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 September 20, 2010   •   VOL. 48, NO. 16   •   Oakland, CA

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What does the Church teach about care for the dying?
Justice can be served without the death penalty
Respect Life Month
What does the Church teach
about care for the dying?

Respect Life Month, an educational program of the U.S. Conference of Catholic Bishops, begins Sunday, Oct. 3. This year’s materials focus on several life issues, including the care of those who are dying. Below is a USCCB interview with Marie Hilliard, director of bioethics and public policy for The National Catholic Bioethics Center. She is a canon lawyer and a registered nurse.

What does the Church teach about pain control and consciousness?

The “Ethical and Religious Directives for Catholic Health Care Services” state, “Patients should be kept as free of pain as possible so that they may die comfortably and 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.”

The Church teaches that unless a person is very near death, nutrition and hydration, even by artificial means, should be administered as long as they can sustain life and alleviate suffering without imposing serious risks or side effects to the patient.

In some cases, pain control may require brief or prolonged periods of unconsciousness. Pain control can be provided even if, in rare cases, the needed doses may have an anticipated, but unintended effect of hastening death.

The intention is to control extreme pain, not to hasten death. With euthanasia, however, there is an explicit intent to terminate the patient’s life, representing a grave evil with eternal consequences.

Currently, three states (Oregon, Washington and Montana) allow physician-assisted suicide. Some states practice a more covert form of euthanasia, providing patients who suffer from physical or even psychological pain with high doses of sedation, when other effective relief is available.

Then assisted nutrition and hydration are withheld, causing death by dehydration or starvation, not the underlying pathology. This is sometimes called “terminal sedation,” distinguishable from the legitimate use of sedation as a last resort to treat patient suffering in their last days. The difference is in the physician’s intent, whether it is to end life or control pain.

What does the Church teach about providing food and water to unconscious or dying patients?

Pope John Paul II taught: “I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.”

This principle has been affirmed by the Congregation for the Doctrine of the Faith and incorporated into the “Ethical and Religious Directives” in 2009.

What does the Church teach about the patient’s right to refuse or forego certain medical treatments?

The papal encyclical “The Gospel of Life” condemns euthanasia, drawing a key distinction between euthanasia and the decision to forego “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.’”

It is clear that there is no moral requirement to utilize burdensome treatments that merely prolong the dying process. Unless the patient is very near death, however, the provision of nutrition and hydration, even by artificial means, should be administered as long as they can sustain life and alleviate suffering without imposing serious risks or side effects to the patient.

Today active interventions or omissions of basic care are proposed for ending the lives of not only the dying, but also patients suffering from a long-term cognitive disability, such as advanced dementia or a so-called persistent “vegetative” state. Some argue that patients who cannot consciously respond have lost their “human dignity.”

This view is dangerously wrong: Human beings never lose their dignity, that is, their inherent and inestimable worth as unique persons loved by God and created in His image. People can be denied respect affirming that dignity, but they never lose their God-given dignity.

What does the Church teach about our duty to care for dying or vulnerable family members?

When a family or health care providers refuse to provide basic care (nutrition, hydration, cleanliness, warmth, and prevention of complications from confinement to bed), finding it “inconvenient” to accompany the loved one on the final journey, the assault on human dignity is grave.

When such abandoning of the disabled or unconscious patient is codified in state laws, the implications for society are frightening. Pope Benedict XVI states in his encyclical “In Hope We Are Saved” (Spe Salvi), Nov. 20, 2007: “The true measure of humanity is essentially determined in relationship to suffering and to the sufferer. . . . A society unable to accept its suffering members and incapable of helping to share their suffering and to bear it inwardly through ‘compassion’ is a cruel and inhuman society.”

Christ calls us to love one another: “This is my commandment: love one another as I love you” (John 15:12). He loved us unto death, even death on the cross. Few are called to such a sacrifice; but we are called to be companions to each other, especially to those suffering on life’s journey.

