EUTHANASIA
In order that the question of euthanasia can be properly dealt with, it is
first necessary to define the words used.
Etymologically speaking, in ancient times euthanasia meant an easy death
without severe suffering. Today one no longer thinks of this original
meaning of the word, but rather of some intervention of medicine whereby the
suffering of sickness or of the final agony are reduced, sometimes also with
the danger of suppressing life prematurely. Ultimately, the word euthanasia
is used in a more particular sense to mean "mercy killing," for the purpose
of putting an end to extreme suffering, or saving abnormal babies, the
mentally ill or the incurably sick from the prolongation, perhaps for many
years, of a miserable life, which could impose too heavy a burden on their
families or on society.
It is, therefore, necessary to state clearly in what sense the word is used
in the present document.
By euthanasia is understood an action or an omission which of itself or by
intention causes death, in order that all suffering may in this way be
eliminated. Euthanasia's terms of reference, therefore, are to be found in
the intention of the will and in the methods used.
It is necessary to state firmly once more that nothing and no one can in any
way permit the killing of an innocent human being, whether a fetus or an
embryo, an infant or an adult, an old person, or one suffering from an
incurable disease, or a person who is dying. Furthermore, no one is
permitted to ask for this act of killing, either for himself or herself or
for another person entrusted to his or her care, nor can he or she consent
to it, either explicitly or implicitly. Nor can any authority legitimately
recommend or permit such an action. For it is a question of the violation of
the divine law, an offense against the dignity of the human person, a crime
against life, and an attack on humanity.
It may happen that, by reason of prolonged and barely tolerable pain, for
deeply personal or other reasons, people may be led to believe that they can
legitimately ask for death or obtain it for others. Although in these cases
the guilt of the individual may be reduced or completely absent,
nevertheless the error of judgment into which the conscience falls, perhaps
in good faith, does not change the nature of this act of killing, which will
always be in itself something to be rejected. The pleas of gravely ill
people who sometimes ask for death are not to be understood as implying a
true desire for euthanasia; in fact, it is almost always a case of an
anguished plea for help and love. What a sick person needs, besides medical
care, is love, the human and supernatural warmth with which the sick person
can and ought to be surrounded by all those close to him or her, parents and
children, doctors and nurses.
THE MEANING OF SUFFERING FOR CHRISTIANS AND THE USE OF PAINKILLERS
Death does not always come in dramatic circumstances after barely tolerable
sufferings. Nor do we have to think only of extreme cases. Numerous
testimonies which confirm one another lead one to the conclusion that nature
itself has made provision to render more bearable at the moment of death
separations that would be terribly painful to a person in full health. Hence
it is that a prolonged illness, advanced old age, or a state of loneliness
or neglect can bring about psychological conditions that facilitate the
acceptance of death.
Nevertheless the fact remains that death, often preceded or accompanied by
severe and prolonged suffering, is something which naturally causes people
anguish.
Physical suffering is certainly an unavoidable element of the human
condition; on the biological level, it constitutes a warning of which no one
denies the usefulness; but, since it affects the human psychological makeup,
it often exceeds its own biological usefulness and so can become so severe
as to cause the desire to remove it at any cost.
According to Christian teaching, however, suffering, especially suffering
during the last moments of life, has a special place in God's saving plan;
it is in fact a sharing in Christ's passion and a union with the redeeming
sacrifice which He offered in obedience to the Father's will. Therefore, one
must not be surprised if some Christians prefer to moderate their use of
painkillers, in order to accept voluntarily at least a part of their
sufferings and thus associate themselves in a conscious way with the
sufferings of Christ crucified (cf. Mt. 27:34). Nevertheless it would be
imprudent to impose a heroic way of acting as a general rule. On the
contrary, human and Christian prudence suggest for the majority of sick
people the use of medicines capable of alleviating or suppressing pain, even
though these may cause as a secondary effect semi-consciousness and reduced
lucidity. As for those who are not in a state to express themselves, one can
reasonably presume that they wish to take these painkillers, and have them
administered according to the doctor's advice.
But the intensive use of painkillers is not without difficulties, because
the phenomenon of habituation generally makes it necessary to increase their
dosage in order to maintain their efficacy. At this point it is fitting to
recall a declaration by Pius XII, which retains its full force; in answer to
a group of doctors who had put the question: "Is the suppression of pain and
consciousness by the use of narcotics...permitted by religion and morality
to the doctor and the patient (even at the approach of death and if one
foresees that the use of narcotics will shorten life)?" the Pope said: "If
no other means exist, and if, in the given circumstances, this does not
prevent the carrying out of other religious and moral duties: Yes."In this
case, of course, death is in no way intended or sought, even if the risk of
it is reasonably taken; the intention is simply to relieve pain effectively,
using for this purpose painkillers available to medicine.
