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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.
Using the principle of therapeutic proportionality, we have examined the use of curative and life-sustaining treatments.
Recall that there is no moral obligation to utilize such treatments, if, in one’s best judgment, such measures would be futile or result in burdens disproportionate to anticipated benefits.
Palliative care
But what about those therapies that, although they do not offer the benefits of curing or sustaining life, are used to make a person more comfortable? Such therapies fall under the umbrella of what’s often called palliative care.
Palliative care, specifically at the end of life, can involve a wide range of therapies, such as prescribing anti-depressants to surgery to drain fluid that has built-up around one’s lungs.
One particular concern is the use of painkillers, especially those that may shorten one’s life.
“Medicines capable of alleviating or suppressing pain may be given to a dying person, even if this therapy may indirectly shorten the person’s life so long as the intent is not to hasten death” (Ethical and Religious Directives, 61).
Likewise, one may receive painkillers that cause semi-consciousness or reduced lucidity.
This is an application of the principle of double effect, which can permit a person to act when he or she foresees that an action will produce both good and bad effects.
Principle of double effect
According to this principle, when certain conditions are met, it is permissible to perform an objectively good action, such as relieving pain, even though this may result in a bad consequence, such as shortening one’s life or causing reduced lucidity.
It is permissible, in part, because one’s intention is not for the bad consequence to occur, but for a good effect to occur. That is, because one’s intention is not that one’s life be shortened or that one’s lucidity be reduced, but for the pain to be managed.
For some individuals, the burdens of pain management may, in some circumstances, outweigh its benefits. For example, a dying person waiting to say goodbye to a loved one, might refuse painkillers to retain their lucidity until after their loved one arrives. Similarly, some Catholics might refuse pain management for spiritual reasons.
Redemptive suffering
As John Paul II explained, “In bringing about [our] Redemption through suffering, Christ has also raised human suffering to the level of the Redemption. Thus each man, in his suffering, can also become a sharer in the redemptive suffering of Christ” (Salvific Doloris, 19). Suffering, especially suffering at the end of one’s life, has a special place in God’s saving plan.
We are able to share in Christ’s passion and unite our suffering with the redeeming sacrifice which He offered on the cross. Suffering in “union with the passion of Christ . . . acquires a new meaning; it becomes a participation in the saving work of Jesus” (CCC, 1521).
Particularly through the Sacrament of Anointing of the Sick, the dying are united with the Passion of Christ which saves, helps, and strengthens them.
Therefore, at the end of life, some Catholics may prefer to moderate their use of painkillers, in order to voluntarily accept at least a part of their sufferings and unite themselves in an intentional way with the sufferings of Christ on the cross.
Not to impose suffering
Importantly, we should never impose this heroic way of acting on others. As Proverbs 31:6 states, “Give strong drink to anyone who is perishing, and wine to the embittered.” For those who are not in a state to express themselves, one can reasonably presume that they wish to receive pain management, and have pain-relieving medicines administered according to their doctor’s advice.
“Patients should be kept as free from pain as possible so that they may die comfortably and with dignity, and in the place where they wish to die” (Ethical and Religious Directives, 61). Likewise, although we ourselves can freely chose to embrace redemptive suffering, there is no requirement to do so.
The last dose
Whenever painkillers are being used, there will always be a “last dose.” Painkillers, whether they be administered orally, via an injection, or using a suppository, can require frequent dosing.
Furthermore, because tolerance builds over time, more and more pain medicine may need to be administer. To those at a dying person’s bedside, it may seem like the drug caused or contributed to death, especially if death occurs within a few minutes after a dose is given. However, in most situations, this does not actually cause the person’s dying. It is simply the last dose given in the minutes or hours before the death naturally occurs.
About sedation
Pain management therapies that cause unconsciousness need special consideration. As Pius XII notes, “It is not right to deprive the dying person of consciousness without a serious reason.”
So, for instance, a burn victim being sedated to prevent harmful movements and to mitigate excruciating pain. Or a cardiac patient being sedated to give the cardiovascular system rest after surgery. Each of these cases indicates a serious and compelling reason for sedation.
While pain management therapies are generally permitted, a person should not be deprived of consciousness without a compelling reason, since every person has the right to prepare for his or her death while fully conscious.
Spiritual support
If possible, those nearing death should be provided spiritual support as well as the opportunity to receive the Sacraments in order to prepare well for death.
Clearly, the use of painkillers, sedation, and other forms of pain management are not without concern.
Sometimes these therapies are used with the specific intent of reducing consciousness or hastening the death of a patient. In these situations, “The administration of narcotics for the sole purpose of depriving the dying person of a conscious end is “a truly deplorable practice” (Charter for Health Care Workers, 124).
When this happens, treatment is no longer patient-centered. It is not so much the relief of a patient’s suffering that is sought, but the comfort of those in attendance.
Decision-making must always center on the patient and, what, given the concrete state-of-affairs, is truly good for him or her. Here the experience of pain and suffering must be reconciled. Reconciled not only within one’s mind, but more difficultly within one’s heart.
As Father Kennedy, a fictional character in the novel The Edge of Sadness remarks: “I myself believe that there is no such thing as purposeless pain or suffering, although I must confess that for much of it I can see no purpose at all. But the point is that if one accepts God, one accepts him totally, accepts what he does and what he permits. One accepts it, but one does not necessarily understand it. Surely it’s a question of vision, for as we are, we can see, but only to the corner; we cannot begin to see the whole design . . .”
Dear Lord Jesus, help us this day to trust in your divine providence and, whatever our crosses may be, to faithfully take them up and follow you!
Fr. Joseph Baker is the ethicist for the Diocese of Madison and the pastor of Blessed Trinity Parish in Dane and Lodi.