The rapid progress in medicine and its associated technology has benefited many people at all stages of life. Where medical technology and processes assist a person who is ill to return to an acceptable quality of life there are few questions about the processes involved, because there is obvious benefit. At the end of life, however, medical technology and processes enter into a different context, where questions about the prolonging of life and the quality of life are altered by the known proximity of death.
The end of life is often characterized by a period when the spiritual and relational aspects of the person come to the fore and become areas of great personal growth. Although medicine cannot provide a cure, during this period the medical support of the person is a vital component in providing the physical condition which will best enable other aspects of the person to develop and mature. However there can be a tendency to place so much emphasis on the provision of medical assistance and technology that it overwhelms and obscures the true growth and work of this stage of life, which is primarily to do with the spiritual dimension of the person and relationships with others. The hospice movement provides an approach to the end of life which recognizes the complexities and multi-layered needs of those facing death. The contribution of the hospice movement to the development of a holistic approach to the end of life has been hugely significant.
There are still many debated issues in end of life care, and more will inevitably appear as medicine and science continue their research work. The Catholic Church has a centuries-old involvement in healthcare and in the care of the dying, an involvement which continues across the world today in hospices, hospitals, and aged care facilities. In this section we have identified some of the issues at the end of life, and provided links to articles which examine the issues in the light of Catholic teaching and thought.
Moral Principles
The Catholic tradition has developed a distinctive approach to the preservation of life. Life is a gift over which we are given stewardship, not absolute dominion. We have a duty to preserve life, while recognizing that there are certain limits to that duty. The moral principles used by the Church in decision-making at the end of life come from its own tradition, they have a much wider relevance because they are based on respect for the dignity of the human person.
Moral principles relating to decision-making at the end of life
Ordinary-Extraordinary Means
We have a duty to preserve our life and to use it for the glory of God, but the duty to preserve life is not absolute, for we may reject life-prolonging procedures that are insufficiently beneficial or excessively burdensome. The use of life-sustaining technology is judged in the light of the Christian meaning of life, suffering, and death. Only in this way are two extremes avoided: on the one hand, an insistence on useless or burdensome technology even when a patient may legitimately wish to forego it and, on the other hand, the withdrawal of technology with the intention of causing death.
(Part Five, Ethical and Religious Directives for Catholic Health Care Services Fourth Edition.)
Medically Assisted Nutrition and Hydration
The obligation to provide humane care to a person in the last stage of life includes oral nutrition and hydration, if the person is able to receive food and fluids in this way. If a person is unable to receive or assimilate nutrition or hydration orally then it can be provided intravenously, through a nasogastric tube or a tube placed into the wall of the stomach. When adequate nutrition and hydration require the skills of trained medical personnel and the use of technology, questions arise as to whether the procedures are care or treatment. For the person close to death they may constitute a greater burden than benefit, and the competent patient may wish to discontinue their use. For a person in a permanent coma (persistent vegetative state) decisions about medically assisted nutrition and hydration need to be made by relatives if the person has not given some previous indication of their wishes. The boundary between allowing a person to die and intentionally causing death is crucial in making decisions about the withholding or withdrawal of nutrition and hydration.
Address Of John Paul II to the Participants in the International Congress on "Life-Sustaining Treatments and Vegetative State: Scientific Advances And Ethical Dilemmas" (Rome 2004)
Pontifical Academy for Life and World Federation of Catholic Medical Associations International Congress on "Life-Sustaining Treatments and Vegetative State: Scientific Advances And Ethical Dilemmas" ( Rome , 10-17 March 2004): Joint Statement On The Vegetative State
Truth Telling
The ethical principle of veracity - truth-telling is an essential part of holistic care of those who are terminally ill and is an important aspect of respect for persons and their autonomy. Knowing when to tell the truth is as important as knowing how to tell the truth. It can not be accomplished in fleeting moments with patient or family, but must be set within a context of listening compassionate care.
Striking a Balance in Truth Telling - Rev Michael McCabe, Issue 4, The Nathaniel Report.
Ordinary Means-Extraordinary Means: A Valid Distinction? Rev Michael J McCabe, Issue 4, The Nathaniel Report.
Living Wills. Nadja Tollemache OBE, Issue 8, The Nathaniel Report
Pontifical Academy for Life: Respect for The Dignity Of The Dying, December 2000