of the deepest forms of
poverty a person can experience is isolation. If
we look closely at other kinds of poverty,
including material forms, we see that they are
born of isolation, from not being loved or from
difficulties in being able to love”.
[34] Cf.
Francis, Apostolic Exhortation Evangelii
gaudium (24 November 2013), 53: AAS 105
(2013), 1042; See also: Id., Address to a
delegation from the Dignitatis Humanae Institute (7
December 2013): AAS 106 (2014) 14-15;
Id., Meeting of the Pope with the Elderly (28
September 2014): AAS 106 (2014) 759-760.
[35] Cf.
John Paul II, Encyclical Letter Evangelium
vitae (25 March 1995), 12: AAS 87
(1995), 414.
[36] Congregation
for the Doctrine of the Faith, Declaration Iura
et bona (5 May 1980), II: AAS 72
(1980), 546.
[37] John
Paul II, Encyclical Letter Evangelium vitae (25
March 1995), 65: AAS 87 (1995), 475; cf.
Congregation For The Doctrine Of The Faith,
Declaration Iura et bona (5 maggio 1980),
II: AAS 72 (1980), 546.
[38] John
Paul II, Encyclical Letter Evangelium vitae (25
March 1995), 65: AAS 87 (1995), 477. It
is a definitively proposed doctrine in which the
Church commits her infallibility: cf.
Congregation For The Doctrine of the Faith, Doctrinal
Commentary on the Concluding Formula of the
Professio Fidei (29 June 1998), 11: AAS 90
(1998), 550.
[39] Congregation
for the Doctrine of the Faith, Declaration Iura
et bona (5 May 1980), II: AAS 72
(1980), 546.
[40] Cf. Catechism
of the Catholic Church, 2286.
[41] Cf. Catechism
of the Catholic Church, 1735 and 2282.
[42] Congregation
for the Doctrine of the Faith, Declaration Iura
et bona (5 May 1980), II: AAS 72
(1980), 546.
[43] Pontifical
Council for Pastoral Assistance to Health Care
Workers, New Charter for Health Care Workers,
n. 169.
[44] Cf. Ibid.,
170.
[45] Cf.
John Paul II, Encyclical Letter Evangelium
vitae (25 March 1995), 72: AAS 87
(1995), 484-485.
[46] Francis, Address
to the Participants of the Plenary Session of
the Congregation for the Doctrine of the Faith (30
January 2020): L’Osservatore Romano, 31
gennaio 2020, 7. (Eng. trans.)
[47] John
Paul II, Encyclical Letter Veritatis splendor (6
August 1993), 15: AAS 85 (1993), 1145.
[48] Cf.
Benedict XVI, Encyclical Letter Spe salvi (30
November 2007), 36, 37: AAS 99 (2007),
1014-1016.
[49] Congregation
for the Doctrine of the Faith, Declaration Iura
et bona (5 May 1980), II: AAS 72
(1980), 546.
[50] John
Paul II, Apostolic Letter Salvifici doloris (11
February 1984), 5: AAS 76 (1984), 204.
[51] Cf.
Benedict XVI, Encyclical Letter Spe salvi (30
November 2007), 38: AAS 99 (2007), 1016.
[52] Cf.
John Paul II, Apostolic Letter Salvifici
doloris (11 February 1984), 29: AAS 76
(1984), 244: “the person who is ‘a neighbor’
cannot indifferently pass by the suffering of
another: this in the name of fundamental human
solidarity, still more in the name of love of
neighbor. He must ‘stop,’ ‘sympathize,’ just
like the Samaritan of the Gospel parable. The
parable in itself expresses a deeply
christian truth, but one that at the
same time is very universally human.”
[53] Cf.
Congregation for the Doctrine of the Faith,
Declaration Iura et bona (5 May 1980),
IV: AAS 72 (1980), 549-551.
