What the Catholic Church teaches about death with dignity

“Death with dignity” laws are both sensible and compassionate; religious prohibitions of suicide are both emotional and cruel.     

Too often, that’s how the narrative goes when we discuss end-of-life issues and the laws surrounding them. Secular folks claim that, when people of faith protest against legalized suicide and euthanasia, our arguments are based in emotion, passion, or even a sadistic appetite for pain and suffering.

On the contrary, the Catholic Church’s teachings are both consistent and compassionate.

In light of recent discussions of Supreme Court nominee Neil Gorsuch and his views on assisted suicide and euthanasia, and in light of the story of a Dutch doctor who directed family members to hold down a struggling old woman so he could carry out her “assisted suicide,” I’m sharing again this article from 2013. The research I did for it corrected many of my own misconceptions about what it means to be pro-life at the end of life.

***

“Technology runs amok without ethics,” says Tammy Ruiz, a Catholic nurse who provides end-of-life care for newborns. “Making sure ethics keeps up with technology is one of the major focuses of my world.”

How do Catholics like Ruiz honor the life and dignity of patients, without playing God—either by giving too much care, or not enough?

Cathy Adamkiewicz had to find that balance when she signed the papers to remove her four-month-old daughter from life support. The child’s bodily systems were failing, and she would not have survived the heart transplant she needed. She had been sedated and on a respirator for most of her life. Off the machines, Adamkiewicz says, “She died peacefully in my husband’s arms. It was a joyful day.”

“To be pro-life,” Adamkiewicz explains, “does not mean you have to extend life forever, push it, or give every type of treatment.”

Many believe that the Church teaches we must prolong human life by any means available, but this is not so. According to the Catechism of the Catholic ChurchDiscontinuing 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).

Does this mean that the Church accepts euthanasia or physician-assisted suicide—that we may end a life to relieve suffering or because we think someone’s “quality of life” is too poor? No. The Catechism continues: “One does not will to cause death; one’s inability to impede it is merely accepted” (CCC, 2278).

Richard Doerflinger, associate director of Pro-Life Activities at the USCCB, explains that caregivers must ask, “What good can this treatment do for this person I love? What harm can it do to him or her? This is what Catholic theology calls ‘weighing the benefits and burdens of a treatment.’ If the benefit outweighs the burden, in your judgment, you should request the treatment; otherwise, it would be seen as morally optional.”

Palliative care is also legitimate, even if it may hasten death—as long as the goal is to alleviate suffering.

But how are we to judge when the burdens outweigh the benefits?

Some decisions are black and white: We must not do anything, or fail to do anything, with the goal of bringing about or hastening death. “An act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator (CCC, 2277).

The dehydration death of Terry Schiavo in 2005 was murder, because Schiavo was not dying. Withdrawing food and water had the direct goal of killing her.

But if a man is dying of inoperable cancer and no longer wishes to eat or drink, or his body can no longer process nutrition, withdrawing food and water from him might be ethical and merciful. He is already moving toward death, and there is no reason to prolong his suffering.

Moral Obligations

Our moral obligations are not always obvious. Laura Malnight struggled with doubt and fear as she contemplated the future of her tiny newborn quadruplets. Two of them had pneumonia.

“It was horrible to watch them go through what they had to go through to live, being resuscitated over and over again,” Malnight says.

One baby was especially sick and had suffered brain damage. The doctors who had pushed her to do “selective reduction” while she was pregnant now urged her to stop trying to keep her son alive. “They said we were making a horrible mistake, and they painted a terrible picture of what his life would be like in an institution,” Malnight says.

Exhausted and overwhelmed, Malnight was not able to get a clear answer about the most ethical choice for her children.

Everyone told her, “The baby will declare himself,” signaling whether he’s meant to live or die. “But,” says Malnight, “my only experience with motherhood was with these babies, in their isolettes. The thing was, we would put our hands over our son and he would open his eyes, his breathing would calm.”

“We just kind of muddled through,” she says. Her quadruplets are now 13 years old, and her son, while blind and brain-damaged, is a delightful and irreplaceable child.

Doerflinger acknowledges Malnight’s struggle: “Often there is no one right or wrong answer, but just an answer you think is best for your loved one in this particular situation, taking into account that patient’s own perspective and his or her ability to tolerate the burdens of treatment.”

The key, says Cathy Adamkiewicz, is “not to put our human parameters on the purpose of a human life.”

