Euthanasia (terminating a life before its natural end) is following the dark footsteps of abortion (ending human life at its beginning) worldwide, especially in Western and rich countries.
To address ethically, theologically and spiritually the growing reality of euthanasia and assisted suicide in our word, the Vatican Congregation for the Doctrine of the Faith (CDF) has issued a dense and long Letter entitled Samaritanus Bonus, SB, or the Good Samaritan (The Vatican, July 14, 2020). Its subtitle concretizes its content: On the care of persons in the critical and terminal phases of life. The text approved by Pope Francis covers in the Vatican edition (www.vatican.va) 32 pages, including 8 pages for its 99 endnotes. The model to follow in caring the terminally ill is the caring and compassionate attitude and behavior of the Good Samaritan of the well-known parable of Jesus (cf. Lk 10:30-37). Let us not forget that the Church is Teacher and also Mother.
The general purpose of the CDF Letter is an attempt “to enlighten pastors and the faithful regarding their questions and uncertainties about medical care, and their spiritual and pastoral obligations to the sick in the critical and terminal stages of life”. The concrete objective: to “reaffirm the message of the Gospel and its expression in the basic doctrinal statements of the Magisterium” and to “provide precise and concrete pastoral guidelines” on the matter ((SB, Introduction).
At the center of caring is suffering – the cross -, which includes physical, psychological, moral and spiritual suffering. When it comes, suffering Christians look at the suffering Christ, and ask for help to accept it with patience, fortitude, and hope. Other Christians help the suffering so that they will not feel abandoned, but strengthened in their hope, and feel loved.
The first four sections (I-IV) of Samaritanus Bonus preset the framework and the main columns of ethics, theology, and spirituality of care: the care due to our sick neighbour; the human experience of suffering and of the suffering of the Crucified and Risen Christ; the proclamation of hope; the sacredness and inviolability of life. The CDF Letter faces current obstacles that obscure the sacredness and value of every human life and the fundamental and universal right to life, in particular, the unethical defence of absolute autonomy, and the false concepts of “a certain quality of life” and a “right to die”, which are presented by utilitarian ethics as compassion when in reality is “false compassion.”
TEACHING OF THE CHURCH
In its fifth and last part (V) – the most important and the longest -, Samaritanus Bonus presents, explains and expands harmoniously the traditional teaching of the Church, and goes beyond a mere repetition of magisterial texts by explicitly excluding any possible ambiguity in the Magisterium (SB, V, 1). The CDF Letter focuses on euthanasia and assisted suicide, on aggressive medical treatment and on palliative care.
Euthanasia is defined as “an action or an omission which of itself causes death, in order that all pain may in this way be eliminated.” SB states that there is a continuing need to “reaffirm as definitive teaching that euthanasia is a crime against human life,” “intrinsically evil in every situation and circumstance.” Euthanasia is “a malice proper to suicide and murder” (SB, V, 1).It is against the primary principles of natural law and against the divine law.
Assisted suicide (or helping directly those patients who want to commit suicide) is gravely immoral when it is formal cooperation (by those who favor euthanasia and directly assist in suicide) or immediate material cooperation (by those who say they are against euthanasia, and contradicting their words, assist by providing the help needed by the patient to be able to commit suicide). Leaders, legislators, politicians, physicians and nurses, donors, and others who recommend, approve or help implement legally unjust laws favouring euthanasia and assisted suicide are also responsible – accomplices - of unjustified cooperation in evil, of an objectively unethical collaboration: “against the dignity of the human person, a crime against life, and an attack on humanity,” and a scandal deforming consciences (cf. SB, V, 1).
This strong teaching appears perhaps too negative, but in reality, it is not, because we are trying to defend something essentially positive as it is the right to life: Every human person has the primary right to life, and there is no right to die: “There is no right to suicide nor to euthanasia; laws exist not to cause death, but to protect life and to facilitate co-existence among human beings. It is, therefore, never morally lawful to collaborate with such immoral actions or to imply collusion in word, action, or omission” (SB V, 9). In this context, Catholic institutions – and also individual doctors or nurses – ought not to collaborate (immoral cooperation) by referring patients who ask for euthanasia or assistance in suicide to other hospitals (cf. SB, V, 9).
A true conscience opposes unjust laws and obliges to disobey immoral laws. If one is asked to collaborate in the practice of euthanasia and assisted suicide, and if he and she want to act ethically, they ought to make recourse to their right to conscientious objection. Conscientious objection, as an expression of freedom of conscience and/or of religion, is a universal human right. “Governments must acknowledge the right to conscientious objection in the medical and healthcare fields.” Healthcare workers, therefore, “should not hesitate to ask for this right as a specific contribution to the common good” (SB, V, 9).
