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Struggling with end of life issues… What does the Church teach?

May 24, 2010 by  
Filed under Church Teaching, Fr. Bartunek

Dear Father John, Recently my mother passed away. She suffered from an irregular heartbeat and congestive heart failure. A week before she passed, she was rushed to the hospital where the ER doctor counseled us to have her put on hospice care and let nature take its course. After that, she was put on morphine and a sedative and had no food or fluids. It took her 5 days to die and it was not a peaceful death. I can't help thinking that, in a sense, we “pulled the plug” on her. While there appeared to be no hope, it still didn't feel right. What does the Church counsel on matters such as these?

This question addresses a moral issue more than a spiritual issue. Yet it is the kind of difficulty that should be brought up in spiritual direction – a practical, where-the-rubber-meets-the-road kind of issue. It’s also happening more and more frequently. And so I think would be helpful to try and answer it.

The Church offers solid principles regarding end-of-life issues. But it is not always easy to apply those principles to particular situations. Let me review the principles, then reflect a little bit on how they may have applied to your mother’s final week.

Guiding Principles

Human life, because each of us is created in God’s image and invited to everlasting friendship with God, is sacred. Because of this human dignity, it is never justified to directly will or cause the death of an innocent person, nor is it justified to purposely try to damage or lessen the quality of a person’s life (through maiming or kidnapping, for example). To defend this sacred dignity of human life, the Church has always taught that abortion and euthanasia (direct killing in order to alleviate suffering) are morally wrong, just as wrong as any other form of murder.

Nevertheless, in this fallen world, death is inevitable. At some point, we all will die. When it becomes clear that someone is dying, therefore, we do not have a moral obligation to do everything possible to extend their life as long as possible. Now, in some cases, there may be a particular reason why we would indeed want to keep someone alive, even at great cost or pain. For example, take the case of a father and son who have been estranged for decades and live on different sides of the globe. The father is facing heart failure, and the doctors agree that intervention at this point would most likely be useless, though some extreme measures may keep the heart functioning for another couple of weeks or a month. The family members, or the father himself, may request that those extreme measures be taken, so that the estranged son can have time to travel to the hospital, in hopes of a final reconciliation. That particular family may decide to use aggressive treatments, whereas a family already at peace may not. Each would be justified.

Accepting the inevitable, however, does not mean abandoning a dying person or hastening their death. That would constitute willing that a person die, just to “get it over with,” rather than humbly accepting death as a natural end of life. Therefore, if someone is dying, it would be immoral to willingly deny them the fundamental necessities that we owe to every human being, for example: shelter and room temperature, clothing, basic nutrition and hydration. In many cases, as a person is dying, their system will no longer accept nutrition and hydration. If that’s the case, it would most often be futile and disproportionate to try and force-feed them. In some cases, the dying process is so painful that the amount or type of palliative medicine required to relieve the pain may actually hasten the death. Nevertheless, such palliative care is acceptable (indeed, even an expression of love), if the person truly is dying. Again, however, if the dying person wants to remain alert in order to be able to converse with his estranged son, for example, they may choose to forego the pain-relievers.

Those are the basic principles: the sacredness of human life, the inevitability of death, the moral duty to provide basic necessities, when possible, but not to provide futile or disproportionate treatments. Here is how the Catholic Catechism summarizes the issue (paragraph numbers 2278, 2279):

Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of “over-zealous” treatment. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.

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.

This Specific Case

From the brief description of your mother’s case, it seems that she was truly dying. This is an important factor. She was not in a persistent vegetative state, for example, in which a person’s system can still sustain itself with basic nutrition (in those cases, “pulling the plug” constitutes actually killing them). Your attitude towards the situation was one of acceptance – you were accepting her death, not striving to hasten it. It seems that your conscience is unclear on one point, however: Did you unjustifiably deny her basic nutrition? I cannot make a judgment on that, as it would depend on specific medical factors. If in the doctor’s estimation, her system was no longer accepting hydration and nutrition, then it may have been futile to force her. But if she was still accepting basic nutrition, it probably would have been better to continue supplying it. If the doctors did not make these distinctions with you (and, sad to say, most doctors are not given careful formation in these ethical issues), you may not know even now what the situation really was. In fact, even in the face of these medical distinctions, theologians and ethicists sometimes disagree about the best way to proceed. If you would like to read a thorough treatment of the moral complexities, you may find this recent article useful.