[54] Cf. Catechism
of the Catholic Church, 2278; Pontifical
Council for Pastoral Assistance to Health Care
Workers, The Charter for Health Care Workers,
Vatican City, 1995, n. 119; John Paul II,
Encyclical Letter Evangelium vitae (25
March 1995), 65: AAS87 (1995), 475;
Francis, Message to the participants in the
european regional meeting of the World Medical
Association (7 November 2017). “And even if
we know that we cannot always guarantee healing
or a cure, we can and must always care for the
living, without ourselves shortening their life,
but also without futilely resisting their
death”; Pontifical Council for Pastoral
Assistance to Health Care Workers, New
Charter for Health Care Workers, n. 149.
[55] Cf. Catechism
of the Catholic Church, 2278; Congregation
For The Doctrine Of The Faith, Declaration Iura
et bona (5 May 1980), IV: AAS 72
(1980), 550-551; John Paul II, Encyclical
Letter Evangelium vitae (25 March 1995),
65: AAS 87 (1995), 475; Pontifical
Council for Pastoral Assistance to Health Care
Workers, New Charter for Health Care Workers,
n. 150.
[56] John
Paul II, Encyclical Letter Evangelium vitae (25
March 1995), 65: AAS 87 (1995), 476.
[57] Cf.
Pontifical Council for Pastoral Assistance to
Health Care Workers, New Charter for Health
Care Workers, n. 150.
[58] Cfr.
Giovanni Paolo II, Discorso ai partecipanti
ad un incontro di studio sulla procreazione
responsabile (5 giugno 1987), n. 1: Insegnamenti
di Giovanni Paolo II X/2 (1987), 1962: “To
speak of a ‘conflict of values or goods’ and of
the consequent need to perform some sort of
‘balance’ of them, choosing one and refuting the
other, is not morally correct” (Eng. trans).
[59] Cf.
John Paul II, Address to the Italian Catholic
Doctors Association (28 December 1978): Insegnamenti
di Giovanni Paolo II, I (1978), 438.
[60] Cf.
Pontifical Council for Pastoral Assistance to
Health Care Workers, New Charter for Health
Care Workers, n. 150.
[61] Cf.
Congregation For The Doctrine Of The Faith, Responses
to certain questions of the United States
Conference of Catholic Bishops concerning
artificial nutrition and hydration (1 August
2007): AAS 99 (2007), 820.
[62] Cf. Ibid.
[63] Cf.
Pontifical Council for Pastoral Assistance to
Health Care Workers, New Charter for Health
Care Workers, n. 152: “Nutrition and
hydration, even if administered artificially,
are classified as basic care owed to the dying
person when they do not prove to be too
burdensome or without any benefit. The
unjustified discontinuation thereof can be
tantamount to a real act of euthanasia: ‘The
administration of food and water even by
artificial means is, in principle, an ordinary
and proportionate means of preserving life. It
is therefore obligatory to the extent which, and
for as long as, it is shown to accomplish its
proper finality, which is hydration and
nourishment of the patient. In this way,
suffering and death by starvation and
dehydration are prevented’”.
[64] Francis, Address
to participants in the plenary of the Pontifical
Academy for Life (5 March 2015): AAS 107
(2015), 274, with reference to: John Paul II,
Encyclical Letter Evangelium vitae (25
March 1995), 65: AAS 87 (1995), 476. Cf. Catechism
of the Catholic Church, 2279.
[65] Cf.
Francis, Address to participants in the
plenary of the Pontifical Academy for Life (5
March 2015): AAS 107 (2015), 275.
[66] Cf.
Pontifical Council for Pastoral Assistance to
Health Care Workers, New Charter for Health
Care Workers, n. 147.
[67] Cf.
John Paul II, Apostolic Letter Salvifici
doloris (11 February 1984), 2: AAS 76
(1984), 202: “Suffering seems to belong to man’s
transcendence: it is one of those points in
which man in a certain sense ‘destined’ to go
beyond himself, and he is called to this in a
mysterious way”.
[68] Benedict
XVI, Encyclical Letter Spe salvi (30
November 2007), 38: AAS 99 (2007), 1016.
[69] Cf.
