Parishable Items

In today’s second reading we hear from St. Paul, a prisoner in Rome on account of Christ and the Gospel.  Paul senses that the end of his life on earth is near. He writes:

“I am already being poured out like a libation,
and the time of my departure is at hand.”

The emperor will soon order Paul to be executed by beheading, sending him to Christ’s eternal reward. Yet this is not to the emperor’s glory, for the blood of St. Paul’s murder will be on his hands.

By God’s grace, Paul was not left all alone in this difficult, final season of his life. Elsewhere in this chapter from 2nd Timothy, he writes, “Luke is the only one with me.”  (This is St. Luke the evangelist, whose Gospel we are reading this liturgical year.) In another letter, Paul calls Luke his “beloved physician.”

Now what if Luke, seeing Paul’s burdens and what trials awaited him, were to procure some hemlock with which to end his friend’s life? Would Paul be pleased with him? Would he not rather be angry that Luke would presume to thwart God’s purposes for him on earth?

The Lord, the author of our lives, is the one to decide when someone’s life story is complete. God has joined our souls to our bodies and what God has joined together, no human being must separate; for it is always and everywhere wrong to intentionally kill the innocent. God sent Luke to Paul not to kill him, but to strengthen, console and support him in this last season of his life.

Healthcare and end of life issues touch all our lives, and people of good will have many questions in this area. Like, “What is wrong with euthanasia or assisted suicide?” “What does Christ’s Church teach about living wills, ventilators, feeding tubes, and palliative care?” And, “What kind medical care is morally required, and what sorts of care are optional?”

The Church calls care and treatments which are morally required “ordinary care.” Treatments which are optional called “extraordinary care.” Each of us has an obligation to respect our lives and bodies as precious gifts from God.  This means that we must always receive, and provide to others, “ordinary care.” However, circumstances can arise where various treatments become “extraordinary” and may be omitted. Treatments which involve great pain, or extreme cost, or little likelihood of doing much good can be deemed extraordinary care.  Burden, cost, and futility can make a treatment morally optional.

Yet, every treatment must be put into context. Sometimes the same procedure, which is ordinary in some cases, will be extraordinary in others. Sometimes a ventilator can be an extraordinary treatment, making it acceptable for people to refuse or discontinue its use. However, imagine if an otherwise healthy person should come to the hospital with a routinely curable lung condition which requires surgery and the short-term use of a ventilator.  In this case, the ventilator—which can be costly and burdensome—is not extraordinary because its benefits far outweigh its burdens.

This is a danger with living wills and advance directives.  Making medical decisions about treatments, in the abstract, in advance, and out of context, can easily lead to wrong decisions. Consider the use of feeding tubes. A person can check a box on a living will that says they never want one, but feeding tubes are quite often ordinary care; however, in some cases, they become extraordinary care.

Sometimes, in the process of dying, a person may no longer be able to digest food. In such an instance, use of a feeding tube would be futile, painful, extraordinary, and rightly omitted. But if someone is not dying, to deprive them of food or water is like preventing a diabetic from taking their insulin. That is not allowing nature to take its course—it is homicide. Pope John Paul II taught that ‘a sick person in a vegetative state, awaiting recovery or a natural end to their life, still has the right to basic health care (such as nutrition, hydration, cleanliness, warmth, and the like), and to the prevention of complications related to his or her confinement to bed. … Causing someone’s death by starvation or dehydration, if done knowingly and willingly, is truly euthanasia by omission.’

We condemn euthanasia and assisted suicide because they are about killing the person rather than killing the disease, and we can never intentionally kill the innocent. It is wrong to kill the sick, but it is good to alleviate their pain and discomfort while they live. This kind of treatment, aimed at increasing a person’s comfort, is called palliative care and it is a great good. The work of Hospice and others is to provide palliative care in the final stages of life.

Would it be wrong to overdose a person with morphine to end their life?  Yes, for it is wrong to intentionally kill the innocent. But what about a case where treating someone’s pain with pain-killers (in the normal doses) might have the unintended side-effect of shortening their remaining days? Would it be wrong to request or administer such a treatment?  No because the aim is not to kill the sick person, but to relieve their pains. Sometimes, people with cancer choose to forgo chemotherapy and its burdens even though treatment might help them live longer than they would without it. Are these people choosing death? No, they are choosing a different way to live. The burdens of chemotherapy can make it an extraordinary treatment, and we are free to forego extraordinary treatments, even if it may shorten our lives.

The three principles I have tried to present today are these: first, that it is always and everywhere wrong to intentionally kill the innocent.  Second, that we must receive, and provide to others, ordinary care. And third, that treatment which entails great pain, or extreme cost, or little likelihood of doing much good can be deemed extraordinary care, and is morally optional.

I hope you now have a clearer understanding of some points of Catholic medical ethics, but these can be complicated issues. If you are facing difficult treatment decisions, for yourself or someone you love, seek out counsel of those who know the Church’s teachings on this subject. Holy Mother Church’s wisdom on healthcare issues is the natural and logical extension of her dedication to human dignity. As Roman Catholics in a culture of death, we must we stand for the dignity of every human life, from conception to natural death, and we need to vote for it, too.

• An article on “ordinary” and “extraordinary” care.