Practical Conclusions

As you can see, moral decisions are not always clear, and they are not always easy. This is one reason it is so important for the mature Catholic to make a strong commitment to ongoing formation. What we learned in CCD and what we hear on Sundays is simply insufficient for the battles of life in the modern world. Our Church has a vast treasure of wisdom and the most dependable moral guidance available on earth, but it doesn’t translate well into sound bites. We need to keep ourselves informed. We need to be as responsible and proactive in this area as we are with our professional life, or with our favorite hobbies. As a priest, I can honestly say that it can be nothing less than heart-wrenching to see adult Catholics – intelligent, well-adjustment human beings – facing life’s major crises with only a rudimentary knowledge of their faith.

If you are looking for more ways to inform yourself and gradually go deeper in your understanding of Catholic wisdom and teaching, I can recommend our own biweekly, national newspaper as an excellent starting place. The National Catholic Register is designed to help intelligent, active Catholics be able to see current issues and events from a truly Catholic perspective. You may want to sign up for three free issues to test it out. God bless you!

Yours in Christ, Father John Bartunek, LC

Q: Recently my mother passed away. She suffered from an irregular heartbeat and congestive heart failure. A week before she passed, she was rushed to the hospital where the ER doctor counseled us to have her put on hospice care and let nature take its course. After that, she was put on morphine and a sedative and had no food or fluids. It took her 5 days to die and it was not a peaceful death. I can't help thinking that, in a sense, we “pulled the plug” on her. While there appeared to be no hope, it still didn't feel right. What does the Church counsel on matters such as these?

A: This question addresses a moral issue more than a spiritual issue. Yet it is the kind of difficulty that should be brought up in spiritual direction – a practical, where-the-rubber-meets-the-road kind of issue. It’s also happening more and more frequently. And so I think would be helpful to try and answer it.

The Church offers solid principles regarding end-of-life issues. But it is not always easy to apply those principles to particular situations. Let me review the principles, then reflect a little bit on how they may have applied to your mother’s final week.

Guiding Principles

Human life, because each of us is created in God’s image and invited to everlasting friendship with God, is sacred. Because of this human dignity, it is never justified to directly will or cause the death of an innocent person, nor is it justified to purposely try to damage or lessen the quality of a person’s life (through maiming or kidnapping, for example). To defend this sacred dignity of human life, the Church has always taught that abortion and euthanasia (direct killing in order to alleviate suffering) are morally wrong, just as wrong as any other form of murder.

Nevertheless, in this fallen world, death is inevitable. At some point, we all will die. When it becomes clear that someone is dying, therefore, we do not have a moral obligation to do everything possible to extend their life as long as possible. Now, in some cases, there may be a particular reason why we would indeed want to keep someone alive, even at great cost or pain. For example, take the case of a father and son who have been estranged for decades and live on different sides of the globe. The father is facing heart failure, and the doctors agree that intervention at this point would most likely be useless, though some extreme measures may keep the heart functioning for another couple of weeks or a month. The family members, or the father himself, may request that those extreme measures be taken, so that the estranged son can have time to travel to the hospital, in hopes of a final reconciliation. That particular family may decide to use aggressive treatments, whereas a family already at peace may not. Each would be justified.

Accepting the inevitable, however, does not mean abandoning a dying person or hastening their death. That would constitute willing that a person die, just to “get it over with,” rather than humbly accepting death as a natural end of life. Therefore, if someone is dying, it would be immoral to willingly deny them the fundamental necessities that we owe to every human being, for example: shelter and room temperature, clothing, basic nutrition and hydration. In many cases, as a person is dying, their system will no longer accept nutrition and hydration.  If that’s the case, it would most often be futile and disproportionate to try and force-feed them. In some cases, the dying process is so painful that the amount or type of palliative medicine required to relieve the pain may actually hasten the death.  Nevertheless, such palliative care is acceptable (indeed, even an expression of love), if the person truly is dying. Again, however, if the dying person wants to remain alert in order to be able to converse with his estranged son, for example, they may choose to forego the pain-relievers.

Those are the basic principles: the sacredness of human life, the inevitability of death, the moral duty to provide basic necessities, when possible, but not to provide futile or disproportionate treatments. Here is how the Catholic Catechism summarizes the issue (#s 2278, 2279):

·Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of “over-zealous” treatment. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.

·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.

