Vatican City, 28 October 2019
The moral, religious, social and legal aspects of the treatment of the dying patient are among the most difficult and widely discussed topics in modern medicine. They have generated intense intellectual and emotional arguments and a very large body of various publications throughout all cultures and societies.
The issues concerning end-of-life decisions present difficult dilemmas, which are not new, but they have intensified greatly in recent years due to several factors and developments:
The dilemmas concerning the care and treatment of the dying patient are not primarily medical or scientific ones, but rather social, ethical, religious, legal and cultural dilemmas. While physicians make decision based on the facts, most of the decisions concerning the dying patient are not of a medical-scientific nature. Rather, they are based on personal values and ethics. Hence, caring for the dying patient by families and health-care providers within societal norms is a challenging task.
The principles and practices of the Abrahamic monotheistic religions, and particularly their understanding of the proper balance between conflicting values, are not always in accord with the current secular humanistic values and practices.
The aims of this position paper are:
A dying patient is defined as a person suffering from a fatal, incurable and irreversible disease, at a stage when death will in all probability occur within the space of a few months as a result of the disease or its directly related complications, despite the best diagnostic and therapeutic efforts.
Suffering and dying
While we applaud medical science for advances to prevent and cure disease, we recognize that every life will ultimately experience death.
Care for the dying is both part of our stewardship of the Divine gift of life when a cure is no longer possible, as well as our human and ethical responsibility toward the dying (and often) suffering patient. Holistic and respectful care of the person must recognize the uniquely human, spiritual and religious dimension of dying as a fundamental objective. This approach to death requires compassion, empathy and professionalism on the part of every person involved in the care of the dying patient, especially from care workers responsible for the psycho-sociological and emotional welfare of the patient.
The use of medical technology at the end of life
Human interventions by medical treatments and technologies are only justified in terms of the help that they can provide. Therefore, their use requires responsible judgment about when life-sustaining and life-prolonging treatments truly support the goals of human life, and when they have reached their limits. When death is imminent despite the means used, it is justified to make the decision to withhold certain forms of medical treatments that would only prolong a precarious life of suffering. Nonetheless, even when persistence in seeking to stave off death seems unreasonably burdensome, we must do whatever is possible to offer comfort, effective pain and symptoms relief, companionship, emotional and spiritual care and support to the patient and his/her family in preparation for death.
The medical team and society at large should respect an authentically independence wish of a dying patient to prolong or preserve his/her life even for an additional short period of time by clinically appropriated medical measures. This includes the continuation of respiratory support, artificial nutrition and hydration, chemotherapy or radiotherapy, antibiotics, pressors and the like. This wish can be expressed either by the patient him/herself, in „real time“; or, if not competent at the time, by advance medical directive, by a surrogate, or by testimony of close family members. This approach represents both the respect for life as well as the respect for independence, which should not only be respected when it is in agreement with the health-care provider. Clergy are often consulted by the family to aid in this decision. In cases of religiously practicing/devout patients or where the immediate next-of-kin are religiously observant/devout, a relevant member of the clergy should be consulted.
The rejection of euthanasia and physician-assisted suicide
Matters pertaining to the duration and meaning of human life should not be in the domain of health care providers whose responsibility is to provide the best possible cure for disease and maximal care of the sick.
We oppose any form of euthanasia – that is the direct, deliberate and intentional act of taking life – as well as physician assisted suicide – that is the direct, deliberate and intentional support of committing suicide – because they fundamentally contradict the inalienable value of human life, and therefore are inherently and consequentially morally and religiously wrong, and should be forbidden without exceptions.
The nurturing community
We emphasize the importance of community support in the decision-making process faced by the dying patient and his/her family. The duty to care for the sick, demands of us also to reform the structures and institutions by which health and religious care are delivered. We, as a society, must assure that patients’ desire not to be a financial burden does not tempt them to choose death rather than receiving the care and support that could enable them to live their remaining lifetime in comfort and tranquility. For religiously observant/devout patients and families there are several possible forms of communal support facilitating thoughtful and prayerful consideration by the parties involved, with medical, religious, and other appropriate counsel. This is a religious duty of the faith community to all its members, according to each one’s responsibilities.
The greatest contribution to humanizing the dying process that health care workers and religious persons can offer is the provision of a faith-and-hope-filled presence. Spiritual and religious assistance is a fundamental right of the patient and a duty of the faith community. It is also acknowledged as an important contribution by palliative care experts. Because of the necessary interaction between the physical, psychological and spiritual dimensions of the person, together with the duty of honoring personal beliefs and faith; all health care providers are duty-bound to create the conditions by which religious assistance is assured to anyone who asks for it, either explicitly or implicitly.
The promotion of palliative care
Any dying patient should receive the best possible comprehensive palliative care – physical, emotional, social, religious and spiritual. The relatively new field in medicine of palliative care has made great advances and is capable of providing comprehensive and efficient support to dying patients and their families. Hence, we encourage palliative care for the patient and for her/his family at the end of life. Palliative care aims at achieving the best quality of life for patients suffering from an incurable and progressive illness, even when their illness cannot be cured, thus expressing the noble human devotion of taking care of one another, especially of those who suffer. Palliative care services, provided by an organized and highly structured system for delivering care, are critical for realizing the most ancient mission of medicine: “to care even when there is no cure.” We encourage professionals and students to specialize in this field of medicine. •
The Catholic Church defines palliative medicine as “the most mature and advanced form of closeness and humanity” for people in the terminal phase of their life. This was reiterated by Msgr. Renzo Pegoraro, Chancellor of the Pontifical Academy for Life, at the opening of the International Congress on Palliative Care held in Murcia, Spain, as reported by the episcopal information service SIR. The aim of palliative care is not a curative approach, but a quality of life as good as possible for people in the terminal phase of their life. “When we speak of Palliative Care we mean a complete and holistic approach to caring for a person in the terminal phase of their life”, Pegoraro is quoted. “Every therapeutic intervention must focus on the good of the person, their dignity, their active involvement in the decisions that concern them”.
Research shows that requests to anti-cipate death are often motivated by pain, loneliness and despair. “Euthanasia appears an easier path to take”, Pegoraro said, but only results in the “globalisation of indifference”.
The two-day international congress about palliative care was organised by the Catholic University of San Antonio in Murcia and the “Pontifical Institute John Paul II for the Science about Marriage and Family”.•
Source: © kna /aerzteblatt.de, https://www.aerzteblatt.de/nachrichten/99128/Vatikan-wirbt-fuer-Palliativpflege, 14 November 2018
Translation by Current Concerns
The WMA reiterates its strong commitment to the principles of medical ethics and that utmost respect has to be maintained for human life. Therefore, the WMA is firmly opposed to euthanasia and physician-assisted suicide.
For the purpose of this declaration, euthanasia is defined as a physician deliberately administering a lethal substance or carrying out an intervention to cause the death of a patient with decision-making capacity at the patient’s own voluntary request. Physician-assisted suicide refers to cases in which, at the voluntary request of a patient with decision-making capacity, a physician deliberately enables a patient to end his or her own life by prescribing or providing medical substances with the intent to bring about death.
No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end.
Separately, the physician who respects the basic right of the patient to decline medical treatment does not act unethically in forgoing or withholding unwanted care, even if respecting such a wish results in the death of the patient. •
Source: www.wma.net/policies-post/declaration-on-euthanasia-and-physician-assisted-suicide/ Adopted by the 70th WMA General Assembly, Tbilisi, Georgia, October 2019
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