Catholic Bioethics
MAGISTERIAL TEXTS on
PALLIATIVE CARE
 

  Articella


1. CATECHISM of the CATHOLIC CHURCH, 1984

2. Bl. POPE JOHN PAUL II, Evangelium Vitae, 1985

3. POPE BENEDICT XVI, 2006 & 2007

4. POPE FRANCIS

5. USCCB (2011), PHYSICIAN-ASSISTED SUICIDE - THREAT TO PALLIATIVE CARE


 4. Catechism on Life

 

 

 

 

 

 

1.  CATECHISM of the CATHOLIC CHURCH, § 2279  (1994)

Bishop Exhorts Faithful

 

 

 

 

 

 


   

2279 Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted. The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable Palliative care is a special form of disinterested charity. As such it should be encouraged.

2279 Etiamsi mors imminere consideretur, curae, quae ordinario personae aegrotae debentur, nequeunt legitime interrumpi. Analgesicorum medicamentorum usus ad moribundi dolores sublevandos, etiam cum periculo eius dies breviandi, potest esse dignitati humanae moraliter conformis, si mors neque ut finis neque ut medium est volita, sed solummodo praevisa et, tamquam inevitabilis, tolerata. Curae lenientes formam constituunt excellentem caritatis gratuitae. Hac ratione foveri debent.


2. Pope John Paul II

 

 

 

 

 

 

2.  POPE JOHN PAUL II
Evangelium Vitae
(1995)

 

 

 

 

 

 


[2.2.] 65. […] 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. 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”.[7] Certainly there is a moral obligation to care for oneself and to allow oneself to be cared for, but this duty must take account of concrete circumstances. It needs to be determined whether the means of treatment available are objectively proportionate to the prospects for improvement. To forego extraordinary or disproportionate means is not the equivalent of suicide or euthanasia; it rather expresses acceptance of the human condition in the face of death.[8]

Ab ea separetur oportet consilium illud, quo quis tractationem reiciat sic dictam “vehementiam therapeuticam”, aliquos nempe medicos interventus non amplius aegrotantis statui congruentes, quia impares iam sunt iis effectibus quos sperari liceret vel etiam quia nimis omnino ipsi aegroto eiusque familiae molesti. His enim in casibus, cum nuntiata iam instat mors nec vitari potest, licet ex conscientia “consilium inire curationibus renuntiandi, quae nonnisi precariam et doloris plenam vitae dilationem afferre valent, haud intermissis tamen ordinariis curis, quae in similibus casibus aegroto debentur” (Ibid. IV). Officium certissime adest morale ut quis se curet curetque se curandum; quod tamen officium metiendum est secundum concreta rerum adiuncta: in re namque nata necesse est diiudicare conveniantne therapeutica instrumenta ad manus aliquando melioris condicionis ipsis exspectationibus. Haud vero tantum valet consiliorum extraordinariorum vel nimiorum reiectio quam voluntaria mors vel euthanasia; consensum potius illa declarat cum humano statu ante mortem (Cfr. ibid.).

In modern medicine, increased attention is being given to what are called “methods of palliative care”, which seek to make suffering more bearable in the final stages of illness and to ensure that the patient is supported and accompanied in his or her ordeal.

Recentissima in medicina arte magis magisque emergunt sic dictae “curae palliativae”, eo scilicet pertinentes ut extremo morbi tempore tolerabilior fiat dolor utque patienti ipsi consentaneus simul praestetur comitatus humanus.

 

 

 

 

 

A particularly praiseworthy example of such gestures is the donation of organs, performed in an ethically acceptable manner, with a view to offering a chance of health and even of life itself to the sick who sometimes have no other hope. Quos inter plurimi ducenda est organorum donatio rationibus ethica disciplina probabilibus effecta, ut salutis vel etiam vitae ipsius opportunitas aegris praebeatur omni nonnumquam spe destitutis.

