As we face terminal illness or complications from aging, determining the proper limits of healthcare can become a challenge. In this instance it is more appropriate to start with the why and then apply it to several different situations including Do Not Resuscitate Orders (DNRs), artificial nutrition and hydration, and palliative care or hospice.
The Church teaches: “A person has a moral obligation to use ordinary and proportionate means of preserving his or her life.” (Ethical and Religious Directives Fifth Edition, USCCB, 56) Proportionate means are those that in the judgement of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or community.
Conversely, “A person may forgo extraordinary or disproportionate means of preserving life.” (Ethical and Religious Directives Fifth Edition, USCCB, 56) “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.” (CCC, 2278)
As you can see, these criteria are not as black-and-white as we would like and need to be applied to each particular case or situation. The general principle is that medical care should be given to sustain life, not to forestall imminent death, as death is a necessary step towards our eternal union with God.
DNR (Do Not Resuscitate) and Medical Durable Power of Attorney
A reasonably healthy person with a good chance of recovery would be illicit (not allowed) in issuing a DNR while another person with chronic illness at the end of life (such as multiple system failure) would be licit (allowed). Situations to which these could apply could be intubation, ventilators and dialysis. In situations where an individual is healthy but needs these tools to overcome a temporary illness, it would be wrong to deny these benefits, which would be considered ordinary and proportionate. However, if there is no hope of recovery and the treatment is just postponing the inevitable conclusion of a terminal illness, then the removal of treatment would be acceptable.
It is not licit for a healthy individual to have a DNR since it would dictate how treatment would be handled regardless of the temporary nature of the illness (e.g. temporary use of a ventilator to treat pneumonia would be with-held). The current recommendation for healthy individuals is to assign a durable power of attorney to a friend who can be trusted to act as you would in difficult situations. It is important therefore to discuss your wishes with him/her. It is also preferable to select someone outside the immediate family so that their own emotional response will not hinder them from following your wishes.
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Artificial Nutrition and Hydration
The CDF’s 2007 clarification, states that food and water, even if provided artificially, should be presumed as ordinary and proportionate. Therefore to remove water or food, even from someone with a chronic illness or in a persistent vegetative state, would be judged illicit. There are a few specific exceptions to this, but the presumption is that artificial nutrition and hydration should be provided. “…everyone has a right to basic care, including food and fluids, even if at times it has to be administered through a tube. This is the ordinary care we owe to everyone, even when we cannot foresee a turnaround in their condition.” (Life Matters: To the End of Our Days, Secretariat of Pro-Life Activities, USCCB, 2011, p.9)
Palliative Care and Hospice
These are considered acts of charity. Taking of pain medicine is considered a good and should be encouraged as long as the intention is not to cause the death of the patient but to alleviate pain.
“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 suffering 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 and ends 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.” (CCC, 2279)
It is important to recognize that palliative care and hospice are reserved for those who are terminally ill and no longer receiving active treatment. They are in a condition where death is inevitable, and providing them comfort and lessening their pain in this final struggle is a loving action. “True solidarity and love requires us to…affirm the suffering person, enabling him to feel that he is cherished and valued and that his life still has meaning. Terminally ill persons in pain should be offered pain relief and compassionate care to keep them comfortable.” (Life Matters: To the End of Our Days, Secretariat of Pro-Life Activities, USCCB, 2011, p.18)