In an age when medical technology makes it possible to extend human life far beyond what was previously possible, the nine active Catholic bishops serving Maryland have completed a new pastoral letter aimed at helping Catholics apply their faith to end-of-life decisions.
“Comfort and Consolation: Care of the Sick and Dying,” was presented June 6 at St. Mary’s Seminary and University in Roland Park during a meeting of the governing and administrative boards of the Maryland Catholic Conference.
Emphasizing the dignity of every human life, the 35-page letter offers moral guidance on questions relating to medical care and treatment, nutrition and hydration, pain-relieving medication, pregnancy and imminent death from terminal illness.
The letter’s publication represents the second time Maryland’s bishops have addressed the topic. In 1993, they issued a 13-page pastoral letter called “Care of the Sick and Dying” on the heels of the passage of the Maryland Medical Decisions Act.
The newest document builds on the earlier one, adding teachings from Evangelium Vitae, Pope John Paul II’s 1995 encyclical on the Gospel of Life.
While “Comfort and Consolation” does not provide what the bishops called “ready-made answers” for every individual situation, it offers the church’s teachings on ways of preserving human dignity in a variety of difficult circumstances.
“Our faith teaches us to see human life as a precious gift from God; we are not its owners but its guardians,” the bishops said. “As such, we must oppose direct attacks on innocent human life.”
Suicide and euthanasia
The bishop reaffirmed that since each person is a “steward of human life,” no one has a right to commit suicide or take another’s life by euthanasia. “We can readily understand how a person in prolonged agony, with no hope of recovery, might view death as a release from suffering,” the bishops said. “We also can appreciate how a family might even pray for the death of a loved one afflicted with an incurable disease. But no one must ever presume to adopt a course of action or inaction which is intended to cause death, even if the motive is to alleviate suffering.”
The bishops said there is a distinction between euthanasia and “morally upright decisions” about accepting or refusing medical treatments in time of grave illness and imminent death.
Caregivers must never be indifferent to human suffering, the bishops said. If a dying person needs increasingly greater dosages of pain medication, the bishops said it is morally acceptable for the patient or caregiver to provide the medication “even if the patient is made less alert or responsive, or if this increase should hasten death.”
“Pain medication, however, must never be given for the purpose of hastening death,” they said.
The bishops emphasized that no one, including the patient, family members, medical professionals or members of the clergy, “has the right to decide that a patient’s life is useless, even when a patient is no longer able to perform basic human functions.”
Recognizing the difficult decisions that must be faced by those in end-of-life situations, the bishops recommended praying for prudence.
“In making decisions for others, we must prudently apply the same principles that we should use if we were making those decisions for ourselves,” they said.
Tube feeding
The bishops said there is a “clear presumption in favor of providing medically assisted nutrition and hydration” to the terminally ill. But there may be certain circumstances in which it may be morally sound to discontinue tube feeding, they said.
“We consider it both morally and medically inappropriate to make a universal statement that medically assisted nutrition and hydration must be given to all who cannot feed themselves,” they said, noting that it is similarly “misleading” to make a universal statement that all gravely ill persons should not be provided nutrition and hydration.
“The prudent course of action is to consider the facts of the particular case and to determine whether a patient’s need for nourishment and fluid can be met effectively through a medical intervention whose use does not impose excessive burdens on the patient,” the bishops said.
The document states that patients or those who represent them should “choose medically assisted nutrition and hydration except when the patient can no longer absorb them or when, having sought good counsel, the patient or the proxy judges it excessively burdensome to the patient.”
The bishops gave the example of a cancer patient who is not expected to live more than six months and who is unable to absorb medically assisted nutrition and hydration. In such a case, the “prudent judgment” is to discontinue tube feeding, they said. Similarly, another patient may have a condition which makes tube feeding so burdensome that the “prudent judgment” would be to discontinue it, they said.
The bishops said there is no moral obligation for caregivers to continue to provide nutrition or hydration that cannot be absorbed by terminal patients near death.
Quoting Pope John Paul II, the bishops noted that in the case of an individual in a persistent vegetative state, medically assisted nutrition and hydration must not be refused or withdrawn. Such persons have a right to basic health care, they said.
Do not resuscitate
With “Do Not Resuscitate” directives (DNRs) becoming increasingly common, the bishops said the decision of whether resuscitation should be attempted “should be based on the patient’s actual medical condition.”
“Though a DNR may be justifiable at times, it often can be inappropriate for individuals to stipulate in advance that they are not to be resuscitated under any circumstances,” the bishops said.
Catholics should consider whether resuscitation is medically useful, futile or unduly burdensome to the patient, they said.
The pastoral letter encourages Catholics to become familiar with Maryland’s health Care Decisions Act which recognizes advance directives – legal documents individuals can use to guide their medical care after they can no longer make decisions or inform others of their desires.
The bishops warned that some advance directives that are available to consumers permit authorization of actions that do respect church teachings.
“We should use great caution in choosing any standardized directive,” they said. The bishops encouraged individuals to choose health care agents who respect their Catholic beliefs.
Comfort and Consolation includes a four-page form Catholics can use to tell health-care providers how they want to direct their care.
For information on purchasing copies of the pastoral letter, call 410-269-1155 or go to www.mdcathcon.org. The letter is $4.75 per copy, with discounts for bulk purchases.