When she got her infant daughter’s prognosis from the neurologist, she told him, “You look at her as a dying system. I see a human being. Her life has value, not because of how much she can offer, but there is value in her life.”

“Our value,” Cathy says, “is not in our doing, but in our being. Doerflinger agrees, and emphasizes that “every life is a gift. Particular treatments may be a burden; no one’s life should be dismissed as a burden.”

He says that human life is “a great good, worthy of respect. At the same time, it is not our ultimate good, which lies in our union with God and each other in eternity. We owe to all our loved ones the kind of care that fully respects their dignity as persons, without insisting on every possible means for prolonging life even if it may impose serious risks and burdens on a dying patient. Within these basic guidelines, there is a great deal of room for making personal decisions we think are best for those we love.”

Because of this latitude, a living will is not recommended for Catholics. Legal documents of this kind cannot take into account specific, unpredictable circumstances that may occur. Instead, Catholic ethicists recommend drawing up an advance directive with a durable power of attorney or healthcare proxy. A trusted spokesman is appointed to make medical decisions that adhere to Church teaching.

Caregivers should do their best to get as much information as possible from doctors and consult any priests, ethicists, or theologians available—and then to give over care to the doctors, praying that God will guide their hearts and hands.

Terri Duhon found relief in submitting to the guidance of the Church when a sudden stroke caused her mother to choke. Several delays left her on a ventilator, with no brain activity. My husband and I couldn’t stand the thought of taking her off those machines. We wanted there to be a chance,” she says. But as the night wore on, she says, “We reached a point where it was an affront to her dignity to keep her on the machines.”

Duhon’s words can resonate with caregivers who make the choice either to extend life or to allow it to go: “I felt thankful that even though all of my emotion was against it, I had solid footing from the Church’s moral teaching. At least I wasn’t making the decision on my own.”

Adamkiewicz agrees. “It’s so terrifying and frustrating in a hospital,” she remembers. “I can’t imagine going through it without having our faith as our touchstone during those moments of fear.”

 *********

End of life resources

Ethical and Religious Directives for Catholic Healthcare Services (from the USCCB)

Evangelium Vitae

Pope John Paul II, To the Congress on Life-Sustaining Treatments and Vegetative State, 20 March 2004 

NCBCenter.org provides samples of an advance directive with durable power of attorney or healthcare proxy.

This article was originally published in Catholic Digest in 2013.

What the Catholic Church teaches about care for the dying

“Death with dignity” laws are both sensible and compassionate; religious prohibitions of suicide are both emotional and cruel.

Too often, that’s how the narrative goes when we discuss end-of-life issues and the laws surrounding them. Secular folks claim that, when Catholics and others protest against legalized suicide and euthanasia, our arguments are based in emotion, passion, or even a sadistic appetite for pain and suffering.

On the contrary, the Catholic Church’s teachings are both consistent and compassionate.

In light of recent discussions of Supreme Court nominee Neil Gorsuch and his views on assisted suicide and euthanasia, and in light of the story of a Dutch doctor who directed family members to hold down a struggling old woman so he could carry out her “assisted suicide,” I’m sharing again this article from 2013. The research I did for it corrected many of my own misconceptions about what it means to be pro-life at the end of life.

 

***

“Technology runs amok without ethics,” says Tammy Ruiz, a Catholic nurse who provides end-of-life care for newborns. “Making sure ethics keeps up with technology is one of the major focuses of my world.”

How do Catholics like Ruiz honor the life and dignity of patients, without playing God—either by giving too much care, or not enough?

Cathy Adamkiewicz had to find that balance when she signed the papers to remove her four-month-old daughter from life support. The child’s bodily systems were failing, and she would not have survived the heart transplant she needed. She had been sedated and on a respirator for most of her life. Off the machines, Adamkiewicz says, “She died peacefully in my husband’s arms. It was a joyful day.”

“To be pro-life,” Adamkiewicz explains, “does not mean you have to extend life forever, push it, or give every type of treatment.”

Many believe that the Church teaches we must prolong human life by any means available, but this is not so. According to the Catechism of the Catholic ChurchDiscontinuing 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).

Does this mean that the Church accepts euthanasia or physician-assisted suicide—that we may end a life to relieve suffering or because we think someone’s “quality of life” is too poor? No. The Catechism continues: “One does not will to cause death; one’s inability to impede it is merely accepted” (CCC, 2278).

