By Father Edward J. Dillon

Father Dillon, a noted canon lawyer, heads the marriage tribunal for the Province of Atlanta. His title is Officialis of the Court of Appeals

On March 12, 1984, under the headline “Pope concurs with Living Will idea” an article appeared in the Atlanta Constitution in the column “Dear Abbey.” The column quoted from a document issued by the Holy See and approved by Pope John Paul II on May 5, 1980 and interpreted the quotes as approving the idea of the so-called “living will” legislation. The quotes are correct, although taken out of context. The conclusion derived from them by Ms. Van Buren, is not correct and is, in fact, misleading.

The Catholic Church holds as a basic value that human life, from conception to death, is sacred. Anything which directly attacks innocent human life is a violation of God’s order, an attack on a fundamental right which stems from human nature and, therefore, always gravely wrong. The Sacred Congregation for the Doctrine of the Faith, acting in the name of the Holy Father and with his explicit approval, on May 5, 1980, issued a declaration which re-states the above doctrine and outlines its application to questions such as euthanasia, suffering and the medical treatment of the gravely ill. It is important at the outset to understand that the Declaration does not in any way change the Church’s position in this but, rather, re-states in a concise way and in response to specific questions the doctrine taught consistently by every Pope since Pius XII. This, in turn, is a formulation of what has consistently been held by the Church’s moral theologians. In this statement, we simply undertake to present the kernel of that doctrine in a concise fashion and to explain it where necessary lest there be any misunderstanding about what the Church teaches.

The DECLARATION is divided into four (4) sections.

I

Human life is always sacred and is held by each individual as a sacred trust from God. Each person, regardless of religious belief, has a duty to conduct his or her life in accordance with God’s plan. Obviously, however, that obligation becomes even more significant in the case of a Christian. The duty involves not only protecting and preserving life but also insuring that, by the manner in which it is led, one’s life constitutes a service of the Father. Two principles follow as a consequence of this.

1. Innocent human life may never be attacked directly. To do so is always gravely wrong.
2. 2. Deliberately attacking one’s own life is equally wrong.

II

The word “euthanasia” is used in a variety of meanings. In the context of the Vatican DECLARATION it is understood to mean any action or omission which of itself or by intention causes death so as to eliminate suffering. It is clear from this definition that the moral issue involved will address itself to both the intention of the individual and the means to accomplish the intended goal.

The Church’s position on euthanasia is very clear. “No one can in any way permit the killing of an innocent human being, whether a fetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying.” Likewise, no one is permitted to ask such killing form himself or herself, or for one entrusted to his or her care. That some people might conscientiously believe such killing to be permissible can be attributed only to an error of conscience which, while it might lessen the sin involved, does not in any way diminish the objective moral sinfulness of the act.

III

Suffering is a part of the human condition. The suffering associated with death sometimes becomes extreme. Such suffering can bring special graces to the sick person when united with the sufferings of Christ and offered as a sacrifice to the Father. At the same time, however, such heroic action is a special call or vocation from the Father and is not demanded as an essential part of being a Christian. The Church teaches that “human and Christian prudence suggest for the majority of sick people the use of medicines capable of alleviating or suppressing pain:” even though their use may diminish significantly the person’s consciousness. Even in the case where the individual patient is not in a position to express the wish that such medication be administered, it can reasonably be presumed that he or she would wish this course to be followed, and the person who is responsible for the care of the patient may direct that they be administered in accordance with medical advice.

Pope Pius XII taught that such medication may be administered even if it would totally deprive the person of consciousness and even if it could reasonably be foreseen that it might shorten life. In this case the direct intention is not to cause death but to alleviate pain. The Pope, however, also cautioned that such medication should be used only for the most serious reason since it deprives a person of consciousness and that it should never be used in such a way that it deprives the patient of the ability to satisfy his or her moral obligations or of the opportunity to prepare spiritually and with full consciousness to meet Christ.

IV

Medical science has made remarkable advances and, in many cases, can maintain life, for long periods of time, for a terminally ill person. When people speak of a “right to die” in this context they are not generally talking about the right to procure death directly by some action such as is mentioned above under the topic of euthanasia. Rather, they are talking about a right to die peacefully with human and Christian dignity.

Since life does not belong to the individual but is held in trust from God, every person has a duty to care for that life. Moral theologians always taught that this duty does not, however, oblige a person to use all possible medical remedies. According to this teaching, which accurately reflects the mind of the Church, one is obliged to resort only to “ordinary” or “proportionate” means to preserve health and life.

A question arises as to what is “ordinary” or “proportionate.” To resolve that question it is necessary to take each individual case under a separate consideration and arrive at a decision after studying the precise type of treatment to be used, the degree of risk or burden involved for the patient and its financial impact on the patient and family. The results of such a consideration must be contrasted with the beneficial result the treatment might have on the patient.

There is, obviously, a delicate balance involved here. Struggling to preserve life artificially at all costs is not an absolute value, especially if the patient will be preserved only in a vegetative state. It is, however, morally permissible for a patient to consent to even experimental medical techniques to alleviate suffering or seek a cure when there is no other reasonably sufficient remedy available. Even when such techniques are initiated, the patient is morally entitled to direct that they cease if it is clear that the techniques impose strain or suffering out of proportion to the benefits he or she may gain from them. Likewise, in such a situation when the patient is unable to make the necessary decision, it can be made by the family or person who has the care of the patient. It may also be made by the physician when it is judged that the above conditions prevail or when it is judged that the investment in medical resources, instruments and personnel, is disproportionate to the good that might be accomplished for the patient.

It is not possible to impose on anyone an obligation to undertake a medical procedure which is gravely burdensome or carries a risk or involves an excessive expense to the family or the community out of proportion to the results that can be expected “disproportionate” or “extraordinary.” It is quite permissible in such cases to accept only the normal means medicine can offer even though it can be foreseen as reasonable that these will not be sufficient.

When death is imminent or inevitable despite the means used, it is morally permissible to refuse forms of treatment which would prolong life only in a precarious or burdensome way. It is likewise morally permissible to refuse treatments when it can reasonably be foreseen that the person cannot be maintained in a cognitive state commensurate with the dignity of the human person. In all such cases, however, the normal care due to a sick person in similar circumstances may not be interrupted or terminated.

The preservation of human life is a fundamental value. It must, however, always be approached in such a way as to preserve also the individual’s dignity as a human being and a child of God. Although a tension may exist between the two, there need never be a contradiction so long as we place our faith and hope in God, seeing Him as our beginning and end. As St. Paul teaches: “If we live, we live to the Lord, and if we die we die to the Lord.” (Romans 14:8).

Catholic opposition locally to proposed “living will” legislation has been based on the fact that, to date, all bills presented on this subject have been and are seriously flawed whether considered from the point of view of a statement of law or from the point of view of a statement of a moral principle. Certainly there is nothing in the Declaration issued by the Holy See on May 5, 1980 which would justify either the conclusion offered by Ms. Van Buren or the headline in the Atlanta Constitution asserting that the “Pope concurs with Living Will idea.”