Magisterium on the end-of-life /1

Pope Francis, September 20th 2019

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ADDRESS OF HIS HOLINESS POPE FRANCIS TO THE NATIONAL FEDERATION OF THE ORDERS OF DOCTORS AND DENTAL SURGEONS - Clementine Hall - Friday, 20 September 2019

Dear brothers and sisters, (…) We must always remember that illness, the object of your concerns, is more than a clinical fact, medically circumscribable; it is always the condition of a person, the sick person, and it is with this entirely human vision that doctors are called to relate to the patient: considering therefore his singularity as a person who has an illness, and not only a case of whatever illness that patient has. For doctors it is a matter of possessing, together with the due technical-professional competence, a code of values and meanings with which to give meaning to the disease and to their work, and to make each individual clinical case a human encounter.

Faced, therefore, with any change in medicine and in the society you have identified, it is important that the doctor does not lose sight of the uniqueness of each patient, with his dignity and his fragility. A man or a woman to be accompanied with conscience, intelligence and heart, especially in the most serious situations. With this attitude we can and must reject the temptation – also induced by legislative changes – to use medicine to support a possible willingness to die of the patient, providing assistance to suicide or directly causing death by euthanasia.

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 discard as a possibility, or false compassion in the face of the request to be helped to anticipate death. As the New Charter for Health Care Workers states: “There is no right to dispose arbitrarily of one's life, so no doctor can become an executive guardian of a non-existent right” (169).

 

Magisterium on the end-of-life /2

Pope Francis, 2017

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MESSAGE OF HIS HOLINESS POPE FRANCIS TO THE PARTICIPANTS IN THE EUROPEAN REGIONAL MEETING OF THE WORLD MEDICAL ASSOCIATION - [Vaticano, Aula Vecchia del Sinodo, 16-17 novembre 2017]

To My Venerable Brother Archbishop Vincenzo Paglia President of the Pontifical Academy for Life (…) It is clear that not adopting, or else suspending, disproportionate measures, means avoiding overzealous treatment; from an ethical standpoint, it is completely different from euthanasia, which is always wrong, in that the intent of euthanasia is to end life and cause death. Needless to say, in the face of critical situations and in clinical practice, the factors that come into play are often difficult to evaluate. To determine whether a clinically appropriate medical intervention is actually proportionate, the mechanical application of a general rule is not sufficient. There needs to be a careful discernment of the moral object, the attending circumstances, and the intentions of those involved. In caring for and accompanying a given patient, the personal and relational elements in his or her life and death – which is after all the last moment in life – must be given a consideration befitting human dignity. In this process, the patient has the primary role.

(…) the supreme commandment of responsible closeness, must be kept uppermost in mind, as we see clearly from the Gospel story of the Good Samaritan (cf. Lk 10:25-37). It could be said that the categorical imperative is to never abandon the sick. The anguish associated with conditions that bring us to the threshold of human mortality, and the difficulty of the decision we have to make, may tempt us to step back from the patient.

Yet this is where, more than anything else, we are called to show love and closeness, recognizing the limit that we all share and showing our solidarity. Let each of us give love in his or her own way—as a father, a mother, a son, a daughter, a brother or sister, a doctor or a nurse.

But give it! 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.

This approach is reflected in palliative care, which is proving most important in our culture, as it opposes what makes death most terrifying and unwelcome—pain and loneliness. Within democratic societies, these sensitive issues must be addressed calmly, seriously and thoughtfully, in a way open to finding, to the extent possible, agreed solutions, also on the legal level. On the one hand, there is a need to take into account differing world views, ethical convictions and religious affiliations, in a climate of openness and dialogue.

On the other hand, the state cannot renounce its duty to protect all those involved, defending the fundamental equality whereby everyone is recognized under law as a human being living with others in society. Particular attention must be paid to the most vulnerable, who need help in defending their own interests.

If this core of values essential to coexistence is weakened, the possibility of agreeing on that recognition of the other which is the condition for all dialogue and the very life of society will also be lost. Legislation on health care also needs this broad vision and a comprehensive view of what most effectively promotes the common good in each concrete situation.

 

Magisterium on the end-of-life /3

Catechism of the Catholic Church

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Euthanasia

2276 Those whose lives are diminished or weakened deserve special respect. Sick or handicapped persons should be helped to lead lives as normal as possible.

2277 Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicapped, sick, or dying persons.
It is morally unacceptable.