Richard Doerflinger, associate director of Pro-Life Activities at the USCCB, explains that caregivers must ask, “What good can this treatment do for this person I love? What harm can it do to him or her? This is what Catholic theology calls ‘weighing the benefits and burdens of a treatment.’ If the benefit outweighs the burden, in your judgment, you should request the treatment; otherwise, it would be seen as morally optional.”

Palliative care is also legitimate, even if it may hasten death—as long as the goal is to alleviate suffering.

But how are we to judge when the burdens outweigh the benefits?

Some decisions are black and white: We must not do anything, or fail to do anything, with the goal of bringing about or hastening death. “An act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator (CCC, 2277).

The dehydration death of Terry Schiavo in 2005 was murder, because Schiavo was not dying. Withdrawing food and water had the direct goal of killing her.

But if a man is dying of inoperable cancer and no longer wishes to eat or drink, or his body can no longer process nutrition, withdrawing food and water from him might be ethical and merciful. He is already moving toward death, and there is no reason to prolong his suffering.

Moral Obligations

Our moral obligations are not always obvious. Laura Malnight struggled with doubt and fear as she contemplated the future of her tiny newborn quadruplets. Two of them had pneumonia.

“It was horrible to watch them go through what they had to go through to live, being resuscitated over and over again,” Malnight says.

One baby was especially sick and had suffered brain damage. The doctors who had pushed her to do “selective reduction” while she was pregnant now urged her to stop trying to keep her son alive. “They said we were making a horrible mistake, and they painted a terrible picture of what his life would be like in an institution,” Malnight says.

Exhausted and overwhelmed, Malnight was not able to get a clear answer about the most ethical choice for her children.

Everyone told her, “The baby will declare himself,” signaling whether he’s meant to live or die. “But,” says Malnight, “my only experience with motherhood was with these babies, in their isolettes. The thing was, we would put our hands over our son and he would open his eyes, his breathing would calm.”

“We just kind of muddled through,” she says. Her quadruplets are now 13 years old, and her son, while blind and brain-damaged, is a delightful and irreplaceable child.

Doerflinger acknowledges Malnight’s struggle: “Often there is no one right or wrong answer, but just an answer you think is best for your loved one in this particular situation, taking into account that patient’s own perspective and his or her ability to tolerate the burdens of treatment.”

The key, says Cathy Adamkiewicz, is “not to put our human parameters on the purpose of a human life.”

When she got her infant daughter’s prognosis from the neurologist, she told him, “You look at her as a dying system. I see a human being. Her life has value, not because of how much she can offer, but there is value in her life.”

“Our value,” Cathy says, “is not in our doing, but in our being. Doerflinger agrees, and emphasizes that “every life is a gift. Particular treatments may be a burden; no one’s life should be dismissed as a burden.”

He says that human life is “a great good, worthy of respect. At the same time, it is not our ultimate good, which lies in our union with God and each other in eternity. We owe to all our loved ones the kind of care that fully respects their dignity as persons, without insisting on every possible means for prolonging life even if it may impose serious risks and burdens on a dying patient. Within these basic guidelines, there is a great deal of room for making personal decisions we think are best for those we love.”

Because of this latitude, a living will is not recommended for Catholics. Legal documents of this kind cannot take into account specific, unpredictable circumstances that may occur. Instead, Catholic ethicists recommend drawing up an advance directive with a durable power of attorney or healthcare proxy. A trusted spokesman is appointed to make medical decisions that adhere to Church teaching.

Caregivers should do their best to get as much information as possible from doctors and consult any priests, ethicists, or theologians available—and then to give over care to the doctors, praying that God will guide their hearts and hands.

Terri Duhon found relief in submitting to the guidance of the Church when a sudden stroke caused her mother to choke. Several delays left her on a ventilator, with no brain activity. My husband and I couldn’t stand the thought of taking her off those machines. We wanted there to be a chance,” she says. But as the night wore on, she says, “We reached a point where it was an affront to her dignity to keep her on the machines.”

Duhon’s words can resonate with caregivers who make the choice either to extend life or to allow it to go: “I felt thankful that even though all of my emotion was against it, I had solid footing from the Church’s moral teaching. At least I wasn’t making the decision on my own.”