“Companion” is taken from the word “cum-panis,” meaning “with bread.” Thus, we are called to share the bread of Eucharist with each other, responding with Christ’s sacrificial love. We are asked not only to care for each other, but to nourish each other, even unto death.

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Justice can be served without the death penalty

In January of 1999, Pope John Paul II made a pastoral visit to St. Louis. When he met with Missouri’s Governor Mel Carnahan, the Holy Father asked him to commute the death sentence of Darrell Mease, who was scheduled to be executed in the next weeks. Carnahan granted the Pope’s wish, saying he was moved by the pope’s appeal for mercy.

The pope did not request a reevaluation of the merits of the condemned man’s case. Rather, he presented a simple and straightforward petition for mercy. The sentence was changed from death by lethal injection to life imprisonment without parole.

The common good of society remained protected from the perpetrator. Justice was not confounded, but a higher purpose was served in putting aside the irreversible remedy of death.

Responsibility to protect society

The Church’s stance on capital punishment has always been based on the responsibility to protect society. St. Thomas Aquinas says that the legitimate civil authority is obliged to defend people from a dangerous criminal.

At the same time, he cautions, “The execution of the wicked is forbidden wherever . . . the wicked are not clearly distinguished from the good.”

Besides reminding us of well-known cases where innocent people were condemned to die, this should remind us that as Christians we are urged not to see anyone as irredeemably wicked.

Prior to his intervention in St. Louis, Pope John Paul had laid out his case for the limitation of the use of the death penalty in his encyclical “The Gospel of Life” (Evangelium Vitae) in 1995 and in his extraordinary 1997 modification of the Catechism of the Catholic Church.

He still allowed for the application of the death penalty as a just choice that authority may make in its responsibility to safeguard society from the unjust aggressor. Yet the revised text goes on to say:

“Today, in fact, as a consequence of the possibilities which the state has for effectively preventing crime, by rendering one who has committed an offense incapable of doing harm — without definitively taking away from him the possibility of redeeming himself — the cases in which the execution of the offender is an absolute necessity ‘are very rare, if not practically nonexistent.’”

The sworn responsibility of authority to secure the common good is not easily laid aside. But here the Church, convinced that society can be protected without executing dangerous criminals, charges us to look to a less violent, less final remedy.

The Catechism directs us to a solution that preserves the common good without definitively curtailing the individual good of the perpetrator, offering him the opportunity for redemption.

Each man, no matter how sinful and flawed, has a final purpose and call to salvation, one that we ought not too easily or unnecessarily preempt.

The above is the “ought” for laying aside the death penalty: legitimate authority can fulfill its responsibility using lesser but sufficient means for protecting the common good. But we should add that the argument of Divine Mercy, while never violating justice, transcends the human “ought.”

Mercy surpasses justice

The correct dispensing of justice always seeks to provide something which is well suited to the person and the circumstance. Justice is giving each person his “due.” (CCC, no. 1807) When Jesus freely submitted to human “justice,” He provided by means of His Cross an act of justification that, because He was divine, satisfied all our sins.

God did not abolish justice. Rather, He intended by the offering of His Son to purge human justice of any sense of wrath or revenge.

Time and again we see that violence begets violence in a seeming unending spiral. God told St. Faustina that “Mankind will not have peace until it turns with trust to My mercy.”

In the Divine Mercy, God receives and quenches human vengeance in Jesus’ own wounded Heart. In this Heart, which is an abyss of love, mercy overcomes hatred. Mercy brings healing that is impossible on a merely human level.

Divine Mercy can restore hope, because it flows from the heart of the Risen Christ, who, once and for all, has vanquished the finality of death. The deep truth that faith teaches is that only in the context of mercy—God’s Mercy and our own forgiveness and mercy—can we, as wounded human men and women, find healing and hope.

“Blessed are the merciful, for they will be shown mercy” (Mt 5:7).

(Bishop Robert Finn is bishop of the Diocese of Kansas City—St. Joseph [Missouri] and a consultant to the Committee on Pro-Life Activities of the United States Conference of Catholic Bishops.)

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