 

 

 

 

[2.2.] 88. […] And when earthly existence draws to a close, it is again charity which finds the most appropriate means for enabling the elderly, especially those who can no longer look after themselves, and the terminally ill to enjoy genuinely humane assistance and to receive an adequate response to their needs, in particular their anxiety and their loneliness. In these cases the role of families is indispensable; yet families can receive much help from social welfare agencies and, if necessary, from recourse to palliative care, taking advantage of suitable medical and social services available in public institutions or in the home.

Sub exitum autem terrestris vitae, caritas adhuc modos quosdam peraptos invenit ut senes, peculiariter qui opibus suis sufficienter non sunt praediti, atque insanabiliter aegrotantes, de cura humana gaudere possint ac rectas responsiones accipere postulationibus suis, singulari modo anxietati suae et solitudini. Familiarum officium substitui non potest his in casibus: suum tamen validum auxilium illae reperire possunt in socialibus adiutoriis praestandis structuris et, cum necesse est, in usurpatione curarum dolorem lenientium, aptis adhibitis sanitatis socialisque rationis ministeriis tum in hospitiis publicis tum domi praestitis.

In particular, the role of hospitals, clinics and convalescent homes needs to be reconsidered. These should not merely be institutions where care is provided for the sick or the dying. Above all they should be places where suffering, pain and death are acknowledged and understood in their human and specifically Christian meaning. This must be especially evident and effective in institutes staffed by Religious or in any way connected with the Church.   

Iterum proprie est considerandum momentum valetudinariorum, clinicarum atque curationis domorum: eorum vera proprietas non spectat solummodo ad instituendas structuras in quibus cura agatur aegrotorum et morientium, sed praesertim ad praebendos ambitus in quibus angustia, dolor atque mors agnoscuntur et explanantur in sua ipsarum humana notione proprieque christiana. Singillatim talis identitas clara et valida apparere debet in institutis quae a religiosis diriguntur vel, quavis ratione, quae cum Ecclesia nectuntur.

 

 

 

 


Benedict XVI

 

 

 

 

 

 

3.  POPE BENEDICT XVI
Addresses, 2006 & 2007

 

 

 

 

 

 


Address of Benedict XVI to Ambassadors of Belgium to the Holy See Thursday, 26 October 2006

When the Bishops of Belgium plead for the development of palliative care to enable those who so desire to die in dignity, or when they intervene in social debates to recall that “an invisible moral frontier exists to which technological progress must give way” (Dignité de l'enfant et technique médicale), their intention is to serve the whole of society, pointing out the conditions for a future of true freedom and dignity for humankind.


Address of Benedict XVI to Authorities and the Diplomatic Corps in Vienna, on the occasion of the 850th anniversary of the foundation of the shrine of Mariazell, Sept. 7, 2007

Another great concern of mine is the debate on what has been termed “actively assisted death”. It is to be feared that at some point the gravely ill or elderly will be subjected to tacit or even explicit pressure to request death or to administer it to themselves. The proper response to end-of-life suffering is loving care and accompaniment on the journey towards death – especially with the help of palliative care – and not “actively assisted death”. But if humane accompaniment on the journey towards death is to prevail, structural reforms would be needed in every area of the social and healthcare system, as well as organized structures of palliative care. Concrete steps would also have to be taken: in the psychological and pastoral accompaniment of the seriously ill and dying, their family members, and physicians and healthcare personnel. In this field the hospice movement has done wonders. The totality of these tasks, however, cannot be delegated to it alone. Many other people need to be prepared or encouraged in their willingness to spare neither time nor expense in loving care for the gravely ill and dying.


Pope_Francis

 

 

 

 

 

 

3.5  POPE FRANCIS
Interview with
Corriere della Sera: March 5, 2014

 

 

 

 

 

 


Vatican City, Mar 5, 2014 / 11:35 am (CNA/EWTN News).- English translation, by CNA’s Estefania Aguirre and Alan Holdren, of the March 5 interview of Pope Francis with Italian daily “Corriere della Sera“. Italian text: http://www.corriere.it/cronache/14_marzo_04/vi-racconto-mio-primo-anno-papa-90f8a1c4-a3eb-11e3-b352-9ec6f8a34ecc.shtml

 

 

Many nations have regulated civil unions. Is it a path that the Church can understand? But up to what point?