PALLIATIVE CARE
Bio-medically, human life may be artificially delayed when there is no true benefit to the dying. However, this is not a due prolongation of life but of dying. Why use useless means of treatment, aggressive medical treatment - to preserve life at all costs - when so many other patients need the scarce resources available? Aggressive treatment is generally considered optional, although it appears more humane and Christian – and fairer - not to use extraordinary means that are not beneficial to the patient. To use or not to use extraordinary means of treatment, however, is a decision of the critically ill patient and/or family (through informed or substitute consent) expressed in an advance directive or will. It is important to note that from the moment a patient enters a hospital s/he and the doctor enter into the so-called “therapeutic covenant.”
Caring for patients is the goal of medicine. Integral medical care includes curing when possible and palliative care for terminal patients. While euthanasia and assisted suicide to shorten life unethically and aggressive or extraordinary means of treatment prolong dying uselessly, palliative care accompanies patients (and their families) holistically, and let them die in their proper time, neither earlier (in euthanasia and assisted suicide) nor later (in aggressive useless treatment). There is a right to life and a right to a death with true dignity, in serenity and peace (cf. SB, V, 10).
Palliative care is an exemplary expression of true compassion and empathetic solidarity. It addresses three main issues: pain, loneliness and abandonment, and the spiritual needs of the terminally ill patients. Healthcare providers deal mainly with pain and try to remove it or at least diminish it; family and significant others provide loving accompaniment - a warm heart - against the patient’s possible feelings of loneliness and abandonment; and pastoral agents provide spiritual care. The pastoral agents in particular offer empathy, sympathy and consolation, prayer and the Sacraments (cf. SB, V, 10). Samaritanus Bonus reminds us of a point critically important in our time of the terrible novel coronavirus Covid-19: “Every person has the natural right to be cared for, which at this time is the highest expression of the religion that one professes” (SB, V, 10).
Palliative treatment must be “disseminated throughout the world” (SB, V, 12). Today, and in general, palliative care is not given the essential importance it has, some preferring the easy and criminal short-cut of legalizing euthanasia and assisted suicide. Palliative care provides beneficial treatment to the terminally ill patient, including nutrition and hydration, which are not a medical treatment per se but human needs – ordinary and beneficial means of treatment - of all terminal patients (including children), also of patients in a persistent vegetative state (PVS). “Obligatory nutrition and hydration can at times be administered artificially, provided that it does not cause harm or intolerable suffering to the patient” (SB, V, 3).
Palliative medical care in particular attempts at making suffering and pain bearable, even meaningful. It may include prescribing analgesics and drugs, and even what is called “deep palliative sedation” that may induce loss of consciousness and shorten the life of the patient (cf. SB, V, 7). Pain killers are given to the terminal patient who needs them with the intention to remove the pain or diminish it, but never with the intention of causing death, for in this case, we are talking of a “euthanistic practice,” which is unacceptable (cf. SB V, 7).
WALKING THE TALK
The Magisterium of the Church, faithful to the teaching of the Word of God and Christian Tradition and attempting at making it relevant, is clear and constantly repeated and expanded. The problem on the matter is whether this traditional teaching is filtered down to the faithful and particularly to those institutions and persons differently involved with the end-of-life issues and problems: Catholic medical and nursing schools, Catholic hospitals and clinics, Ecclesiastical faculties and Catholic schools, and Catholic families.
We all know that the basic and essential principle on life is this: Human life must be defended from the moment of conception to natural death. How come that many Catholic leaders, politicians and legislators, donors, and Catholic families are in favor of euthanasia and assisted suicide? Something is failing in our faith. The teaching on life ought to become a commitment of faith in favour of a culture of life and against a culture of death. On the matters of life and death, no believer in Jesus, who is the Good Samaritan and the Crucified and Risen Lord, can just be a spectator on the side of the road of life: “Every Christian must feel as called personally to bear witness to love in suffering” (SB, Conclusion). Our personal and communitarian witnessing builds the way of life, peace and love – the way of hope. In a partly hopeless world, we believers in hope are asked to give a reason for our hope - of our hope in eternal life (cf. 1 Pet 3:15): “The greatest misery consists in the loss of hope in the face of death” (SB, V, Conclusion).
We continue praying for the grace of God to increase our hopeful faith and for the courage to witness our faith in love for all, particularly for those of our brother and sisters who are critically and terminally ill. We remember the words of Jesus: “I was sick and you visited me.” When, Lord? “Every time you did it for the least ones, for a suffering brother or sister, you did it for me” (cf. Mt 25:31-46). We petition Jesus to help us be good Samaritans to all.
May this note on the letter Samaritanus Bonus be a fraternal invitation to you to read the whole text and pray over it! You will not regret it.
Fr. Fausto Gómez, OP.
