On the Care of Persons in the Critical and Terminal Phases of Life
Congregation of the Doctrine of the Faith
22 September, 2019
This document reiterates Catholic teaching about euthanasia and assisted suicide and provides moral guidance on care and treatment near the end of life. It is arranged as follows:
- I. Care For One's Neighbour
- II. The Living Experience of the Suffering Christ and the Proclamation of Hope
- III. The Samaritan's "heart that sees": human life is a sacred and inviolable gift
- IV. The Cultural Obstacles that Obscure the Sacred Value of Every Human Life
- V. The Teaching of the Magisterium
- V.1 The prohibition of euthanasia and assisted suicide
- V.2 The moral obligation to exclude aggressive medical treatment
- V.3 Basic care: the requirement of nutrition and hydration
- V.4 Palliative care
- V.5 The role of the family and hospice
- V.6 Accompaniment and care in prenatal and pediatric medicine
- V.7 Analgesic therapy and loss of consciousness
- V.8 The vegetative state aand the state of minimal consciousness
- V.9 Conscientious objections on the part of healthcare workers and of Catholic healthcare institutions
- V.10 Pastoral accompaniment and the support of the sacraments
- V.11 Pastoral discernment towards those who request Euthanasia or Assisted Suicide
- V.12 The reform of the education and formation of the healthcare workers
Extracts of the document from Part III and V relevant to conscientious objection are reproduced below. V.9 is reproduced in full.
III. The Samaritan's "heart that sees": human life is a sacred and inviolable gift
. . . The Church affirms that the positive meaning of human life is something already knowable by right reason, and in the light of faith is confirmed and understood in its inalienable dignity. This criterion is neither subjective nor arbitrary but is founded on a natural inviolable dignity. Life is the first good because it is the basis for the enjoyment of every other good including the transcendent vocation to share the trinitarian love of the living God to which every human being is called: "The special love of the Creator for each human being 'confers upon him or her an infinite dignity'.
The uninfringeable value of life is a fundamental principle of the natural moral law and an essential foundation of the legal order. 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, andof their life by excluding any further possibility of human relationship, of sensing the meaning of their existence, or of growth in the theologal life.
Moreover, it is to take the place of God in deciding the moment of death. For this reason, "abortion, euthanasia and wilful 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".
V. The Teaching of the Magisterium
1. The prohibition of euthanasia and assisted suicide
With her mission to transmit to the faithful the grace of the Redeemer and the holy law of God already discernible in the precepts of the natural moral law, the Church is obliged to intervene in order to exclude once again all ambiguity in the teaching of the Magisterium concerning euthanasia and assisted suicide, even where these practices have been legalized. . .
. . . the Church is convinced of the necessity to reaffirm as definitive teaching that euthanasia is a crime against human life because, in this act, one chooses directly to cause the death of another innocent human being. The correct definition of euthanasia depends, not on a consideration of the goods or values at stake, but on the moral object properly specified by the choice of "an action or an omission which of itself or by intention causes death, in order that all pain may in this way be eliminated". "Euthanasia's terms of reference, therefore, are to be found in the intention of the will and in the methods used". The moral evaluation of euthanasia, and its consequences does not depend on a balance of principles that the situation and the pain of the patient could, according to some, justify the termination of the sick person. Values of life, autonomy, and decision-making ability are not on the same level as the quality of life as such.
Euthanasia, therefore, is an intrinsically evil act, in every situation or circumstance. In the past the Church has already affirmed in a definitive way "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. Depending on the circumstances, this practice involves the malice proper to suicide or murder".
Any formal or immediate material cooperation in such an act is a grave sin against human life: "No authority can legitimately recommend or permit such an action. For it is a question of the violation of the divine law, an offense against the dignity of the human person, a crime against life, and an attack on humanity".
Therefore, euthanasia is an act of homicide that no end can justify and that does not tolerate any form of
complicity or active or passive collaboration. Those who approve laws of euthanasia and assisted suicide, therefore, become accomplices of a grave sin that others will execute. They are also guilty of scandal because by such laws they contribute to the distortion of conscience, even among the faithful.
Each life has the same value and dignity for everyone: the respect of the life of another is the same as the respect owed to one's own life. One who choses with full liberty to take one's own life breaks one's relationship with God and with others, and renounces oneself as a moral subject. Assisted suicide aggravates the gravity of this act because it implicates another in one's own despair. Another person is led to turn his will from the mystery of God in the theological virtue of hope and thus to repudiate the authentic value of life and to break the covenant that establishes the human family. Assisting in a suicide is an unjustified collaboration in an unlawful act that contradicts the theologal relationship with God and the moral relationship that unites us with others who share the gift of life and the meaning of existence.
When a request for euthanasia rises from anguish and despair, "although in these cases the guilt of the individual may be reduced, or completely absent, nevertheless the error of judgment into which the conscience falls, perhaps in good faith, does not change the nature of this act of killing, which will always be in itself something to be rejected". The same applies to assisted suicide. Such actions are never a real service to the patient, but a help to die.