Thus an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator.
The error of judgment into which one can fall in good faith does not change the nature of this murderous act, which must always be forbidden and excluded.

2278 Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of "over-zealous" treatment.
Here one does not will to cause death; one's inability to impede it is merely accepted.
The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.

2279 Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted.
The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable
Palliative care is a special form of disinterested charity.
As such it should be encouraged.

Suicide

2280 Everyone is responsible for his life before God who has given it to him.
It is God who remains the sovereign Master of life.
We are obliged to accept life gratefully and preserve it for his honor and the salvation of our souls.
We are stewards, not owners, of the life God has entrusted to us.
It is not ours to dispose of.

2281 Suicide contradicts the natural inclination of the human being to preserve and perpetuate his life.
It is gravely contrary to the just love of self.
It likewise offends love of neighbor because it unjustly breaks the ties of solidarity with family, nation, and other human societies to which we continue to have obligations.
Suicide is contrary to love for the living God.

2282 If suicide is committed with the intention of setting an example, especially to the young, it also takes on the gravity of scandal.
Voluntary co-operation in suicide is contrary to the moral law.
Grave psychological disturbances, anguish, or grave fear of hardship, suffering, or torture can diminish the responsibility of the one committing suicide.

2283 We should not despair of the eternal salvation of persons who have taken their own lives. By ways known to him alone, God can provide the opportunity for salutary repentance. the Church prays for persons who have taken their own lives.

 

CONGREGATION FOR THE DOCTRINE OF THE FAITH DECLARATION ON EUTHANASIA

1980

IV. DUE PROPORTION IN THE USE OF REMEDIES

Today it is very important to protect, at the moment of death, both the dignity of the human person and the Christian concept of life, against a technological attitude that threatens to become an abuse. Thus some people speak of a "right to die," which is an expression that does not mean the right to procure death either by one's own hand or by means of someone else, as one pleases, but rather the right to die peacefully with human and Christian dignity. From this point of view, the use of therapeutic means can sometimes pose problems. In numerous cases, the complexity of the situation can be such as to cause doubts about the way ethical principles should be applied. In the final analysis, it pertains to the conscience either of the sick person, or of those qualified to speak in the sick person's name, or of the doctors, to decide, in the light of moral obligations and of the various aspects of the case. Everyone has the duty to care for his or he own health or to seek such care from others. Those whose task it is to care for the sick must do so conscientiously and administer the remedies that seem necessary or useful. However, is it necessary in all circumstances to have recourse to all possible remedies? In the past, moralists replied that one is never obliged to use "extraordinary" means. This reply, which as a principle still holds good, is perhaps less clear today, by reason of the imprecision of the term and the rapid progress made in the treatment of sickness. Thus some people prefer to speak of "proportionate" and "disproportionate" means. In any case, it will be possible to make a correct judgment as to the means by studying the type of treatment to be used, its degree of complexity or risk, its cost and the possibilities of using it, and comparing these elements with the result that can be expected, taking into account the state of the sick person and his or her physical and moral resources.

In order to facilitate the application of these general principles, the following clarifications can be added:

- If there are no other sufficient remedies, it is permitted, with the patient's consent, to have recourse to the means provided by the most advanced medical techniques, even if these means are still at the experimental stage and are not without a certain risk. By accepting them, the patient can even show generosity in the service of humanity.

- It is also permitted, with the patient's consent, to interrupt these means, where the results fall short of expectations. But for such a decision to be made, account will have to be taken of the reasonable wishes of the patient and the patient's family, as also of the advice of the doctors who are specially competent in the matter. The latter may in particular judge that the investment in instruments and personnel is disproportionate to the results foreseen; they may also judge that the techniques applied impose on the patient strain or suffering out of proportion with the benefits which he or she may gain from such techniques.

- It is also permissible to make do with the normal means that medicine can offer. Therefore one cannot impose on anyone the obligation to have recourse to a technique which is already in use but which carries a risk or is burdensome. Such a refusal is not the equivalent of suicide; on the contrary, it should be considered as an acceptance of the human condition, or a wish to avoid the application of a medical procedure disproportionate to the results that can be expected, or a desire not to impose excessive expense on the family or the community.

- When inevitable death is imminent in spite of the means used, it is permitted in conscience to take the decision to 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. In such circumstances the doctor has no reason to reproach himself with failing to help the person in danger.