Molti Paesi regolano le unioni civili. È una strada che la Chiesa può comprendere? Ma fino a che punto?

Marriage is between a man and a woman. Secular states want to justify civil unions to regulate different situations of cohabitation, pushed by the demand to regulate economic aspects between persons, such as ensuring health care. It is about pacts of cohabitating of various natures, of which I wouldn’t know how to list the different ways.

One needs to see the different cases and evaluate them in their variety.

«Il matrimonio è fra un uomo e una donna. Gli Stati laici vogliono giustificare le unioni civili per regolare diverse situazioni di convivenza, spinti dall’esigenza di regolare aspetti economici fra le persone, come ad esempio assicurare l’assistenza sanitaria. Si tratta di patti di convivenza di varia natura, di cui non saprei elencare le diverse forme.

Bisogna vedere i diversi casi e valutarli nella loro varietà».

 

 

 

 

At half a century from Paul VI’s Humanae Vitae, can the Church take up again the theme of birth control? Cardinal Martini, your confrere, thought that the moment had come.

A mezzo secolo dall’Humanae Vitae di Paolo VI, la Chiesa può riprendere il tema del controllo delle nascite? Il cardinale Martini, suo confratello, riteneva che fosse ormai venuto il momento.

All of this depends on how Humanae Vitae is interpreted. Paul VI himself, at the end, recommended to confessors much mercy, and attention to concrete situations. But his genius was prophetic, he had the courage to place himself against the majority, defending the moral discipline, exercising a culture brake, opposing present and future neo-Malthusianism. The question is not that of changing the doctrine but of going deeper and making pastoral (ministry) take into account the situations and that which it is possible for people to do. Also of this we will speak in the path of the synod.

«Tutto dipende da come viene interpretata l’Humanae Vitae. Lo stesso Paolo VI, alla fine, raccomandava ai confessori molta misericordia, attenzione alle situazioni concrete. Ma la sua genialità fu profetica, ebbe il coraggio di schierarsi contro la maggioranza, di difendere la disciplina morale, di esercitare un freno culturale, di opporsi al neo-malthusianesimo presente e futuro. La questione non è quella di cambiare la dottrina, ma di andare in profondità e far sì che la pastorale tenga conto delle situazioni e di ciò che per le persone è possibile fare. Anche di questo si parlerà nel cammino del Sinodo».

Palliative Care

 

 

 

Science evolves and redesigns the frontiers of life. Does it make sense to artificially prolong life in a vegetative state? Can a living will be a solution?

La scienza evolve e ridisegna i confini della vita. Ha senso prolungare artificialmente la vita in stato vegetativo? Il testamento biologico può essere una soluzione?

I am not a specialist in bioethical issues. And I fear that every one of my sentences may be wrong. The traditional doctrine of the Church says that no one is obligated to use extraordinary means when it is known that they are in the terminal phase. In my pastoral ministry, in these cases, I have always advised palliative care. In more specific cases it is good to seek, if necessary, the counsel of specialists.

«Io non sono uno specialista negli argomenti bioetici. E temo che ogni mia frase possa essere equivocata. La dottrina tradizionale della Chiesa dice che nessuno è obbligato a usare mezzi straordinari quando si sa che è in una fase terminale. Nella mia pastorale, in questi casi, ho sempre consigliato le cure palliative. In casi più specifici è bene ricorrere, se necessario, al consiglio degli specialisti ».