Euthanasia and assisted suicide are always the wrong choice: "the medical personnel and the other health care workers – faithful to the task 'always to be at the service of life and to assist it up until the very end' – cannot give themselves to any euthanistic practice, neither at the request of the interested party, and much less that of the family. In fact, since there is no right to dispose of one's life arbitrarily, no health care worker can be compelled to execute a non-existent right".
This is why euthanasia and assisted suicide are a defeat for those who theorize about them, who decide upon them, or who practice them.
For this reason, it is gravely unjust to enact laws that legalize euthanasia or justify and support suicide, invoking the false right to choose a death improperly characterized as respectable only because it is chosen. Such laws strike at the foundation of the legal order: the right to life sustains all other rights, including the exercise of freedom. The existence of such laws deeply wound human relations and justice, and threaten the mutual trust among human beings. The legitimation of assisted suicide and euthanasia is a sign of the degradation of legal systems. . .
9. Conscientious objections on the part of healthcare workers and of Catholic healthcare institutions
In the face of the legalization of euthanasia or assisted suicide – even when viewed simply as another form of medical assistance – formal or immediate material cooperation must be excluded. Such situations offer specific occasions for Christian witness where "we must obey God rather than men" (Acts 5:29). There is no right to suicide nor to euthanasia: laws exist, not to cause death, but to protect life and to facilitate co-existence among human beings. It is therefore never morally lawful to collaborate with such immoral actions or to imply collusion in word, action or omission. The one authentic right is that the sick person be accompanied and cared for with genuine humanity. Only in this way can the patient's dignity be preserved until the moment of natural death. "No health care worker, therefore, can become the defender of a non-existing right, even if euthanasia were requested by the subject in question when he was fully conscious".
In this regard, the general principles regarding cooperation with evil, that is, with unlawful actions, are thus reaffirmed: "Christians, like all people of good will, are called, with a grave obligation of conscience, not to lend their formal collaboration to those practices which, although allowed by civil legislation, are in contrast with the Law of God. In fact, from the moral point of view, it is never licit to formally cooperate in evil. This cooperation occurs when the action taken, either by its very nature or by the configuration it is assuming in a concrete context, qualifies as direct participation in an act against innocent human life, or as sharing the immoral intention of the principal agent. This cooperation can never be justified neither by invoking respect for the freedom of others, nor by relying on the fact that civil law provides for it and requires it: for the acts that each person personally performs, there is, in fact, a moral responsibility that no one can ever
escape and on which each one will be judged by God himself (cf. Rm 2:6; 14:12)".
Governments must acknowledge the right to conscientious objection in the medical and healthcare field, where the principles of the natural moral law are involved and especially where in the service to life the voice of conscience is daily invoked.Where this is not recognized, one may be confronted with the obligation to disobey human law, in order to avoid adding one wrong to another, thereby conditioning one's conscience. Healthcare workers should not hesitate to ask for this right as a specific contribution to the common good.
Likewise, healthcare institutions must resist the strong economic pressures that may sometimes induce them to accept the practice of euthanasia. If the difficulty in finding necessary operating funds creates an enormous burden for these public institutions, then the whole society must accept an additional liability in order to ensure that the incurably ill are not left to their own or their families' resources. All of this requires that episcopal conferences and local churches, as well as Catholic communities and institutions, adopt a clear and unified position to safeguard the right of conscientious objection in regulatory contexts where euthanasia and suicide are sanctioned.
Catholic healthcare institutions constitute a concrete sign of the way in which the ecclesial community takes care of the sick following the example of the Good Samaritan. The command of Jesus to "cure the sick," (Lk 10:9) is fulfilled not only by laying hands on them, but also by rescuing them from the streets, assisting them in their own homes, and creating special structures of hospitality and welcome. Faithful to the command of the Lord, the Church through the centuries has created various structures where medical care finds its specific form in the context of integral service to the sick person.
Catholic healthcare institutions are called to witness faithfully to the inalienable commitment to ethics and to the fundamental human and Christian values that constitute their identity. This witness requires that they abstain from plainly immoral conduct and that they affirm their formal adherence to the teachings of the ecclesial Magisterium. Any action that does not correspond to the purpose and values which inspire Catholic healthcare institutions is not morally acceptable and endangers the identification of the institution itself as"Catholic."
Institutional collaboration with other hospital systems is not morally permissible when it involves referrals for persons who request euthanasia. Such choices cannot be morally accepted or supported in their concrete realization, even if they are legally admissible. Indeed, it can rightly be said of laws that permit euthanasia that "not only do they create no obligation for the conscience, but instead there is a grave and clear obligation to oppose them by conscientious objection. From the very beginnings of the Church, the apostolic preaching reminded Christians of their duty to obey legitimately constituted public authorities (cf. Rm 13:1-7; 1 Pt 2:13-14), but at the same time firmly warned that 'we must obey God rather than men' (Acts 5:29)".
The right to conscientious objection does not mean that Christians reject these laws in virtue of private religious conviction, but by reason of an inalienable right essential to the common good of the whole society. They are in fact laws contrary to natural law because they undermine the very foundations of human dignity and human coexistence rooted in justice.