Catholic Teaching on Euthanasia and Care of the Dying
16 November 2010
Human dignity is unconditional
In New Zealand we are currently witnessing renewed calls for euthanasia to be legalised. Those in favour of euthanasia promote the understanding that 'a dignified death' or 'death with dignity' rests on our right to have control over our own death, including the right to have someone end it for us at a time of our choosing.
The Catholic tradition, along with many others, rejects this understanding. As discussed by Pope John Paul II in his 1995 encyclical The Gospel of Life: Human life comes from God; it is God's gift, and is a sharing in God's own breath of life. We cannot do with human life as we will. Its sacredness gives rise to its absolute or unconditional value, something that is written from the beginning in our heart and in our conscience (n. 39-40).
It is not only religious groups who oppose euthanasia. The belief that the unconditional dignity of human life is written into the heart and conscience of every person has been borne out in human history by the protections societies and cultures of all kinds have placed around human life. It is apparent, in particular, through the longstanding commitment of medical practitioners to the Hippocratic Oath, an oath which originated in pre-Christian times. At the heart of this oath is the phrase which is commonly translated today as 'firstly do no harm'.
The belief that human life has unconditional value means that it is not dependant (or conditional) on the way others value us or on the way we value our own life. Neither is it a reality that derives from, and therefore depends on, some form of legal concession made by our society or the state. Rather, our human dignity exists independently; it belongs to us by virtue of the simple fact that we exist. Two obligations flow from this principle; (i) the obligation not to intentionally harm or destroy life and (ii) the positive obligation to nurture and support life. In the Bible the unconditional dignity of human life is revealed in the commandment not to kill and comes to its culmination in the positive commandment of love for one's neighbour as affirmed by Jesus in the Gospels.
All forms of intentional killing, including the euthanasing of another person, are therefore morally wrong no matter what the circumstances.
It is noteworthy that in response to the latest discussion about euthanasia the New Zealand Medical Association (NZMA) has spoken out strongly and unequivocally against the involvement of doctors in this practice. Its Chairman has been recently quoted as saying that doctors are "trained to promote life ... and no matter what the law of the land does ... the New Zealand Medical Association will still say that the deliberate act of killing a patient is unethical."
The call by some to legalise euthanasia, including a number of medical practitioners, thus represents a contradiction of a fundamental tenet of the human conscience. At the same time it provides a timely opportunity to clarify long-standing Catholic teaching regarding care of the dying.
Preparing for death
For some people death comes suddenly and unexpectedly. For others, death is preceded by a period of terminal illness. The latter provides a time for the sick person and their family and loved ones to contemplate and prepare for death. It is a time in which we find ourselves confronted with opportunities, challenges and fears.
At such times the relational and spiritual aspects of our lives come to the fore. For those of us who are Christian it is a time to appreciate again, and grow more fully into, the unconditional love God has for each of us.
The opportunity to prepare for our own death, or to walk alongside someone who is dying, also presents as an occasion for human growth. Death does not simply happen upon us from the outside. Rather, it is a process that calls us to be active even as we face the inevitability of our mortality and accept that the postponement of death is beyond our control. These situations call for great courage, hope, love and faith. In such circumstances 'a dignified death' is one in which we courageously face our mortality, hopefully surrounded by the love and support of family, friends and our faith communities.
Care of the Dying
When medicine can no longer provide a cure for persons at the end of life the proper management of a patient's pain and other physical symptoms is vital. We are obliged to provide treatment only where we can, but we are obliged always to care for the person who is dying, including the alleviation of pain.
It is important to make the distinction between pain and suffering. While the two terms are often used interchangeably, it needs to be emphasised that pain and suffering are not the same thing. Suffering is a very personal matter, arising from our mental and emotional state of being and often exists quite independently of our state of physical well-being. Physical pain can be a significant cause of suffering. However, not every person who experiences physical pain is necessarily suffering.
When confronted by human illness we have a duty to take all reasonable efforts to maintain human life and restore health. Equally, however, acceptance of the finite nature of human existence challenges us to accept that there are limits to the duty to maintain life and restore health. Specifically, no one is required to use 'extraordinary' or 'disproportionate' means of preserving life – that is, means which are understood as offering no reasonable hope of benefit or involving excessive burdens.In these circumstances the priority is to give the person whatever pain relief they need to make them comfortable while accompanying them emotionally and spiritually.
In this way, the Catholic position avoids two extreme views. One extreme, known as 'vitalism', promotes the idea that physical life must be preserved at all costs. This extreme leads to the indignity of over-treatment of persons at the end of life. The opposite extreme, which leads to the abuse of under-treatment, values life only for its usefulness or 'quality' and, at its worst, advocates for the deliberate ending of human life when it is perceived as being too burdensome or meaningless.
The difference between killing and allowing to die
The Gospel of Life defines euthanasia as any action or omission which of itself and by intention causes death with the purpose of eliminating all suffering (n. 65). From a Catholic perspective, all crimes against life, including euthanasia, must be vigorously opposed.
In the application of this teaching the Catholic tradition relies on a clear moral distinction between killing and allowing to die. "Killing is any intentional action or omission bringing about the death of another; the cause of death is the human intervention or omission." On the other hand: "Allowing to die is withholding or withdrawing futile or overly burdensome treatment; therefore, the disease or fatal condition overtaking the person is the cause of death." [1] In effect, the outcome of withdrawing or withholding futile or burdensome treatment is that it returns the patient to their dying. This is not euthanasia. The withdrawing of futile or burdensome treatment reflects good medical practice.
In applying the principle that prohibits killing, the Catholic tradition also makes a moral distinction between killing and those actions (such as the administration of pain relief) that may have the foreseen effect of shortening a person's life. The intention of the health professional involved is a critical factor in determining the acceptability of such actions. If the health professional concerned directly intends the death of the patient, then the action is wrong because, as already noted, all forms of intentional killing are wrong irrespective of how well-meaning the person may be.
If, however, the health professional's intention is solely the relief of their patient's pain but their action inadvertently has more than one outcome – one outcome positive (relief of pain) and the other negative (an earlier death) – then their action is morally acceptable. Once again, this is not euthanasia and it is misleading and confusing to refer to such actions as "passive euthanasia" as some people do. The provision of adequate pain relief represents good medical practice and all patients have a right to access good palliative care.
In summary, euthanasia is not to be identified with the use of such medication as is required to alleviate pain nor with the withholding or withdrawing of futile or burdensome treatment.
A holistic approach to the end of life
There are many social drivers behind the renewed call for euthanasia. Chief among these are the fear of a painful death and the fear of becoming a burden. From a pastoral perspective it is ultimately our commitment to persons at the end of life, shown above all by the way we care for them, that gives the most powerful witness to Catholic convictions about the unconditional dignity of life.
The hospice movement, with its philosophy of neither deliberately hastening nor unnecessarily postponing death, provides a balanced and holistic approach to end of life care that is consistent with Catholic teaching. Good palliative care is aimed at the alleviation of all pain as part of an approach that includes meeting a person's relational and spiritual needs.
While the principles that inform Catholic decision-making at the end of life reflect its own moral tradition, they have a wider relevance because they are based on a universal and unconditional respect that reflects the fundamental equality of all persons.
All New Zealanders should have access to adequate palliative care. A lack of access to good palliative care constitutes a medical crisis that requires a political response to provide the resources that are needed rather than a change of law to allow euthanasia.
[1] Catholic Health Association of the United States. (1993). Care of the Dying: a Catholic Perspective.