Vital Organs / Unconscious State

PART FIVE

Issues in Care for the Seriously Ill and Dying

Introduction

Christ’s redemption and saving grace embrace the whole person, especially in his or her

illness, suffering, and death.35 The Catholic health care ministry faces the reality of death with

the confidence of faith. In the face of death—for many, a time when hope seems lost—the

Church witnesses to her belief that God has created each person for eternal life.36

Above all, as a witness to its faith, a Catholic health care institution will be a community

of respect, love, and support to patients or residents and their families as they face the reality

of death. What is hardest to face is the process of dying itself, especially the dependency, the

helplessness, and the pain that so often accompany terminal illness. One of the primary

purposes of medicine in caring for the dying is the relief of pain and the suffering caused by it.

Effective management of pain in all its forms is critical in the appropriate care of the dying.

The truth that life is a precious gift from God has profound implications for the question

of stewardship over human life. We are not the owners of our lives and, hence, do not have

absolute power over life. 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. Suicide and euthanasia are never

morally acceptable options.

The task of medicine is to care even when it cannot cure. Physicians and their patients

must evaluate the use of the technology at their disposal. Reflection on the innate dignity of

human life in all its dimensions and on the purpose of medical care is indispensable for

formulating a true moral judgment about the use of technology to maintain life. The use of

life-sustaining technology is judged in light of the Christian meaning of life, suffering, and

death. In this way two extremes are avoided: on the one hand, an insistence on useless or

burdensome technology even when a patient may legitimately wish to forgo it and, on the

other hand, the withdrawal of technology with the intention of causing death.37

The Church’s teaching authority has addressed the moral issues concerning medically

assisted nutrition and hydration. We are guided on this issue by Catholic teaching against

euthanasia, which is “an action or an omission which of itself or by intention causes death, in

order that all suffering may in this way be eliminated.” 38 While medically assisted nutrition

and hydration are not morally obligatory in certain cases, these forms of basic care should in

principle be provided to all patients who need them, including patients diagnosed as being in a

“persistent vegetative state” (PVS), because even the most severely debilitated and helpless

patient retains the full dignity of a human person and must receive ordinary and proportionate

care.

Directives

55. Catholic health care institutions offering care to persons in danger of death from illness, 21

Ethical and Religious Directives for Catholic Health Care Services, Sixth Edition

accident, advanced age, or similar condition should provide them with appropriate

opportunities to prepare for death. Persons in danger of death should be provided with

whatever information is necessary to help them understand their condition and have the

opportunity to discuss their condition with their family members and care providers. They

should also be offered the appropriate medical information that would make it possible to

address the morally legitimate choices available to them. They should be provided the

spiritual support as well as the opportunity to receive the sacraments in order to prepare

well for death.

56. A person has a moral obligation to use ordinary or proportionate means of preserving his

or her life. Proportionate means are those that in the judgment of the patient offer a

reasonable hope of benefit and do not entail an excessive burden or impose excessive

expense on the family or the community.39

57. A person may forgo extraordinary or disproportionate means of preserving life.

Disproportionate means are those that in the patient’s judgment do not offer a reasonable

hope of benefit or entail an excessive burden, or impose excessive expense on the family

or the community.

58. In principle, there is an obligation to provide patients with food and water, including

medically assisted nutrition and hydration for those who cannot take food orally. This

obligation extends to patients in chronic and presumably irreversible conditions (e.g., the

“persistent vegetative state”) who can reasonably be expected to live indefinitely if given

such care.40 Medically assisted nutrition and hydration become morally optional when

they cannot reasonably be expected to prolong life or when they would be “excessively

burdensome for the patient or [would] cause significant physical discomfort, for example

resulting from complications in the use of the means employed.” 41 For instance, as a

patient draws close to inevitable death from an underlying progressive and fatal condition,

certain measures to provide nutrition and hydration may become excessively burdensome

and therefore not obligatory in light of their very limited ability to prolong life or provide

comfort.

59. The free and informed judgment made by a competent adult patient concerning the use or

withdrawal of life-sustaining procedures should always be respected and normally

complied with, unless it is contrary to Catholic moral teaching.

60. Euthanasia is an action or omission that of itself or by intention causes death in order to

alleviate suffering. Catholic health care institutions may never condone or participate in

euthanasia or assisted suicide in any way. Dying patients who request euthanasia should

receive loving care, psychological and spiritual support, and appropriate remedies for pain

and other symptoms so that they can live with dignity until the time of natl death.42

61. Patients should be kept as free of pain as possible so that they may die comfortably and 22

Ethical and Religious Directives for Catholic Health Care Services, Sixth Edition

with dignity, and in the place where they wish to die. Since a person has the right to

prepare for his or her death while fully conscious, he or she should not be deprived of

consciousness without a compelling reason. Medicines capable of alleviating or suppressing

pain may be given to a dying person, even if this therapy may indirectly shorten the person’s

life so long as the intent is not to hasten death. Patients experiencing suffering that cannot

be alleviated should be helped to appreciate the Christian understanding of redemptive

suffering.

62. The determination of death should be made by the physician or competent medical

authority in accordance with responsible and commonly accepted scientific criteria.

63. Catholic health care institutions should encourage and provide the means whereby those

who wish to do so may arrange for the donation of their organs and bodily tissue, for

ethically legitimate purposes, so that they may be used for donation and research after

death.

64. Such organs should not be removed until it has been medically determined that the patient

has died. In order to prevent any conflict of interest, the physician who determines death

should not be a member of the transplant team.

65. The use of tissue or organs from an infant may be permitted after death has been

determined and with the informed consent of the parents or guardians.