Francis sends a message to a meeting on end-of-life in which he says the sick must be accompanied with love in the last phase of their life, given information and allowed to decide. This requires “careful discernment of the moral object, the attending circumstances, and the intentions of those involved”. From this perspective, palliative care plays a major role.
Vatican City (AsiaNews) – Pope Francis sent a message to the Pontifical Academy of Life on the occasion of the European regional meeting of the World Medical Association on the end-of-life issue.
In his letter, the pontiff said that from an ethical point of view, overzealous treatment “is completely different from euthanasia, which is always wrong, in that the intent of euthanasia is to end life and cause death”.
Following Catholic doctrine, the sick should be accompanied with love in the last phase of their life, given information and allowed to decide. This requires “careful discernment of the moral object, the attending circumstances, and the intentions of those involved.” From this perspective, palliative care plays a major role.
Such questions “have always challenged humanity, but [. . .] today take on new forms by reason of increased knowledge and the development of new technical tools” in medical care.
It has become “possible nowadays to extend life by means that were inconceivable in the past”. These “can sustain, or even replace, failing vital functions, but that is not the same as promoting health. Greater wisdom is called for today, because of the temptation to insist on treatments that have powerful effects on the body, yet at times do not serve the integral good of the person.”
To back his point, Francis cites Pope Pius XII who in 1957 wrote that “it is morally licit to decide not to adopt therapeutic measures, or to discontinue them”. This requires taking into account “the result that can be expected, [. . .] the state of the sick person and his or her physical and moral resources. It thus makes possible a decision that is morally qualified as withdrawal of ‘overzealous treatment’.”
“Such a decision responsibly acknowledges the limitations of our mortality, once it becomes clear that opposition to it is futile. ‘Here one does not will to cause death; one’s inability to impede it is merely accepted’ (Catechism of the Catholic Church, No. 2278). This difference of perspective restores humanity to the accompaniment of the dying, while not attempting to justify the suppression of the living.”
“Needless to say, in the face of critical situations and in clinical practice, the factors that come into play are often difficult to evaluate. To determine whether a clinically appropriate medical intervention is actually proportionate, the mechanical application of a general rule is not sufficient. There needs to be a careful discernment of the moral object, the attending circumstances, and the intentions of those involved.
“In caring for and accompanying a given patient, the personal and relational elements in his or her life and death – which is after all the last moment in life – must be given a consideration befitting human dignity. In this process, the patient has the primary role. The Catechism of the Catholic Church makes this clear: ‘The decisions should be made by the patient if he is competent and able’ (loc. cit.).
Indeed, it “The patient, first and foremost, [who] has the right, obviously in dialogue with medical professionals, to evaluate a proposed treatment and to judge its actual proportionality in his or her concrete case, and necessarily refusing it if such proportionality is judged lacking. That evaluation is not easy to make in today's medical context, where the doctor-patient relationship has become increasingly fragmented and medical care involves any number of technological and organizational aspects.”
In addition, we must take into account “the combination of technical and scientific capability and economic interests. Increasingly sophisticated and costly treatments are available to ever more limited and privileged segments of the population, and this raises questions about the sustainability of healthcare delivery”.
Such a gap is growing not only between rich and poor countries, but also within rich countries. Against this background, “the categorical imperative is to never abandon the sick”.
Thus, “Let each of us give love in his or her own way – as a father, a mother, 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 healing or a cure, we can and must always care for the living, without ourselves shortening their life, but also without futilely resisting their death. This approach is reflected in palliative care, which is proving most important in our culture, as it opposes what makes death most terrifying and unwelcome – pain and loneliness.”
Finally, “Within democratic societies, these sensitive issues must be addressed calmly, seriously and thoughtfully, in a way open to finding, to the extent possible, agreed solutions, also on the legal level.
“On the one hand, there is a need to take into account differing world views, ethical convictions and religious affiliations, in a climate of openness and dialogue. On the other hand, the state cannot renounce its duty to protect all those involved, defending the fundamental equality whereby everyone is recognized under law as a human being living with others in society.
“Particular attention must be paid to the most vulnerable, who need help in defending their own interests. If this core of values essential to coexistence is weakened, the possibility of agreeing on that recognition of the other which is the condition for all dialogue and the very life of society will also be lost. Legislation on health care also needs this broad vision and a comprehensive view of what most effectively promotes the common good in each concrete situation.