Church Guidance on Medical Treatment Decisions

Details: 12 November 2010

The recent solemnity of All Souls Day is an appropriate time

to consider the Church’s teaching on end-of-life care and medical treatment decisionmaking.. Making medical decisions about our care or the care of a loved one, with fidelity to our Catholic faith, can be among the toughest decisions we’ll make in our lives.

Fortunately, the Catholic Church provides the moral guidance we need to make medical treatment decisions in accord with our responsibility as Christians. For example, the Nebraska Catholic Conference (NCC), which represents the Bishops of Nebraska, issued a document many years ago entitled "Medical-Treatment Decisionmaking: Moral Guidance and Considerations from Catholic Teaching."

The document’s introduction presents the basic foundation for our moral obligation to be responsible stewards of our lives: "The Catholic Church affirms the sanctity and dignity of every human life as a precious gift of a loving God. All men and women must respect the lives of others while accepting the duties of responsible stewardship for their own lives and for the lives in their care.

"At the same time, however, faith in the resurrection and hope for eternal life have enabled the Catholic tradition to accept death as the inevitable end to temporal life and to believe that death is the gateway to eternal life. It is for this reason that there is no obligation to utilize all possible medical interventions, all possible means of prolonging life. Death need not be avoided at all costs.

"Although Catholic teaching does not look upon biological life as an absolute value, nevertheless it rejects suicide, assisted suicide and mercy killing because they are intrinsically opposed to the reverence for life that Christians are called upon to manifest and express. Compassion and care for dying and seriously ill or disabled persons must never include the willingness to assist in the direct ending of their lives."

In other words, by applying Catholic teaching on the meaning of life, suffering and death to the use of life-sustaining technology we can avoid two extremes: withholding or withdrawing technology with the intention of causing death on the one hand, and insisting on useless or disproportionately burdensome treatment to avoid death at all costs on the other hand.

Most decisions that individuals or families must make about whether to utilize or forego medical treatment fall somewhere between these extremes. Therefore, the NCC document provides this basic moral principle to assist us in determining whether a medical intervention is morally required or morally optional:

"If a particular medical intervention is necessary or useful for the preservation of life or restoration of health, it is ethically ordinary and there is a moral obligation to use it. If, however, a particular medical intervention is analyzed and judged by the patient to be useless (offering no reasonable hope of benefit) or excessively burdensome, it is ethically extraordinary and therefore morally optional."

With regard to artificially-administered nutrition and hydration (ANH), the Church has a longstanding teaching, reflected in several documents, that ANH should be provided as part of any patient’s normal care, even when the assistance of medical intervention is necessary. This obligation, however, does not apply if the provision of ANH is clinically useless or causes excessive burdens to the patient.

This teaching, specifically applied to persons in a so-called persistent vegetative state, was confirmed by Pope John Paul II in a 2004 address to participants at the International Congress on "Life-Sustaining Treatments and Vegetative State". The Pope’s statement prompted the U.S. Bishops to revise their document "Ethical and Religious Directives for Catholic Health Care Services" in November 2009 to say the following:

"In principle, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally. This obligation extends to patients in…the ‘persistent vegetative state’" unless such provision becomes useless or "excessively burdensome for the patient."

I strongly urge Catholics to obtain the Nebraska Catholic Conference’s Medical Treatment Decisionmaking document and become familiar with the principles it presents. It can be obtained online at www.nebcathcon.org or by calling my office. My office also can provide a sample healthcare power of attorney document that reflects the Church’s moral teaching.