This Specific Case

From the brief description of your mother’s case, it seems that she was truly dying. This is an important factor. She was not in a persistent vegetative state, for example, in which a person’s system can still sustain itself with basic nutrition (in those cases, “pulling the plug” constitutes actually killing them). Your attitude towards the situation was one of acceptance – you were accepting her death, not striving to hasten it. It seems that your conscience is unclear on one point, however: Did you unjustifiably deny her basic nutrition? I cannot make a judgment on that, as it would depend on specific medical factors. If in the doctor’s estimation, her system was no longer accepting hydration and nutrition, then it may have been futile to force her. But if she was still accepting basic nutrition, it probably would have been better to continue supplying it. If the doctors did not make these distinctions with you (and, sad to say, most doctors are not given careful formation in these ethical issues), you may not know even now what the situation really was. In fact, even in the face of these medical distinctions, theologians and ethicists sometimes disagree about the best way to proceed. If you would like to read a thorough treatment of the moral complexities, you may find this recent article useful.

Practical Conclusions

As you can see, moral decisions are not always clear, and they are not always easy. This is one reason it is so important for the mature Catholic to make a strong commitment to ongoing formation. What we learned in CCD and what we hear on Sundays is simply insufficient for the battles of life in the modern world. Our Church has a vast treasure of wisdom and the most dependable moral guidance available on earth, but it doesn’t translate well into sound bites. We need to keep ourselves informed. We need to be as responsible and proactive in this area as we are with our professional life, or with our favorite hobbies. As a priest, I can honestly say that it can be nothing less than heart-wrenching to see adult Catholics – intelligent, well-adjustment human beings – facing life’s major crises with only a rudimentary knowledge of their faith.

If you are looking for more ways to inform yourself and gradually go deeper in your understanding of Catholic wisdom and teaching, I can recommend our own biweekly, national newspaper as an excellent starting place. The National Catholic Register is designed to help intelligent, active Catholics be able to see current issues and events from a truly Catholic perspective. You may want to sign up for three free issues to test it out. God bless you!

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About Fr. John Bartunek, LC

Fr. John Bartunek, LC, S.Th.D, received his BA in History from Stanford University in 1990. He comes from an evangelical Christian background and became a member of the Catholic Church in 1991. After college, he worked as a high school history teacher, drama director, and baseball coach. He then spent a year as a professional actor in Chicago before entering the religious Congregation of the Legionaries of Christ in 1993. He was ordained a Catholic priest in 2003 and earned his doctorate in moral theology in 2010. He provided spiritual support on the set of Mel Gibson’s "The Passion of the Christ" while researching the 2005 Catholic best seller, "Inside the Passion"--the only authorized, behind-the-scene explanation of the film. Fr. John has contributed news commentary regarding religious issues on NBC, CNN, Fox, and the BBC. He also served as the English-language press liaison for the Vatican’s 2005 Synod of Bishops on the Eucharist. His most widely known book is called: "The Better Part: A Christ-Centered Resource for Personal Prayer". His most recent books are "Spring Meditations", "Seeking First the Kingdom: 30 Meditations on How to Love God with All Your Heart, Soul, Mind and Strength", and "Answers: Catholic Advice for Your Spiritual Questions". Fr. John currently splits his time between Michigan (where he continues his writing apostolate and serves as a confessor and spiritual director at the Queen of the Family Retreat Center) and Rome, where he teaches theology at Regina Apostolorum. His online, do-it-yourself retreats are available at RCSpirituality.org, and he answers questions about the spiritual life at SpiritualDirection.com.

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  • $1650412

    Thank you for addressing this topic, Father. Your manner of answering these questions helps me immensely and I very much appreciate the example you set in how you approach most problems presented in this forum.

  • Karen Kamphaus

    Father, you addressed this topic very well. I work in Home care and Hospice. Most people misunderstand what it is all about. Most people wait until death is a few days or weeks, when they and their families could benefit from the care given. We have many patients that graduate from Hospice. Also many people when actively dying can’t or don’t want to eat or drink. The body no longer needs nutrition,because it is slowly shutting down. The pain caused from the disease process can many times be managed with certain drugs, usually the pain itself will cause a person not to be alert. So for this reason many people choose not to take medication which would give comfort and relief.

  • Thank you Father for answering my question with such detail and care. It helped a great deal.

    And thank you too to karring57 for your response – that helped a lot too!

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