 

 

 

 



 

 

 

 

 

 

3.6  POPE FRANCIS
On THE END of LIFE
Message to the World Medical Association

Nov. 16-17
, 2017

 

 

 

 

 

 



[...] Surgery and other medical interventions have become ever more effective, but they are not always beneficial: they can sustain, or even replace, failing vital functions, but that is not the same as promoting health.  Greater wisdom is called for today, because of the temptation to insist on treatments that have powerful effects on the body, yet at times do not serve the integral good of the person.

 Gli interventi sul corpo umano diventano sempre più efficaci, ma non sempre sono risolutivi: possono sostenere funzioni biologiche divenute insufficienti, o addirittura sostituirle, ma questo non equivale a promuovere la salute. Occorre quindi un supplemento di saggezza, perché oggi è più insidiosa la tentazione di insistere con trattamenti che producono potenti effetti sul corpo, ma talora non giovano al bene integrale della persona.

Some sixty years ago, Pope Pius XII, in a memorable address to anaesthesiologists and intensive care specialists, stated that there is no obligation to have recourse in all circumstances to every possible remedy and that, in some specific cases, it is permissible to refrain from their use (cf. AAS XLIX [1957], 1027-1033)

Il Papa Pio XII, in un memorabile discorso rivolto 60 anni fa ad anestesisti e rianimatori, affermò che non c’è obbligo di impiegare sempre tutti i mezzi terapeutici potenzialmente disponibili e che, in casi ben determinati, è lecito astenersene (cfr Acta Apostolicae Sedis XLIX [1957],1027-1033).

Consequently, it is morally licit to decide not to adopt therapeutic measures, or to discontinue them, when their use does not meet that ethical and humanistic standard that would later be called “due proportion in the use of remedies” (cf. CDF, Declaration on Euthanasia, 5 May 1980, IV: AAS LXXII [1980], 542-552)The specific element of this criterion is that it considers “the result that can be expected, taking into account the state of the sick person and his or her physical and moral resources” (ibid.).  It thus makes possible a decision that is morally qualified as withdrawal of “overzealous treatment”. È dunque moralmente lecito rinunciare all’applicazione di mezzi terapeutici, o sospenderli, quando il loro impiego non corrisponde a quel criterio etico e umanistico che verrà in seguito definito “proporzionalità delle cure” (cfr Congregazione per la Dottrina della Fede, Dichiarazione sull’eutanasia, 5 maggio 1980, IV: Acta Apostolicae Sedis LXXII [1980], 542-552). L’aspetto peculiare di tale criterio è che prende in considerazione «il risultato che ci si può aspettare, tenuto conto delle condizioni dell’ammalato e delle sue forze fisiche e morali» (ibid.). Consente quindi di giungere a una decisione che si qualifica moralmente come rinuncia all’“accanimento terapeutico”.

Such a decision responsibly acknowledges the limitations of our mortality, once it becomes clear that opposition to it is futile.  ”Here one does not will to cause death; one’s inability to impede it is merely accepted” (Cat.Cath.Ch., No. 2278)This difference of perspective restores humanity to the accompaniment of the dying, while not attempting to justify the suppression of the living.  It is clear that not adopting, or else suspending, disproportionate measures, means avoiding overzealous treatment; from an ethical standpoint, it is completely different from euthanasia, which is always wrong, in that the intent of euthanasia is to end life and cause death.

È una scelta che assume responsabilmente il limite della condizione umana mortale, nel momento in cui prende atto di non poterlo più contrastare. «Non si vuole così procurare la morte: si accetta di non poterla impedire», come specifica il Catechismo della Chiesa Cattolica (n. 2278). Questa differenza di prospettiva restituisce umanità all’accompagnamento del morire, senza aprire giustificazioni alla soppressione del vivere. Vediamo bene, infatti, che non attivare mezzi sproporzionati o sospenderne l’uso, equivale a evitare l’accanimento terapeutico, cioè compiere un’azione che ha un significato etico completamente diverso dall’eutanasia, che rimane sempre illecita, in quanto si propone di interrompere la vita, procurando la morte.

