WITHHOLDING TREATMENT OR CARE —

               IS IT MORAL?     

 

 

 

Unfortunately, when approaching death many make decision about withholding medical care without understanding the moral implications of those decisions.   Yet such decisions, coming at the end of life as one prepares to meet Our Lord, are of utmost importance.

Normal Care versus Obligatory and Optional Medical Care

It is important to recognize the distinctions between what is morally obligatory and what is morally optional.   While you are bound to perform moral obligations, you may use discretion regarding providing or omitting moral options.   When evaluating treatment of disease or injury, moral theologians traditionally used the terms "ordinary” or “proportionate” means  and "extraordinary” or “disproportionate” means" to distinguish between which acts are obligations (e.g., ordinary means) and which are options (“e.g. extraordinary means”).

There is a distinction between medical care or treatment and normal care.   Normal care include those things that are needed by all human life to survive (e.g., food, shelter, bathing).  Nutrition and hydration, even when provided artificially (e.g., via and I.V. or through a feeding tube), are considered “basic care” or  “normal care” and are presumed to be proportionate as long as the body still derives greater benefit than harm from its receipt.

Extraordinary/ Disproportionate Means:  

A medical procedure that has little chance of benefiting the human person or which is unduly burdensome, is considered an "extraordinary means" and is not obligatory. For example, a cancer patient may decide, in good conscience, to forgo an aggressive treatment after concluding that the burden associated with the procedure is too much to bear in light of the negligible potential benefit.   This is not an easy analysis.  Consequently, one should consult with a well-grounded priest and/or moral theologian before making the decision.

 ORDINARY/PROPORTIONATE MEANS:

 “A person has a moral obligation to use ordinary or proportionate means of preserving his or her life.  Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or immense excessive expense on the family or community.”  Most Reverend Jose H. Gomez, STD, A Will to Live: Clear Answers on End of Life Issues, Basilica Press (2006) pg. 59.

For example, a respirator used on a young person suffering from temporary  paralysis following an accident might be considered a morally proportionate method of treatment while the use of the same respirator on a patient in the advances stages of terminal lung cancer might be a morally disproportionate method of care.

 

SPECIFIC ISSUES:

Artificial Nutrition and HydrationNutrition and hydration, even when provided artificially (e.g., via and I.V. or through a feeding tube), are considered “basic care” or  “normal care.”    Consequently, the Church teaches that nutrition and hydration must be provided, even to the terminally ill or those in a persistent vegetative state, as long as the body can still absorb and benefit from its receipt and it does not result in a greater burden to the body than benefits.

 “The undue suspension of nourishment or hydration would inevitably cause the patient’s death by starvation or dehydration, such that it “could amount to euthanasia in a proper sense.”   Pontifical Council for Pastoral Assistance, Charter, p. 120.  

John Paul II clarified this issue further in 2004 by clearing stating that the obligation to provide nutrition and hydration included through artificial means.   John Paul II, “Address to Congress on ‘Life -Sustaining Treatments an Vegetative State”   Pointing out that:

 “[D]eath by starvation or dehydration is, in fact, the only possible outcome as a result of their [nutrition and hydration] withdrawal.  In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission.”

 He went on to clarify that, when evaluating withdrawing nutrition and hydration,:

 “[C]onsideration about the “quality of life,” often actually dictated by psychological, social and economic pressures, cannot take precedence over general principles.”  

Experimental Procedures: Patients acting with a free and informed conscious may morally elect to use the most advanced medical techniques available even if the procedure is experimental and/or involves some reasonable risk.  Patients may also elect to stop such treatment if the benefits prove to be inadequate.

When Death is Imminent:  When death become imminent, a patient may morally refuse to receive medical treatment if it would only result in a precarious and burdensome prolongation of life.  It is important to note, however, that nutrition and hydration, even if artificial, is considered “normal care” not “medical treatment.”

Pain Medication/Palliative Care:   Applying the principle of double effect, the Church has taught for years that the use of narcotics to subdue pain is permissible, even though they may have the effect of shortening life, as long as there is no effective alternative available.   Pain medication can never be morally given with the intention of hastening death.

Pain Medication and Preparation for Death  As we approach death, the Church teaches that we should try to remain as conscious as possible so that we can properly prepare and receive the sacraments.   Palliative medicine can adversely affect this ability.  With today’s advances in palliative care, most people can be treated and remain relatively alert.  We should aggressively strive to be treated in a way that allows us to remain as alert as possible.  However, while it is preferable to die in a conscious state of prayer, there is no moral obligation to forgo needed medications and pain relief even if those treatments cause disorientation or produce unconsciousness.

Receipt of the SacramentsWe should approach death with the joyful anticipation of seeing face to face our Blessed Lord whom we have loved and served in this life. In order to prepare to see Him face to face, Catholics should receive the sacraments.   It is a good idea to include this desire in any Health Directive you execute.

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