Respecting the Dignity of the Human Person at the End of Life
by Richard Doerflinger
Associate Director, Secretariat of Pro-Life Activities
United States Conference of Catholic Bishops
My mother was in an emergency room, gasping for
breath, and she seemed to be dying.
Mom was eighty-five years old, with serious heart
and lung problems. My wife and I had rushed her to the hospital when she
started being unable to catch her breath. The diagnosis: she had too much fluid
around her lungs to breathe properly. Now she was panicking from that crisis
and from the claustrophobic experience of having an oxygen mask cover most of
As she couldn't listen or communicate, a doctor said
my wife and I had to make a decision. If a diuretic administered to drain off
the excess fluid did not work soon, they could step up the medication to
relieve Mom's panic, but then she may not take in enough oxygen. Or they could
perform minor surgery to intubate her, which would get her enough air but might
raise new dilemmas later if she became dependent on it.
After hemming and hawing and looking at each other
in alarm, we were about to approve intubation when a nurse said, "Doctor, I
think the diuretic has begun to work." Mom was breathing more normally and the
crisis passed. She was able to return home with us and live there for more than
a year, enjoying her grandchildren and great-granddaughter. Later, she passed
away peacefully in hospice care, a few weeks after a final heart attack.
This is not an unusual story. Every day, Catholics
and others face unexpected dilemmas about treatment for themselves and their
loved ones. Each situation is a unique and bewildering set of facts, forcing us
to choose what we hope will be the best or "least bad" outcome.
So where do we turn for guidance? How does the
Church help us make decisions that are consistent with God's will for us?
People are often surprised to find that Catholic
teaching provides no single authoritative answer to many of the questions that
arise near the end of life. For example, it has no list of medical treatments
we must always use. It does provide key moral principles we can apply to
concrete situations, using the virtue of prudence. And those principles are
based on a vision of the human person that is at the core of the Gospel.
Let's begin with the principles. They explain two
things we must never do, and provide guidance to help us decide what we can and should do for those we love.
First is God's Commandment, "Thou shalt not kill." We
must never deliberately take a human life, our own or anyone else's. Such a
wrongful intention might be carried out by a positive act, or by omitting
needed support in order to bring on someone's death. Even motives of compassion
or altruism cannot justify such taking of innocent human life. In short, we
should always reject euthanasia, which is "an action or omission
which of itself and by intention causes death, with the purpose of eliminating
all suffering" (Pope John Paul II, Evangelium
Vitae [Washington, DC: Libreria
Editrice Vaticana (LEV)–United States Conference of Catholic Bishops (USCCB),
1995], no. 65). Sometimes, the effort to control pain
or provide other important benefits to a patient may risk an earlier death as
an inevitable side-effect; that is not the same thing as deliberately aiming to
end the patient's life, which is always wrong.
Second, we must not discriminate against those most
in need. We should not lavish every life-saving option on those who are rich or
smart or able-bodied or powerful, while ignoring the value of life for people
with lesser abilities or accomplishments. This has enormous implications for
our treatment of people with mental or physical disabilities, including those
seen as being in a "vegetative state." Sometimes, demeaning judgments about
people with a low "quality of life" have even led to the taking of life, as when
some doctors have withheld routine surgery and nourishment from newborn infants
with Down syndrome to ensure their death.
Third, we have a positive obligation to take
reasonable care of our own lives and the lives of those who depend on us. The
limits of that obligation are outlined in the distinction between "ordinary"
and "extraordinary" means. Some prefer to speak of "proportionate" and
"disproportionate" means instead. But the basic idea is that we are not obliged
to support and sustain earthly life by every means technically possible. In each
case we should ask: Will this treatment have real benefit for this patient, in
this particular situation? Can it be effective in sustaining life, alleviating
disease, or relieving suffering? And even if it can, does it impose serious
burdens on this patient—suffering, hardship, expense, etc.—that outweigh those
benefits? In other words, we have to assess what good the treatment can do for the patient and weigh it against the
harm it may do to the patient.
This is where the Catholic virtue of prudence comes
in. Prudence is not a reserved or modest attitude. It is the ability to apply
general moral principles to a specific situation so we can decide the best
action to take here and now. The Church has no list of "ordinary" means that
must always be used, no matter what, because that judgment will depend on the
patient and the details of the situation.
The classic case—not the only case—in which
life-sustaining treatments can become extraordinary or disproportionate is one
in which the person is very near death from a terminal illness, and nothing
more can reasonably be done to sustain his or her life: "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'" (Evangelium Vitae, no. 65, citing Declaration on Euthanasia). In forgoing
such overly aggressive treatment, we are not aiming at death but accepting the
human condition and the limits of our ability to stave off death.