[...] The Catechism of the Catholic Church makes this clear: “The decisions should be made by the patient if he is competent and able” (loc. cit.). The patient, first and foremost, has the right, obviously in dialogue with medical professionals, to evaluate a proposed treatment and to judge its actual proportionality in his or her concrete case, and necessarily refusing it if such proportionality is judged lacking. [...]

Lo dice con chiarezza il Catechismo della Chiesa Cattolica: «Le decisioni devono essere prese dal paziente, se ne ha la competenza e la capacità» (ibid.). È anzitutto lui che ha titolo, ovviamente in dialogo con i medici, di valutare i trattamenti che gli vengono proposti e giudicare sulla loro effettiva proporzionalità nella situazione concreta, rendendone doverosa la rinuncia qualora tale proporzionalità fosse riconosciuta mancante.

In the complexity resulting from the influence of these various factors on clinical practice, but also on medical culture in general, the supreme commandment of responsible closeness, must be kept uppermost in mind, as we see clearly from the Gospel story of the Good Samaritan (cf. Lk 10:25-37)It could be said that the categorical imperative is to never abandon the sick.  [...] Let each of us give love in his or her own way—as a father, a mother, a son, a daughter, a brother or sister, a doctor or a nurse.  But give it!  And even if we know that we cannot always guarantee healing or a cure, we can and must always care for the living, without ourselves shortening their life, but also without futilely resisting their death.  This approach is reflected in palliative care, which is proving most important in our culture, as it opposes what makes death most terrifying and unwelcome—pain and loneliness.

Nella complessità determinata dall’incidenza di questi diversi fattori sulla pratica clinica, ma anche sulla cultura della medicina in generale, occorre dunque tenere in assoluta evidenza il comandamento supremo della prossimità responsabile, come chiaramente appare nella pagina evangelica del Samaritano (cfr Luca 10, 25-37). Ma questo è il luogo in cui ci vengono chiesti amore e vicinanza, più di ogni altra cosa, riconoscendo il limite che tutti ci accumuna e proprio lì rendendoci solidali. Ciascuno dia amore nel modo che gli è proprio: come padre o madre, figlio o figlia, fratello o sorella, medico o infermiere. Ma lo dia! E se sappiamo che della malattia non possiamo sempre garantire la guarigione, della persona vivente possiamo e dobbiamo sempre prenderci cura: senza abbreviare noi stessi la sua vita, ma anche senza accanirci inutilmente contro la sua morte. In questa linea si muove la medicina palliativa. Essa riveste una grande importanza anche sul piano culturale, impegnandosi a combattere tutto ciò che rende il morire più angoscioso e sofferto, ossia il dolore e la solitudine.



3. USCCB

 

 

 

 

 

 

4.  U. S. CONFERENCE of CATHOLIC BISHOPS

Bishops in Council

 

 

 

 

 

 

  PART FOUR

PHYSICIAN-ASSISTED SUICIDE -
 
THREAT TO IMPROVED PALLIATIVE CARE
2011

 


Advocates for assisted suicide claim that the practice can simply be added to the “palliative care” options now available to patients. There is good reason to conclude that the opposite is true -- that legalizing assisted suicide undermines efforts to maintain and improve good care for patients nearing the end of life, including patients who never wanted assisted suicide.

“We must solve the real and pressing problems of inadequate care, not avoid them through solutions such as physician-assisted suicide. A broad right to physician-assisted suicide could undermine efforts to marshal the needed resources, and the will, to ensure humane and dignified care for all persons facing terminal illness or severe disability.”

L. Snyder and D. Sulmasy, “Physician-Assisted Suicide” (Position Paper of the American College of Physicians and American Society of Internal Medicine), 135 Annals of Internal Medicine (2001) 209-16 at 214.

