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Magisterium on the end-of-life /1Pope Francis, September 20th 2019

ADDRESS OF HIS HOLINESS POPE FRANCIS TO THE NATIONALFEDERATION OF THE ORDERS OF DOCTORS AND DENTALSURGEONS - Clementine Hall - Friday, 20 September 2019Dear brothers and sisters, (…) We must always remember that illness,the object of your concerns, is more than a clinical fact, medicallycircumscribable; it is always the condition of a person, the sick person,and it is with this entirely human vision that doctors are called to relate tothe patient: considering therefore his singularity as a person who has anillness, and not only a case of whatever illness that patient has. For doctorsit is a matter of possessing, together with the due technical-professionalcompetence, a code of values and meanings with which to give meaningto the disease and to their work, and to make each individual clinical casea human encounter.Faced, therefore, with any change in medicine and in the society youhave identified, it is important that the doctor does not lose sight of theuniqueness of each patient, with his dignity and his fragility. A man ora woman to be accompanied with conscience, intelligence and heart,especially in the most serious situations. With this attitude we can andmust reject the temptation – also induced by legislative changes – to usemedicine to support a possible willingness to die of the patient, providingassistance to suicide or directly causing death by euthanasia.These are hasty ways of dealing with choices that are not, as they mightseem, an expression of the person’s freedom, when they include the

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discarding of the patient discard as a possibility, or false compassion in theface of the request to be helped to anticipate death. As the New Charterfor Health Care Workers states: “There is no right to dispose arbitrarilyof one's life, so no doctor can become an executive guardian of a non-existent right” (169).

Magisterium on the end-of-life /2Pope Francis, 2017

MESSAGE OF HIS HOLINESS POPE FRANCIS TO THEPARTICIPANTS IN THE EUROPEAN REGIONAL MEETING OF THEWORLD MEDICAL ASSOCIATION - [Vaticano, Aula Vecchia del Sinodo,16-17 novembre 2017]To My Venerable Brother Archbishop Vincenzo Paglia President of thePontifical Academy for Life (…) It is clear that not adopting, or elsesuspending, disproportionate measures, means avoiding overzealoustreatment; from an ethical standpoint, it is completely different fromeuthanasia, which is always wrong, in that the intent of euthanasia isto end life and cause death. Needless to say, in the face of criticalsituations and in clinical practice, the factors that come into play are oftendifficult to evaluate. To determine whether a clinically appropriate medicalintervention is actually proportionate, the mechanical application of ageneral rule is not sufficient. There needs to be a careful discernment ofthe moral object, the attending circumstances, and the intentions of thoseinvolved. In caring for and accompanying a given patient, the personal andrelational elements in his or her life and death – which is after all the lastmoment in life – must be given a consideration befitting human dignity. Inthis process, the patient has the primary role.(…) the supreme commandment of responsible closeness, must be keptuppermost in mind, as we see clearly from the Gospel story of the Good

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Samaritan (cf. Lk 10:25-37). It could be said that the categorical imperativeis to never abandon the sick. The anguish associated with conditionsthat bring us to the threshold of human mortality, and the difficulty of thedecision we have to make, may tempt us to step back from the patient.Yet this is where, more than anything else, we are called to show loveand closeness, recognizing the limit that we all share and showing oursolidarity. Let each of us give love in his or her own way—as a father, amother, a son, a daughter, a brother or sister, a doctor or a nurse.But give it! And even if we know that we cannot always guarantee healingor a cure, we can and must always care for the living, without ourselvesshortening their life, but also without futilely resisting their death.This approach is reflected in palliative care, which is proving mostimportant in our culture, as it opposes what makes death most terrifyingand unwelcome—pain and loneliness. Within democratic societies, thesesensitive issues must be addressed calmly, seriously and thoughtfully, ina way open to finding, to the extent possible, agreed solutions, also on thelegal level. On the one hand, there is a need to take into account differingworld views, ethical convictions and religious affiliations, in a climate ofopenness and dialogue.On the other hand, the state cannot renounce its duty to protect allthose involved, defending the fundamental equality whereby everyoneis recognized under law as a human being living with others in society.Particular attention must be paid to the most vulnerable, who need helpin defending their own interests.If this core of values essential to coexistence is weakened, the possibilityof agreeing on that recognition of the other which is the condition for alldialogue and the very life of society will also be lost. Legislation on healthcare also needs this broad vision and a comprehensive view of what mosteffectively promotes the common good in each concrete situation.

