End of Life Bioethics

Overview:

A time of serious sickness is naturally distressing for the one who is ill and for the family and friends of the one who is stricken. Making sound moral decisions in the face of such circumstances may be especially difficult when we consider the emotional strains that are natural when someone we love undergoes great suffering.  End of life bioethics investigates the principles to apply to situations that people may face toward the end of their lives.

The Church has articulated how someone ought to approach end-of-life decisions in light of their dignity as human beings.  To understand these issues, it is important to consider the redemptive nature of suffering, the important difference between morally obligatory and optional means of conserving one's life, the moral and legal status of Advance Medical Directives and Durable Power of Attorney, and the spread of euthanasia advocacy in America today.

Useful Links:

National Catholic Bioethic Center

Declaration on Euthanasia

Evangelium Vitae (The Gospel of Life)

Brief Reflections on Euthanasia

Euthanasia:

The following excerpt is from the encyclical:  Evangelium Vitae.

65. For a correct moral judgment on euthanasia, in the first place a clear definition is required. Euthanasia in the strict sense is understood to be an action or omission which of itself and by intention causes death, with the purpose of eliminating all suffering. "Euthanasia's terms of reference, therefore, are to be found in the intention of the will and in the methods used".

Euthanasia must be distinguished from the decision to forego so-called "aggressive medical treatment", in other words, medical procedures which no longer correspond to the real situation of the patient, either because they are by now disproportionate to any expected results or because they impose an excessive burden on the patient and his family. In such situations, when death is clearly imminent and inevitable, one can in conscience "refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted". Certainly there is a moral obligation to care for oneself and to allow oneself to be cared for, but this duty must take account of concrete circumstances. It needs to be determined whether the means of treatment available are objectively proportionate to the prospects for improvement. To forego extraordinary or disproportionate means is not the equivalent of suicide or euthanasia; it rather expresses acceptance of the human condition in the face of death. 

In modern medicine, increased attention is being given to what are called "methods of palliative care", which seek to make suffering more bearable in the final stages of illness and to ensure that the patient is supported and accompanied in his or her ordeal. Among the questions which arise in this context is that of the licitness of using various types of painkillers and sedatives for relieving the patient's pain when this involves the risk of shortening life. While praise may be due to the person who voluntarily accepts suffering by forgoing treatment with pain-killers in order to remain fully lucid and, if a believer, to share consciously in the Lord's Passion, such "heroic" behaviour cannot be considered the duty of everyone. Pius XII affirmed that it is licit to relieve pain by narcotics, even when the result is decreased consciousness and a shortening of life, "if no other means exist, and if, in the given circumstances, this does not prevent the carrying out of other religious and moral duties". In such a case, death is not willed or sought, even though for reasonable motives one runs the risk of it: there is simply a desire to ease pain effectively by using the analgesics which medicine provides. All the same, "it is not right to deprive the dying person of consciousness without a serious reason":  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.

Taking into account these distinctions, in harmony with the Magisterium of my Predecessors  and in communion with the Bishops of the Catholic Church, I confirm 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.

 To concur with the intention of another person to commit suicide and to help in carrying it out through so-called "assisted suicide" means to cooperate in, and at times to be the actual perpetrator of, an injustice which can never be excused, even if it is requested. In a remarkably relevant passage Saint Augustine writes that "it is never licit to kill another: even if he should wish it, indeed if he request it because, hanging between life and death, he begs for help in freeing the soul struggling against the bonds of the body and longing to be released; nor is it licit even when a sick person is no longer able to live". Even when not motivated by a selfish refusal to be burdened with the life of someone who is suffering, euthanasia must be called a false mercy, and indeed a disturbing "perversion" of mercy. True "compassion" leads to sharing another's pain; it does not kill the person whose suffering we cannot bear. Moreover, the act of euthanasia appears all the more perverse if it is carried out by those, like relatives, who are supposed to treat a family member with patience and love, or by those, such as doctors, who by virtue of their specific profession are supposed to care for the sick person even in the most painful terminal stages.

 

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Vocabulary:

Euthanasia - Literally meaning “Good Death” or “Easy Death”, euthanasia is defined as an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated. (Declaration on Euthanasia)

Physician Assisted Suicide (P.A.S.) - entails making lethal means available to the patient to be used at a time of the patient’s own choosing.

Voluntary Euthanasia - Euthanasia when the person wants to die and says so.

Involuntary Euthanasia - Euthanasia when the person wants to live but is killed anyway.

Non-voluntary Euthanasia -  Euthanasia when the person cannot make a decision or cannot make their wishes known (coma, too young, senile, brain damaged.

Active Euthanasia -  intending the death of a patient by some act

Passive Euthanasia -  intending the death of a patient by some omission

Ordinary Means of Health Care -  “not only normal food, drink, and rest but all medicines, treatments, and operations which offer a reasonable hope of benefit and which can be obtained and used without excessive pain or other inconvenience”

Extraordinary Means of Health Care - “all medicines, treatments, and operations, which cannot be obtained without excessive expense, pain, or other inconvenience, or which, if used, would not offer a reasonable hope of benefit."

Artificial Nutrition and Hydration (A.N.H.) - supplementing or replacing ordinary eating and drinking by giving a chemically balanced mix of nutrients and fluids through a tube placed directly into the stomach, the upper intestine or a vein - i.e. a feeding tube

Persistant Vegetative State (P.V.S.) -  a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness.

Advance Directive - Living Will - An Advance Medical Directive specifies what medical procedures the patient wishes to receive or to avoid. (An Advance Medical Directive sometimes is called "A Living Will

  •  By this document a person decides completely in advance whether they want to be kept alive by technology. It is a "yes" or "no" statement, which then places the matter in the hands of the medical community. Many Catholic bishops and moralists consider this an unsatisfactory approach, as it does not provide for unforeseen circumstances.

Advance Directive with a Durable Power of Attorney (or a Health Care Proxy) - Durable Power of Attorney specifies a particular individual (variously called a "proxy," "agent," or "surrogate") to make medical decisions on behalf of the patient (or the "principal") when the patient is no longer able to do so. 

  •  These documents give a friend or family member the authority to make health care decisions according to one's mind as expressed in an Advance Directive.  Many Catholic bishops and moralits consider this the wiser decision because it allows the person making decisions to take into account the specific circumstances that the patient is in when they make decisions on their behalf.