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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.
Keeping the principle of therapeutic proportionality in mind, we can now examine when it is possible to discontinue or forgo treatment.
Especially at the end-of-life, one of the most difficult decisions is when to discontinue treatment, or when to forgo the use of life-sustaining medical treatments.
When you can discontinue treatment
The Catholic approach in this situation is very consistent.
Like other scenarios, if a treatment does not offer a reasonable hope of proportionate benefit or if there is a physical or moral impossibility in the utilization of a particular treatment, individuals are not morally obliged to utilize such treatments.
Importantly, from a Catholic perspective, there is no ethical distinction between withholding treatment and withdrawing treatment.
Sometimes individuals feel that by removing or discontinuing treatment they are somehow causing and therefore responsible for their loved one’s death.
The same principle of therapeutic proportionality applies to withholding treatment as it does to withdrawing it.
Even though some would feel more comfortable having tried everything, there is no moral obligation to do this if, in one’s best judgment, such measures would be futile or result in burdens disproportionate to anticipated benefits.
When the continuation of treatment is harmful
Indeed, in some situations when the burdens clearly outweigh the benefits, the continuation of treatment can be harmful.
This is termed therapeutic obstinacy.
Death should not be avoided at all costs.
All have a right to die peacefully with human dignity.
In end-of-life situations, particularly when life and death decisions must be made, it can be difficult to make judgments in the concrete circumstances when uncertainty is often present, emotions are heightened, treatment options may seem vast, and family dynamics are stressed.
When benefits and burdens are unknown
Sometimes it is helpful, especially if the benefits or burdens of a treatment are unknown, to start a particular course of treatment and discontinue it if it becomes disproportionate.
For example, when the benefits or burdens of beginning chemotherapy and radiation treatment are unclear.
In this situation, depending on the circumstances of the individual, it may be useful to begin this course of treatment, thus allowing the benefits and burdens to become better known and for a decision to be made in light of this.
Generally speaking, there is a presumption in favor of utilizing treatment or other means to sustain life.
As stewards of our lives, we have the moral duty to circumvent death. Yet this duty is not absolute. Whenever a treatment is disproportionate, we are not obliged to utilize such means.
We can and should intervene but, at the same time, we need not do everything possible to postpone death.
When death is imminent, it is permitted to refuse treatments that would only secure a precarious and burdensome prolongation of life, so long as the normal care is not interrupted.
When a disproportionate life-sustaining treatment is withheld or withdrawn, this is not suicide or euthanasia.
The intention is to avoid a disproportionate treatment with the foreseen but unintended effect that the person may die.
Different from euthanasia
This is different from euthanasia which is understood as “an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated” (Declaration on Euthanasia, II).
The intention of euthanasia is to end someone’s life, whereas the discontinuance of care simply allows sickness to take its course.
As the Wisconsin bishops note, the key question is “Am I bringing about death or allowing death to occur naturally because continuing therapy is not beneficial for the patient?” (Now and at the Hour of Our Death, 5).
The cause of death is the underlying condition or illness which, given the situation, one no longer has the duty to treat.
In discontinuing treatment, the goal is not to end one’s life, but to avoid a disproportionate treatment. The fact that one can foresee that death will occur if a particular treatment is withheld or withdrawn is not the same as directly causing the death.
So, for instance, the decision to discontinue the use of a ventilator. Some mistakenly believe that it is acceptable to forgo the use of a ventilator altogether, but that it is somehow impermissible to discontinue its use once it has begun.
In some cases, the use of a ventilator is initially proportionate, but, due to changes in circumstances, it becomes disproportionate. Perhaps an individual develops pneumonia, a common complication associated with ventilation, which increases the burdens of continued treatment while diminishing its benefits.
In such situations, when the continued use of a ventilator becomes disproportionate, it is morally licit to discontinue its use.
Principle of double-effect
Here we employ the principle of double-effect.
According to this principle, when certain conditions are met, it is permissible to perform an objectively good or morally indifferent action, even though this may result in a bad consequence.
It is permissible, in part, because one’s intention is not for the bad consequence to occur, but for a good effect to occur (Catechism of the Catholic Church, 1737).
Even though the discontinued use of the ventilator may result in death, the intention is not for this to happen, but to cease an overly burdensome treatment.
As with every stage of life, if a treatment fails to be proportionately beneficial, it is morally acceptable to discontinue or forgo that treatment.
Even at the end of life, this same principle applies. As Catholics, while we want to be responsible stewards, we don’t need to avoid death at all costs.
Prayer for a happy death
Although no one knows for certain how St. Joseph died, pious tradition holds that he passed away in presence of both Jesus and Mary.
This beautiful image has led the Church to proclaim St. Joseph the patron saint of a happy death.
Trusting in his intercession, we make this our prayer: O Blessed Joseph, who yielded up thy last breath in the arms of Jesus and Mary, obtain for me this grace, O holy Joseph, that I may breathe forth my soul in praise, saying in spirit, if I am unable to do so in words: “Jesus, Mary and Joseph, I give Thee my heart and my soul.” Amen.
Fr. Joseph Baker is the ethicist for the Diocese of Madison and the pastor of Blessed Trinity Parish in Dane and Lodi.