The Catholic moral tradition and its articulation in modern Catholic Social Teaching (CST) not only forbids euthanasia (death through a lethal drug administered by a physician), it also excludes aggressive medical treatment in some cases. The secular discussion of the ethics of prolonging life tends toward two extremes: do everything possible by any means to extend life and no ethical obligation to do anything.
Taking a more nuanced approach the American Medical Association (AMA) has developed guidelines for a physician caring for terminally ill patients. Physicians have the twofold commitment to sustain life and to relive suffering. When the two are in conflict, the preferences of the patient should prevail. “The principle of patient autonomy” requires physicians to respect the decision of competent patients to forgo life-sustaining treatments which do not reverse the underlying medical condition such as mechanical ventilation, renal dialysis and artificial nutrition and hydration. In this regard, the guidelines clearly state, “There is no ethical distinction between withdrawing and withholding life-sustaining treatment.” Promoting the “dignity and autonomy of dying patients” also includes “providing effective palliative treatment even though it may foreseeably hasten death.”
The 2020 Vatican letter, “The Good Samaritan” takes up the issue of extending life in a section entitled, “The moral obligation to exclude aggressive medical treatment.” It begins with a general principle: “The dignity of the human person entails the right to die with the greatest possible serenity and with one’s proper human and Christian dignity intact.” The letter recognizes that modern medicine can “artificially delay death, often without real benefit to the patient.” When death is imminent, it is “lawful according to science and conscience to renounce treatments that provide only a precarious and painful extension of life.”
The renunciation of “extraordinary” or “disproportionate” means is not equivalent to suicide or euthanasia, it rather expresses an acceptance of the limitations of the human condition and respect for the wishes of dying patients. As to removing artificial means of nourishment and hydration from the terminally ill, the Vatican document states: “When the provision of nutrition and hydration no longer benefits the patient,” or “causes harm or intolerable suffering,” their “administration should be suspended.” This “does not unlawfully hasten death,” but “respects the natural course of the critical and terminal illness.”
In sum, human beings have a right to nutrition and hydration, and artificial means, such as a feeding tube, can help meet that need. It is morally legitimate both to refuse such extraordinary artificial means to prolong life and to remove them when they do more harm than good. From a Christian perspective, all care for dying persons should be guided by the example of the Good Samaritan, who prompts us to accompany them on their journey to God with respect and compassion.
More on euthanasia and public policy in the next mediation.
What part of CST on prolonging life is most helpful to me and most challenging?