Magisterium on the end-of-life /3Catechism of the Catholic Church

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Euthanasia2276 Those whose lives are diminished or weakened deserve specialrespect. Sick or handicapped persons should be helped to lead lives asnormal as possible.2277 Whatever its motives and means, direct euthanasia consists inputting an end to the lives of handicapped, sick, or dying persons.It is morally unacceptable.Thus an act or omission which, of itself or by intention, causes death inorder to eliminate suffering constitutes a murder gravely contrary to thedignity of the human person and to the respect due to the living God, hisCreator.The error of judgment into which one can fall in good faith does not changethe nature of this murderous act, which must always be forbidden andexcluded.2278 Discontinuing medical procedures that are burdensome, dangerous,extraordinary, or disproportionate to the expected outcome can belegitimate; it is the refusal of "over-zealous" treatment.Here one does not will to cause death; one's inability to impede it is merelyaccepted.The decisions should be made by the patient if he is competent and ableor, if not, by those legally entitled to act for the patient, whose reasonablewill and legitimate interests must always be respected.

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2279 Even if death is thought imminent, the ordinary care owed to a sickperson cannot be legitimately interrupted.The use of painkillers to alleviate the sufferings of the dying, even at therisk of shortening their days, can be morally in conformity with humandignity if death is not willed as either an end or a means, but only foreseenand tolerated as inevitablePalliative care is a special form of disinterested charity.As such it should be encouraged.Suicide2280 Everyone is responsible for his life before God who has given it tohim.It is God who remains the sovereign Master of life.We are obliged to accept life gratefully and preserve it for his honor andthe salvation of our souls.We are stewards, not owners, of the life God has entrusted to us.It is not ours to dispose of.2281 Suicide contradicts the natural inclination of the human being topreserve and perpetuate his life.It is gravely contrary to the just love of self.It likewise offends love of neighbor because it unjustly breaks the tiesof solidarity with family, nation, and other human societies to which wecontinue to have obligations.Suicide is contrary to love for the living God.2282 If suicide is committed with the intention of setting an example,especially to the young, it also takes on the gravity of scandal.Voluntary co-operation in suicide is contrary to the moral law.Grave psychological disturbances, anguish, or grave fear of hardship,suffering, or torture can diminish the responsibility of the one committingsuicide.2283 We should not despair of the eternal salvation of persons who havetaken their own lives. By ways known to him alone, God can provide theopportunity for salutary repentance. the Church prays for persons whohave taken their own lives.

CONGREGATION FOR THE DOCTRINE OF THEFAITH DECLARATION ON EUTHANASIA1980IV. DUE PROPORTION IN THE USE OF REMEDIES

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Today it is very important to protect, at the moment of death, both thedignity of the human person and the Christian concept of life, againsta technological attitude that threatens to become an abuse. Thus somepeople speak of a "right to die," which is an expression that does notmean the right to procure death either by one's own hand or by meansof someone else, as one pleases, but rather the right to die peacefullywith human and Christian dignity. From this point of view, the use oftherapeutic means can sometimes pose problems. In numerous cases,the complexity of the situation can be such as to cause doubts about theway ethical principles should be applied. In the final analysis, it pertainsto the conscience either of the sick person, or of those qualified to speakin the sick person's name, or of the doctors, to decide, in the light ofmoral obligations and of the various aspects of the case. Everyone hasthe duty to care for his or he own health or to seek such care from others.Those whose task it is to care for the sick must do so conscientiouslyand administer the remedies that seem necessary or useful. However,is it necessary in all circumstances to have recourse to all possibleremedies? 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 andthe rapid progress made in the treatment of sickness. Thus some peopleprefer to speak of "proportionate" and "disproportionate" means. In anycase, it will be possible to make a correct judgment as to the means bystudying 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 withthe result that can be expected, taking into account the state of the sickperson and his or her physical and moral resources.In order to facilitate the application of these general principles, thefollowing clarifications can be added:- If there are no other sufficient remedies, it is permitted, with the patient'sconsent, to have recourse to the means provided by the most advancedmedical techniques, even if these means are still at the experimental stageand are not without a certain risk. By accepting them, the patient can evenshow 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 tobe made, account will have to be taken of the reasonable wishes of thepatient and the patient's family, as also of the advice of the doctors whoare specially competent in the matter. The latter may in particular judgethat the investment in instruments and personnel is disproportionate to the

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results foreseen; they may also judge that the techniques applied imposeon the patient strain or suffering out of proportion with the benefits whichhe or she may gain from such techniques.- It is also permissible to make do with the normal means that medicinecan offer. Therefore one cannot impose on anyone the obligation to haverecourse to a technique which is already in use but which carries a riskor is burdensome. Such a refusal is not the equivalent of suicide; onthe contrary, it should be considered as an acceptance of the humancondition, or a wish to avoid the application of a medical proceduredisproportionate to the results that can be expected, or a desire not toimpose excessive expense on the family or the community.- When inevitable death is imminent in spite of the means used, it ispermitted in conscience to take the decision to refuse forms of treatmentthat 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 notinterrupted. In such circumstances the doctor has no reason to reproachhimself with failing to help the person in danger.