Francis, Apsotolic Exhortation Amoris
laetitia (19 March 2016), 48: AAS 108
(2016), 330.
[70] C.
Saunders, Watch with Me: Inspiration for a
life in hospice care, Observatory House,
Lancaster, UK, 2005, 29.
[71] Francis, Address
to the Participants of the Plenary Session of
the Congregation for the Doctrine of the Faith (30
January 2020): L’Osservatore Romano, 31
gennaio 2020, 7. (Eng. trans.)
[72] Cf.
Pontifical Council for Pastoral Assistance to
Health Care Workers, New Charter for Health
Care Workers, n. 148.
[73] Cfr.
Pio XII, Allocutio. Trois questions
religieuses et morales concernant l'analgésie (24
febbraio 1957): AAS 49 (1957) 134-136;
Congregation for the Doctrine of the Faith,
Declaration Iura et bona (5 May 1980),
III: AAS 72 (1980), 547; John Paul II,
Apostolic Letter Salvifici doloris (11
February 1984), 19: AAS 76 (1984), 226.
[74] Cfr.
Pio XII, Allocutio. Iis qui interfuerunt
Conventui internationali.
Romae habito, a «Collegio Internationali
Neuro-Psycho-Pharmacologico» indicto (9
settembre 1958): AAS 50 (1958), 694;
Congregation for the Doctrine of the Faith,
Declaration Iura et bona (5 May 1980),
III: AAS 72 (1980), 548; Catechism of
the Catholic Church, 2779; Pontifical
Council for Pastoral Assistance to Health Care
Workers, New Charter for Health Care Workers,
n. 155 “Moreover there is the possibility of
painkillers and narcotics causing a loss of
consciousness in the dying person. Such usage
deserves particular consideration. In the
presence of unbearable pain that is resistant to
typical pain-management therapies, if the moment
of death is near or if there are good reasons
for anticipating a particular crisis at the
moment of death, a serious clinical indication
may involve, with the sick person’s consent, the
administration of drugs that cause the loss of
consciousness. This deep palliative sedation in
the terminal phase, when clinically motivated,
can be morally acceptable provided that it is
done with the patient's consent, appropriate
information is given to the family members, that
any intention of euthanasia is ruled out, and
that the patient has been able to perform his
moral, familial and religious duties: ‘As they
approach death people ought to be able to
satisfy their moral and family duties, and above
all they ought to be able to prepare in a fully
conscious way for their definitive meeting with
God’. Therefore,‘ it is not right to deprive the
dying person of consciousness without a serious
reason’”.
[75] Cfr.
Pio XII, Allocutio. Trois questions
religieuses et morales concernant l'analgésie (24
febbraio 1957): AAS 49 (1957) 145;
Congregation for the Doctrine of the Faith,
Declaration Iura et bona (5 May 1980),
III: AAS 72 (1980), 548; John Paul II,
Encyclical Letter Evangelium vitae (25
March 1995), 65: AAS 87 (1995), 476.
[76] Cf.
Francis, Address to Participants in the
Commemorative Conference of the Italian Catholic
Physicians’ Association on the occassion of its
70th Anniversary of foundation (15 November
2014): AAS 106 (2014), 978.
[77] Cfr.
Pio XII, Allocutio. Trois questions
religieuses et morales concernant l'analgésie (24
febbraio 1957): AAS 49 (1957), 146; Id., Allocutio. Iis
qui interfuerunt Conventui internationali. Romae
habito, a «Collegio Internationali
Neuro-Psycho-Pharmacologico» (9
settembre 1958): AAS 50 (1958), 695;
Congregation for the Doctrine of the Faith,
Declaration Iura et bona, III: AAS 72
(1980), 548; Catechism of the Catholic Church,
2279; John Paul II, Encyclical Letter Evangelium
vitae (25 March 1995), 65: AAS 87
(1995), 476; Pontifical Council for Pastoral
Assistance to Health Care Workers, New
Charter for Health Care Workers, n. 154.
[78] Cf.