The fourth principle is about the term used above,
"the normal care due to the sick person." There is a basic level of care we owe
to everyone, out of respect for their human dignity. Keeping the patient comfortable,
relieving pain, providing personal hygiene—these are things we do for our
children when they are very young, and we do them for ailing adults when they
can no longer do them for themselves. Providing food and water is part of this
basic care, though providing it may require some medical assistance such as
tube feeding. Rarely, especially in the final stages of terminal illness, even
food and fluids may no longer be effective in providing nourishment or
preventing suffering. But as a general rule, they are "a natural means of
preserving life, not a medical act,"
and we are morally obliged to provide them (Pope John Paul II, Address, March
20, 2004, no. 4, w2.vatican.va/content/john-paul-ii/en/speeches/2004/march/documents/hf_jp-ii_spe_20040320_congress-fiamc.html).
Fifth, in the context of
these moral principles, we should address patients' pain and suffering. One
reason suffering exists in this world is "in order to unleash love in the
human person, that unselfish gift of one's "I" on behalf of other people,
especially those who suffer" (Pope John Paul II, Salvifici Doloris,no.
We are called to empathize with those who suffer, to keep company with them and
alleviate their pain. As Christians, we may also choose to endure suffering and
join more closely with Christ by uniting our sufferings with his own; but "such
'heroic' behavior cannot be considered the duty of everyone" (Evangelium Vitae,
Where do these principles come from? What is their
basis in a Catholic vision of human life?
Dignity of the Human Person
The foundation for everything the Church says on
these and many other moral issues is the dignity of the human person. Each of
us, of whatever age or condition, is a unique and unrepeatable gift of God, "a
masterpiece of God's creation," as Pope Francis has said. The human person is
made in God's image, "the only creature on earth that God has willed for its
own sake" (Catechism of the Catholic Church [CCC], 2nd ed. [Washington, DC: LEV–USCCB, 2000], no. 356). Each of us was specially
created by God out of his boundless love, and called to live in ways that make
us ready for eternal life with him.
Two aspects of this dignity are especially relevant
to moral issues near the end of life.
First, this incomparable dignity does not belong
only to our immortal souls. We are not souls trapped in earthly bodies, "freed"
from this prison by death as some philosophers have imagined. We are a union of
body and soul, and our bodies share in our human dignity. Death is not a
liberation but the separation of a body and soul that belong together. "God did
not make death, and he does not delight in the death of the living" (CCC, no.
413, citing Wis 1:13). The cure for our fear of death is not to see death itself
as a good thing but to remember that, beyond the suffering of death, there is
something infinitely greater—the resurrection of the body and eternity with
Christ. Whether we treat bodily life here and now with care and respect will
help determine whether we share in that glorious resurrection.
Second, dignity means inherent worth, beyond all differences of age, illness, or
disability. Some people speak of "death with dignity" in an immoral sense,
glorifying death as a solution to problems. More responsibly, others mean only
that people near the end of life need to be treated with respect for the human dignity
they still have. In reality, we have that dignity from the very beginning of
our lives to its end, and no illness or limitation can take it away. People can
remember that and treat us accordingly, or they might forget it and mistreat us
as though we have lost our dignity because we lack some physical or mental
abilities. "Even our brothers and sisters who find themselves in the clinical
condition of a 'vegetative state' retain their human dignity in all its
fullness. The loving gaze of God the Father continues to fall upon them,
acknowledging them as his sons and daughters, especially in need of help" (Pope
John Paul II, Address, March 20, 2004, no. 3).
Recognizing the dignity of each person does not
paralyze us in the face of illness and death. It frees us to make sensible
decisions that respect the gift of life. We must never deliberately attack
human life. More than this, we should practice careful stewardship over this
gift, taking reasonable steps to support life, improve health, and ease
suffering. We do not ignore the fearful power of death, but we see it in the
perspective of Christ's ultimate victory over death and his invitation to enjoy
eternal life with him.
© 2015, United States Conference of Catholic Bishops, Washington, DC. All
rights reserved. Permission is hereby granted to duplicate this work without
adaptation for non-commercial use.
Excerpts from the Catechism of the Catholic
Church, second edition, copyright © 2000, Libreria Editrice Vaticana–United
States Conference of Catholic Bishops, Washington, DC. Used with permission.
All rights reserved.
Excerpt from Pope John Paul II, Apostolic
Letter Salvifici Doloris, copyright
© 1984, Libreria Editrice Vaticana (LEV); Evangelium
Vitae, copyright © 1995, LEV; Address, March 20, 2004,copyright
© 2004, LEV. Used with permission. All rights reserved.