However, painkillers that cause unconsciousness need special consideration.
For a person not only has to be able to satisfy his or her moral duties and
family obligations; he or she also has to prepare himself or herself with
full consciousness for meeting Christ. Thus Pius XII warns: "It is not right
to deprive the dying person of consciousness without a serious reason."
DUE PROPORTION IN THE USE OF REMEDIES
Today it is very important to protect, at the moment of death, both the
dignity of the human person and the Christian concept of life, against a
technological attitude that threatens to become an abuse. Thus some people
speak of a "right to die," which is an expression that does not mean the
right to procure death either by one's own hand or by means of someone else,
as one pleases, but rather the right to die peacefully with human and
Christian dignity. From this point of view, the use of therapeutic means can
sometimes pose problems.
In numerous cases, the complexity of the situation can be such as to cause
doubts about the way ethical principles should be applied. In the final
analysis, it pertains to the conscience either of the sick person, or of
those qualified to speak in the sick person's name, or of the doctors, to
decide, in the light of moral obligations and of the various aspects of the
case.
Everyone has the duty to care for his or her own health or to seek such care
from others. Those whose task it is to care for the sick must do so
conscientiously and administer the remedies that seem necessary or useful.
However, is it necessary in all circumstances to have recourse to all
possible remedies?
In the past, moralists replied that one is never obliged to use
"extraordinary" means. This reply, which as a principle still holds good, is
perhaps less clear today, by reason of the imprecision of the term and the
rapid progress made in the treatment of sickness. Thus some people prefer to
speak of "proportionate" and "disproportionate" means. In any case, it will
be possible to make a correct judgment as to the means by studying the type
of treatment to be used, its degree of complexity or risk, its cost and the
possibilities of using it, and comparing these elements with the result that
can be expected, taking into account the state of the sick person and his or
her physical and moral resources.
In order to facilitate the application of these general principles, the
following clarifications can be added:
-If there are no other sufficient remedies, it is permitted, with the
patient's consent, to have recourse to the means provided by the most
advanced medical techniques, even if these means are still at the
experimental stage and are not without a certain risk. By accepting them,
the patient can even show generosity in the service of humanity.
-It is also permitted, with the patient's consent, to interrupt these means,
where the results fall short of expectations. But for such a decision to be
made, account will have to be taken of the reasonable wishes of the patient
and the patient's family, as also of the advice of the doctors who are
specially competent in the matter. The latter may in particular judge that
the investment in instruments and personnel is disproportionate to the
results foreseen; they may also judge that the techniques applied impose on
the patient strain or suffering out of proportion with the benefits which he
or she may gain from such techniques.
-It is also permissible to make do with the normal means that medicine can
offer. Therefore one cannot impose on anyone the obligation to have recourse
to a technique which is already in use but which carries a risk or is
burdensome. Such a refusal is not the equivalent of suicide; on the
contrary, it should be considered as an acceptance of the human condition,
or a wish to avoid the application of a medical procedure disproportionate
to the results that can be expected, or a desire not to impose excessive
expense on the family or the community.
-When inevitable death is imminent in spite of the means used, it is
permitted in conscience to take the decision to refuse forms of treatment
that would only secure a precarious and burdensome prolongation of life, so
long as the normal care due to the sick person in similar cases is not
interrupted. In such circumstances the doctor has no reason to reproach
himself with failing to help the person in danger.
CONCLUSION
The norms contained in the present Declaration are inspired by a profound
desire to serve people in accordance with the plan of the Creator. Life is a
gift of God, and on the other hand death is unavoidable; it is necessary,
therefore, that we, without in any way hastening the hour of death, should
be able to accept it with full responsibility and dignity. It is true that
death marks the end of our earthly existence, but at the same time it opens
the door to immortal life. Therefore, all must prepare themselves for this
event in the light of human values, and Christians even more so in the light
of faith.
As for those who work in the medical profession, they ought to neglect no
means of making all their skill available to the sick and the dying; but
they should also remember how much more necessary it is to provide them with
the comfort of boundless kindness and heartfelt charity. Such service to
people is also service to Christ the Lord, who said: "As you did it to one
of the least of these my brethren, you did it to me" (Mt. 25:40).
At the audience granted to the undersigned Prefect, His Holiness Pope John
Paul II approved this Declaration, adopted at the ordinary meeting of the
Sacred Congregation for the Doctrine of the Faith, and ordered its
publication.
Rome, the Sacred Congregation for the Doctrine of the Faith, May 5, 1980.
F. Cardinal Seper
Prefect
Jerome Hamer, O.P.
Tit. Archbishop of Lorium
Secretary