John Paul II, Address to the participants in
the International Congress “Life sustaining
treatments and vegeative state. Scientific
progress and ethical dilemmas” (20 March
2004), 3: AAS 96 (2004), 487: “A man,
even if seriously ill or disabled in the
exercise of his highest functions, is and always
will be a man, and he will never become a
‘vegetable’ or an ‘animal’”.
[79] Pontifical
Council for Pastoral Assistance to Health Care
Workers, New Charter for Health Care Workers,
n. 151.
[80] Ibid.,
n. 151; John Paul II, Encyclical Letter Evangelium
vitae (25 March 1995), 74: AAS 87
(1995), 487.
[81] Cf.
Francis, Address to Participants in the
Commemorative Conference of the Italian Catholic
Physicians’ Association on the occassion of its
70th Anniversary of foundation (15 November
2014): AAS 106 (2014), 977.
[82] John
Paul II, Encyclical Letter Evangelium vitae (25
March 1995), 73: AAS 87 (1995), 486.
[83] Benedict
XVI, Address to the participants in the
Congress organized by the Pontifical Academy for
Life on the theme “Close by the incurable sick
person and the dying: scientific and ethical
aspects” (25 February 2008): AAS 100
(2008), 171.
[84] Francis, General
Audience, (10 June 2015): L’Osservatore
Romano, 11 giugno 2015, 8.
[85] Catechism
of the Catholic Church,
1420.
[86] Cfr.
Rituale Romanum, ex decreto Sacrosancti
Oecumenici Concilii Vaticani II instauratum
auctoritate Pauli PP.
VI promulgatum, Ordo unctionis infirmorum
eorumque pastoralis curae, Editio typica,
Praenotanda,
Typis Polyglottis Vaticanis, Civitate Vaticana
1972, n. 26; Catechism of the Catholic Church,
1524.
[87] Cf.
Francis, Encyclical Letter Laudato si’ (24
May 2015), 235: AAS 107 (2015), 939.
[88] Cf.
John Paul II, Encyclical Letter Evangelium
vitae (25 March 1995), 67: AAS 87
(1995), 478-479.
[89] Council
of Trent, Sess. XIV, De sacramento
penitentiae, chap. 4: DH 1676.
[90] Cf. Code
of Canon Law, can. 987.
[91] Cf. Code
of Canon Law, can. 1007: “The anointing of
the sick is not to be conferred upon those who
persevere obstinately in manifest grave sin”.
[92] Cf. Code
of Canon Law, can. 915 and can. 843 § 1.
[93] Cf.
Congregation for the Doctrine of the Faith,
Declaration Iura et bona, II: AAS 72
(1980), 546.
[94] Cf.
John Paul II, Apostolic Letter Salvifici
doloris (11 February 1984), 29: AAS 76
(1984), 244-246.
[95] Cf.
Francis, Address to the doctors in
Spain and Latin America: compassion is the very
soul of medicine (9 June 2016): AAS 108
(2016), 727-728. “Frailty, pain and infirmity
are a difficult trial for everyone, including
medical staff; they call for patience, for
suffering-with; therefore, we must not give in
to the functionalist temptation to apply rapid
and drastic solutions moved by false compassion
or by mere criteria of efficiency or
cost-effectiveness. The dignity of human life is
at stake; the dignity of the medical vocation is
at stake”.
[96] John
Paul II, Apostolic Letter Salvifici doloris (11
February 1984), 29: AAS 76 (1984), 246.
[97] John
Paul II, Encyclical Letter Evangelium vitae (25
March 1995), 5: AAS 87 (1995), 407.
[98] Saint
Thomas Aquinas, Summa Theologiae, I, q.
21, a. 3.
[99] Cf.
Benedict XVI, Encyclical Letter Spe salvi (30
November 2007), 39: AAS 99 (2007), 1016.
“To suffer with the other and for others; to
suffer for the sake of truth and justice; to
suffer out of love and in order to become a
person who truly loves – these are fundamental
elements of humanity, and to abandon them would
destroy man himself”.
[01077-EN.01] [Original text: Italian]
|