Vatican Statements at Foundation of End of Life Care Positions

Vatican Letter on Care in Critical and Terminal Phases of Life

In September of 2020, the Congregation of the Doctrine of the Faith published the letter, Samaritanus bonus, on the care of persons in the critical and terminal phases of life.  This letter reaffirms the clear teaching of the Church to oppose euthanasia even if patients or family members request it by clarifying the limits of personal autonomy:

“Just as we cannot make another person our slave, even if they ask to be, so we cannot directly choose to take the life of another, even if they request it. Therefore, to end the life of a sick person who requests euthanasia is by no means to acknowledge and respect their autonomy, but on the contrary to disavow the value of both their freedom, now under the sway of suffering and illness, and of their life by excluding any further possibility of human relationship, of sensing the meaning of their existence, or of growth in the theological life. Moreover, it is to take the place of God in deciding the moment of death. For this reason, “abortion, euthanasia and willful self-destruction (…) poison human society, but they do more harm to those who practice them than those who suffer from the injury. Moreover, they are a supreme dishonor to the Creator.”

The letter goes on to discuss approaching death with one’s proper human and Christian dignity intact which includes recognition that while disproportionate medical interventions can be morally withdrawn, basic care must always be provided.

“The Magisterium of the Church recalls that, when one approaches the end of earthly existence, the dignity of the human person entails the right to die with the greatest possible serenity and with one’s proper human and Christian dignity intact. To precipitate death or delay it through “aggressive medical treatments” deprives death of its due dignity. Medicine today can artificially delay death, often without real benefit to the patient. When death is imminent, and without interruption of the normal care the patient requires in such cases, it is lawful according to science and conscience to renounce treatments that provide only a precarious or painful extension of life. It is not lawful to suspend treatments that are required to maintain essential physiological functions, as long as the body can benefit from them (such as hydration, nutrition, thermoregulation, proportionate respiratory support, and the other types of assistance needed to maintain bodily homeostasis and manage systemic and organic pain). The suspension of futile treatments must not involve the withdrawal of therapeutic care. This clarification is now indispensable in light of the numerous court cases in recent years that have led to the withdrawal of care from – and to the early death of–critically but not terminally ill patients, for whom it was decided to suspend life-sustaining care which would not improve the quality of life.”

This letter also emphasizes the importance of the rights of conscience of healthcare providers:

“Every medical action must always have as its object—intended by the moral agent—the promotion of life and never the pursuit of death. The physician is never a mere executor of the will of patients or their legal representatives, but retains the right and obligation to withdraw at will from any course of action contrary to the moral good discerned by conscience.”[1]

In addition to addressing obligations to receive or exclude interventions, the statement also addresses the value of palliative care:

“Palliative medicine constitutes a precious and crucial instrument in the care of patients during the most painful, agonizing, chronic and terminal stages of illness. Palliative care is an authentic expression of the human and Christian activity of providing care, the tangible symbol of the compassionate “remaining” at the side of the suffering person.

“Experience teaches us that the employment of palliative care reduces considerably the number of persons who request euthanasia. To this end, a resolute commitment is desirable to extend palliative treatments to those who need them, within the limits of what is fiscally possible, and to assist them in the terminal stages of life, but as an integrated approach to the care of existing chronic or degenerative pathologies involving a complex prognosis that is unfavorable and painful for the patient and family.”

[1] Samaritanus Bonus, no. 2, Congregation for the Doctrine of the Faith

Pope Pius XII on Principle of Disproportionate Means

This principle constitutes an important approach to the analysis of ethical questions arising from the general obligation to preserve human life and the limits of that obligation. Among other questions, the principle addresses whether the foregoing of life-sustaining treatment constitutes euthanasia or physician-assisted suicide in certain circumstances and it guides individuals and surrogate decision-makers in the weighing of benefits and burdens. Pope Pius XII gave magisterial expression to the distinction between ordinary and extraordinary means in his November 24, 1957 address to Catholic physicians and anesthesiologists:

“Normally one is held to use only ordinary means--according to the circumstances of persons, places, times and culture--that is to say, means that do not involve any grave burden for oneself or another. A stricter obligation would be too burdensome for most people and would render the attainment of the higher, more important good too difficult. Life, health, all temporal activities are in fact subordinated to spiritual ends. On the other hand, one is not forbidden to take more than the strictly necessary steps to preserve life and health, as long as one does not fail in some more serious duty.”

Pope Paul VI on the Role of the Physician

Pope Paul VI addressed the role of physician in delivering end of life care in his Oct. 3 1970 letter to the International Federation of Catholic Medical Associations:

"The physician's duty consists rather of endeavoring to soothe the suffering instead of prolonging as long as possible by any means and under any conditions a life that is naturally approaching its conclusion."

He further developed this theme of the physicians role to respect life and dignity in his 1975 address to the International College of Psychosomatic Medicine, stating:

“Keeping in mind the value of every human person, we wish to recall that it is the physician's duty always to be at the service of life and to assist it until the end without ever accepting euthanasia or renouncing the exquisitely human duty to help it complete it’s earthly course with dignity.”

Vatican on Balanced Resolution of Disagreements on End-of-Life Care and Death with Christian Dignity

The Declaration on Euthanasia, published by the Congregation for the Doctrine of the Faith on May 5, 1980, explained the distinction between proportionate and disproportionate means, and between therapeutic treatments and the normal care due to the sick person

“It is also permitted to interrupt these [disproportionate] 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 doctors who are specifically competent in the matter.” (IV)

In addition, this critical Vatican document also outlined the concept of a Christian life and death.

“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 n expression that does not mean the right to procure death, either by one’s own hand or by means of someone else’s one pleases, but rather the right to die peacefully with human and Christian dignity.” (IV)

Pope John Paul II on Forgoing Aggressive Medical Treatment

Pope John Paul II’s 1995 encyclical, The Gospel of Life, is the seminal document on the protection of the life and dignity of the human person. In this encyclical, Blessed Pope John Paul II makes the distinction between euthanasia and forgoing aggressive medical treatment:

“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.” (No. 65)

“In such situations when death is clearly imminent and inevitable, one can certainly 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." (No. 65)

Vatican on Provision of Artificially Administered Nutrition & Hydration

In August of 2007, the Congregation of the Doctrine of the Faith responded to questions posted by the United States Bishops concerning the moral obligation to provide artificially administered nutrition and hydration. It is here that they outlined exceptions to it’s use:

“Nor is the possibility excluded that, due to emerging complications, a patient may be unable to assimilate food and liquids, so that their provision becomes altogether useless. Finally, the possibility is not absolutely excluded that, in some rare cases, artificial nourishment and hydration may be excessively burdensome for the patient or may cause significant physical discomfort, for example resulting from complications in the use of the means employed.”