Adamkiewicz agrees. “It’s so terrifying and frustrating in a hospital,” she remembers. “I can’t imagine going through it without having our faith as our touchstone during those moments of fear.”

 *********

End of life resources

 

Ethical and Religious Directives for Catholic Healthcare Services (from the USCCB)

Evangelium Vitae

Pope John Paul II, To the Congress on Life-Sustaining Treatments and Vegetative State, 20 March 2004 

NCBCenter.org provides samples of an advance directive with durable power of attorney or healthcare proxy.

This article was originally published in Catholic Digest in 2013.

For all the saints (including all the jerks)

A few years ago, Max Lindenman asked “What saints can’t you stand?” The responses are pretty interesting: There are some saints that no one likes, because they were unpleasant weirdos. Then there are some that inspire and enchant some people, while repelling and disgusting others. For me, St. John Vianney is one of these repellant types. Every time I hear a saint quote that makes me go, “WHAT?!?!” it turns out to be St. John Vianney. Oh, well—there are plenty of other saints.

When John Paul II was canonized, all of my favorite people were overjoyed that this holy man was being honored, but some Catholics were dubious, even snotty. Some simply don’t like him (how??), while others had serious doubts about his worthiness. It occurs to me that, when people react differently to the saints, there are three lessons to be drawn.

First is that even saints are a product of their times. Sincere spirituality takes different forms according to fads and culture—that’s just the human condition. And so when Padre Pio threw the lady out of his confessional and refused to speak to her until she stopped selling pants to women—well, he was a man of his times. At the time, selling women’s pants truly was a deliberate assault against gender distinction as it existed in that time. The woman in question probably was doing something wrong, just as a woman from the Middle Ages would have been doing something wrong by showing her bare knees: It’s not because knees or pants are intrinsically evil, but because it’s all about context and intention.

Now, it’s very possible that a Padre Pio alive in 2014 would be just as furious at a female pants-seller of 2014. And there’s our second lesson, which is: Saints can be jerks, too. Saints are not infallible; saint are not flawless. Saints sin. They may say or do t hings which are false, silly or harmful. If a priest today threw a woman out of confession for selling pants, he’d be sinning. He might still be a saint: He’d just have to go to confession for that particular sin.

And the third lesson we can learn is that this variety in saintliness is a feature, not a bug. When I adore Saint Fonofrius, but you think he’s a drippy bore, that’s part of God’s plan. It’s one of those “Catholic with a small c” ideas: The Church is here for everybody. While there are certain things that every single living soul is called to, there is always a matter of proportion. For some saints, generosity is their talent. For others, it’s great physical courage. For some saints, their entire lives tell a story of incredible singlemindedness and purity of intention; for others, God used them as the finest living example of someone who kept screwing up, repenting and trying again.

God is the light, and the saints are various types of lamps: Some produce a lovely glow; some produce a brilliant beam. Some make more heat; others are better for atmosphere. Some are for ballrooms, some are for bedsides, some are for keeping traffic orderly. The light inside is the same, but different styles show that light in different ways. A surgeon wouldn’t use a Tiffany lamp in the operating room—but that doesn’t mean there’s something wrong with the Tiffany lamp. It’s just not the right one for that particular job.

So, the grumblers against John Paul II wish he had been a better administrator? Me too. But it wasn’t his particular talent. They wish John Paul II had been more canny, more suspicious of Maciel? Me too, and can you even imagine how much he must have wished it himself. But that wasn’t his particular talent.

When he trusted Maciel, it was a mistake committed because he was a product of his times (nearly everyone trusted Maciel; the Legionaries were apparently bearing wonderful fruit; and false accusations of pedophilia were a common tactic in his home country). It’s also possible that he committed this mistake because of personal flaw: He was Pope, and should have been more careful. (That is absolutely not for me to say—but this is a man who went to confession daily, so he clearly thought he was a sinner.)

But let’s not forget the third lesson: A saint is someone who does the most he can with his particular gifts from God. John Paul’s particular talents were an incredible strength and courage, a contagious joy, a spectacularly original mind, and an unprecedented ability to reach out and draw people to Christ. All of his works were works of love. And that’s why he was declared a saint: He used what God gave him to reflect his share of the light of Christ.

*****
[This post originally ran in a slightly different form in 2011.]

Brilliant men in dark boxes

Anybody remember when this happened?

