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| Death: Our Birth into Eternal life
Fr. Joseph Baker |
The following article is the next installment in a series that will appear in the Catholic Herald to offer catechesis and formation concerning end of life decisions, dying, death, funerals, and burial of the dead from the Catholic perspective.
In my first article, we explored the four guiding values for approaching end of life health care decisions from a Catholic perspective.
One of these values is the stewardship we have been given over our lives. Each of us has a duty to care for his or her own health and, when necessary, to seek appropriate care from others.
But what is appropriate care?
Which treatments, medicines, therapies, or surgeries are obligatory, and which are optional?
Therapeutic proportionality
To distinguish when a particular medical treatment is obligatory or optional, Catholics employ the principle of therapeutic proportionality.
According to the principle of therapeutic proportionality, a person has a moral obligation to use proportionate means of preserving his or her life, while a person may forgo disproportionate means of preserving life (USCCB, Ethical and Religious Directives, 56-57).
This begs the obvious question: How can we know whether a treatment is proportionate or disproportionate?
The principle of therapeutic proportionality focuses on the reasonably hoped for benefits of a treatment weighed against its expected burdens.
A treatment is proportionate when the reasonably hoped for benefits outweigh the expected burdens.
Likewise, it is disproportionate when the expected burdens outweigh the reasonably hoped for benefits.
In this way, when a person judges that the benefits of a treatment are proportionate to its burdens, it is obligatory.
However, when a person judges that the burdens of a treatment are disproportionate to its benefits, it is not obligatory.
Factors for consideration
As the Congregation for the Doctrine of the Faith explains, judging what is proportionate should consider several factors.
These include “the type of treatment to be used, its degree of complexity or risk, its cost and the possibility 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” (Declaration on Euthanasia, IV).
It is important to point out that just because a treatment is commonplace or standard practice does not mean that it is obligatory.
Even though medical art has technically perfected a particular treatment, the hoped-for benefit may not necessarily outweigh the risk or burden involved. Obligation is not derived from the statistical frequency of a treatment’s use.
For this reason, when we consider the burdens and benefits of a particular treatment, we should not only consider the physiological impact, but also the psychological, emotional, spiritual, and other effects of an intervention.
For instance, an elderly woman nearing the end of her life may want to continue the use of a certain drug in order to extend her life, because it will give her the opportunity to interact with loved ones traveling from a distance, while another person who is disconnected from his family might choose to forego it.
This judgment needs to be grounded on objective state of affairs regarding both the concrete clinical condition of the patient and the present state of the medical art.
For this to occur, it is critical for us to trust our doctors and to do our best to understand the situation at hand.
If we cannot trust our doctor, we should ask to be reassigned to another physician.
If we cannot comprehend the complexities of a medical issue, we should ask a family member or a friend to accompany us to help us make sound decisions.
Not held to the impossible
At this point, it is important to note something that might seem obvious — no one is held to the impossible.
In some cases, certain physical or moral factors render the utilization of a particular therapy “impossible” on the part of an individual.
As far as physical impossibilities are concerned, there are two potential causes.
One is that the therapy is not available or cannot be utilized.
For example, during the early days of dialysis, very few machines were available to the public, so access to this treatment was not universal.
Another cause is that the physical condition of the patient is incompatible with the use of a particular treatment.
One example would be the resuscitation of a very large person using CPR.
There are also moral causes of impossibility.
One example is the extreme difficulty or excessive hardship in the utilization of a treatment, such as chemotherapy or radiation treatment of an aged person.
A second example is the excruciating pain caused by a treatment.
Imagine a situation when sedatives are unavailable for someone experiencing intense pain due to an amputation.
A third example is the extraordinary cost of a treatment.
The cost of an organ transplant can run into hundreds of thousands of dollars.
A fourth example is the intense fear at the utilization of a particular treatment.
Imagine having to undergo open brain surgery while being awake.
Again, for any measure to be obligatory, all physical and moral impossibilities must be absent.
Proportionality vs. proportionalism
Some Catholics confuse the principle of therapeutic proportionality with proportionalism.
According to proportionalism, the moral quality of an action derives exclusively from the proportion of good or bad consequences. So, as long as one has good intentions and seeks a good end, then an action is morally good.
A primary example of this in practice is physician-assisted suicide.
Following the logic of proportionalism, as long as one has the good intention of eliminating suffering and this end is achieved by ending one’s life, the intentional killing of oneself is morally permissible.
Obviously, this is not what the Catholic Church teaches.
We are not able to employ evil means, such as the taking of an innocent life, no matter our intention.
Another misunderstanding comes from focusing too much on “quality of life.”
A wide-spread criterion used for distinguishing morally obligatory therapies from those that are not is by placing a superior value on “quality of life.”
According to this thinking, when one’s “quality of life” is very bad, it could be judged that a treatment is imposing more burdens than benefits on a patient.
This view holds that life does not have an intrinsic value, rather it is only by virtue of the good that it permits us to experience, especially happiness and pleasure, that it has value.
But as you may remember, the Church holds that human life is always sacred.
For many Catholics, the Church’s approach concerning end of life treatments is refreshingly common sense.
Outside of certain actions that are morally prohibited (e.g., euthanasia), it is impossible to determine the moral character of a given therapy independent of the particular person and circumstance in which it is going to be utilized.
We are not held to the impossible and are only required to do what is proportionately beneficial.
While some might desire black and white answers, the Church leaves room for prudence.
Fr. Joseph Baker is the ethicist for the Diocese of Madison and the pastor of Blessed Trinity Parish in Dane and Lodi.