* * *

From one study of severe pain and distress in dying patients in Oregon, comparing the period before the assisted suicide law took effect (1996-1997) to a period after it took effect (1999- 2002): “The frequency of family reports of moderate or severe pain or distress in Oregon decedents increased – from 30.8% in 1996-1997 to 48% in 1999-2002... An increase from 30.8% to 48% represents the increased suffering of over 5,000 additional decedents and families. Higher levels of pain have profound effects on seriously ill patients and are associated with greater functional impairment, greater depression, anxiety and suicidal ideation, and worsening cognition.... In Oregon, there is evidence that ...resources [for end-of-life care] have been stretched more thinly. Medicare patients in Oregon have among the lowest reimbursement in the United States during the last 6 months of life and have fallen significantly during the study period.”

E. Fromme et al., “Increased Family Reports of Pain or Distress in Dying Oregonians: 1996 to 2002,” 7 Journal of Palliative Medicine (2004): 431-42 at 437, 439.

* * *

While supporters of the Oregon assisted suicide law say it has helped the state maintain and improve its status as a leader in end-of-life care, this was not borne out by a nationwide study by the respected Last Acts coalition in 2002. The study “graded” the 50 states on various elements of such care, and found that a number of states where assisted suicide is illegal outpaced Oregon in key areas. According to the Last Acts report card: On median number of days in hospice, Oregon received a “D” (6 states had a better grade); on percentage of hospitals reporting a pain management program, a C (5 states and the District of Columbia); on percentage of hospitals reporting a hospice program, a D (three states); on percentage of hospitals reporting a palliative care program, an E (11 states and the District of Columbia); on percentage of nursing home residents with persistent pain, a C (one state, Hawaii, had a better grade; only 11 states had a worse one); on strength of the state’s pain policies, a C (16 states better); on percentage of primary care physicians who are certified in palliative medicine, a C (14 states); on percentage of nurses certified in palliative care, a B (5 states). As a sign of hope, the study noted that 30 states had statewide coalitions or partnerships to improve care of the dying; Oregon was not among them.

Last Acts, Means to a Better End: A Report on Dying in America Today (November 2002), www.rwjf.org/files/publications/other/meansbetterend.pdf, at 19, 23, 24, 25, 32, 36, 41, 42, 55.

* * *

In his concurring opinion in the U.S. Supreme Court’s 1997 rulings against a constitutional right to assisted suicide, Justice Breyer noted that a study by the British House of Lords found that “the number of palliative care centers in the United Kingdom, where physician assisted suicide is illegal, significantly exceeds that in the Netherlands, where such practices are legal.” The study found 185 such centers in the UK, but only 3 in the Netherlands.

Washington v. Glucksberg, 521 U.S. 702 (1997) at 792 (Breyer, J., concurring in the judgment), citing 2 House of Lords, Session 1993-1994 Report of Select Committee on Medical Ethics 113 (1994).

* * *

A leading hospice physician in the Netherlands writes: “Accepting euthanasia or assisted suicide as a normal medical practice for some cases of unacceptable suffering assumes that the process will be controllable... Regulation has proved to be difficult if not impossible and is fraught with danger. It also serves to stifle creativity in palliative care and even to make proper care impossible to achieve.”

The physician recounts that he once had to explain to a colleague how to relieve a bowel obstruction that was causing great distress for a cancer patient. “Usually I solve this kind of problem by euthanasia,” the colleague explained, but in this case the patient did not accept euthanasia. The author comments: “The physician’s remark that he usually solves such problems with euthanasia is disturbing. It illustrates how euthanasia becomes a substitute for learning how to relieve the suffering of dying patients. Ordinarily physicians learn more from their patients than from books. By endangering this process, euthanasia has consequences not only for a particular patient, but also for the quality of care in general.”

Z. Zylicz, “Palliative Care and Euthanasia in the Netherlands: Observations of a Dutch Physician,” in K. Foley and H. Hendin, The Case Against Assisted Suicide: For the Right to End-of-Life Care (Johns Hopkins University Press 2002), 122-43 at 140-41, 142.

6/9/11

 


This Webpage was created for a workshop held at Saint Andrew's Abbey, Valyermo, California in 2002....x....   “”.