 

 

PIC statue behind box

 

This was back in 2011, when the NAACP hid a prominent statue of George Washington inside a wooden box during a MLK Day rally, offering the terminally lame excuse that the box that shielded the crowd from Washington’s face would make a more suitable backdrop for the rally’s speakers.   The NAACP denies any intention of disrespect, but their narrow view of history is no secret:  anyone who owned slaves is a racist, and anyone who is a racist cannot be called a great man.  This is what is taught in history class, and several generations have been nourished on these junk food ideas.

Students are taught that they must not squander their exquisite admiration on someone who owned slaves.  They are taught, by implication, that it’s not enough for a man to give up his family and his safety for the noble cause of independence.  It’s not enough to inspire and command.  It’s not even enough to triumph in a way that directly benefits millions of people today.

He must also be . . . EVERYTHING MAN.

He must leap out of his time, and see with the eyes of every possible future type of enlightenment.  Did he accomplish the massive victories that his generation desperately needed?  Not good enough.  We also require him to be the role model for solving any type of conflict that might ever turn up, or else he’s no good to us.  Into the box you go, little George.  You don’t impress us anymore.

Where else do we see this same lazy, self-absorbed analysis of history?  In the sour voices that grumble over John Paul II’s beatification.   He may have been good, they say, but oh, he was not great.  Oh, sure, he was very charismatic and all.  He clearly prayed a lot, and that’s commendable.  But what a hash he made of the Church!  It’s all his fault!  He’s the one who wrote all those lame hymns, he’s the one who offered free butch haircuts to nuns, if you’ll recall.  And who can forget those Woodstock-style World Youth Day rallies, where he encouraged the youth to hold hands during the Our Father?  Never mind that the number of Catholics worldwide grew from 700 million to 1.2 billion while he was Pope — the guy was a squish, a pushover, a washout.

Listen to me.  God sends certain men to achieve certain great deeds while they live.  They are not responsible for what future generations may require:  that is up to the heroes born of those generations.  Great men are great because they do what needs to be done at the time.  They put their own desires and frailties aside, and they make the world new with their particular strengths, their particular form of brilliance.  Heck, that’s what Martin Luther King Jr. did.  A holy man?  No.  He was a serial adulterer.  And Washington owned slaves, and John Paul II allowed the monster Maciel to flourish.

But they were great men.  They took their personal, God-given talents and turned them into something immense — something that made the world better.

It’s not just that we should forgive the wrong they did because they did so much good (although that is also true).  No.  I’m saying that these men were good in the way that they were designed to be good, great according to their own natures.  George Washington’s great strength wasn’t as an abolitionist, you know?  John Paul II’s great strength wasn’t as a disciplinarian.  It wasn’t his calling.

Do we criticize Fra Angelico for not figuring out how to split the atom?  Or do we sneer at Herman Melville because he couldn’t outrun Carl Lewis?  I mean, what do we want from these guys?  And can’t we even imagine that whatever  heroes we admire today may someday be judged harshly by our great great grandchildren — and wouldn’t that seem unfair?  Men are men, and they live when they live.   Who is good enough for us?  Who can escape our endlessly dissatisfied dissection?

There was only one perfect Man.   The other great men of the world — Washington, King, John Paul II, and any hero you can name — are only mirrors, who catch and show to us a little bit of His radiant light.  The world is dark enough already.  Let’s not become so enlightened that we spend our time setting up boxes around the brilliance of great men.

 

****
This post originally ran in 2011.

At Synod, Sex-Obsessed Catholic Church Finally Talks About Sex, Finally

It is stunning that the Bishops are talking about sex! As long as you are the kind of person who wakes up stunned to see the sun rise, stunned to find that you have feet at the end of your legs, stunned to discover that the floor under those feet is still made out of wood, just like it has been for decades and decades.

Read the rest at the Register. 

PIC John Paul II waving

Gut yontiff, Pontiff!

That’s what the Jewish Daily Forward can say to Pope Francis, because they just named him one of the 50 most influential Jews in the United States.  (Apparently they traditionally choose two non-Jewish candidates who show “respect and an understanding of Jewish culture”).

Of course, they could just as easily have chosen Benedict XVI

 

or John Paul II

Or Pope Paul VI

or Pope John XXIII

and of course Pope Pius XII.

So next time you meet the pope and want to wish him “happy holidays,” go ahead and sing out, “Gut Yontiff, Pontiff!”  He’s the Pope.  He’ll get it.