LETTER SAMARITANUS BONUS – ON EUTHANASIA AND ASSISTED SUICIDE
Caring for the terminally ill
Fausto Gomez OP
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, long and well-grounded Letter entitled Samaritanus Bonus(SB), or the Good Samaritan, on July 14, 2020. Its subtitle: On the care of persons in the critical and terminal phases of life. The text approved by Pope Francis covers 33 pages, including 8 pages for its 99 footnotes. It is divided into five parts (I-V). 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). The Church is Teacher and Mother.
The purpose of the CDF Letter is “to enlighten pastors and faithful [and all caregivers] on the care of the sick in critical and terminal stages of life,” and to point out their obligation to patients crossing those stages. The Letter wishes to “reaffirm the teaching of the Magisterium.”In its fifth part (V), the CDF Letter presents, explains and expands 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).
TEACHING OF THE CHURCH
Samaritanus Bonus 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”: against the primary principles of natural law and against the divine law. It is “intrinsically evil in every situation and circumstance.” Euthanasia is “a malice proper to suicide and murder” (SB, V, 1).
Assisted suicide (or helping directly those patients who want to commit suicide) is gravely immoral when it is formal cooperation (those who favor euthanasia and directly assist in suicide) or immediate material cooperation (those who say they are against euthanasia [?] and assist by providing help needed by the patient to be able to commit suicide).
Moreover, leaders, legislators, physicians and nurses, and others who recommend and approve legally unjust laws favoring 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” (SB, V, 1).
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. Conscientiousobjection, 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 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 (through informed or substitute consent) expressed in an advance directive or will. From the moment a patient enters a hospital s/he and the doctor enter into the so-called “therapeutic covenant.”
Caring for patients always is the goal of medicine. Integral medical caring includes curing when possible and palliative care for terminal patients. While euthanasia and assisted suicide 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) nor later (in aggressive useless treatment). There is a right – medically, morally and spiritually – to a death with dignity, in serenity and peace.
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 pastors, hospital chaplains and members of the pastoral team care for the spiritual life of patients.
Palliative care provides beneficial treatment to the terminally ill patient, including nutrition and hydration, which are not medical treatment per se but human needs of all terminal patients, 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).
With the other collaborators, palliative medical care in particular attempts at making suffering and pain bearable, even meaningful. It may prescribe analgesics and drugs, and evenwhat is called “deep palliative sedation” that may induce loss of consciousness and shorten the life of the patient (cf. SB, V, 7). Painkillers are given to the patient with the intention to remove pain or diminish it, but never with the intention of causing death, for in this case we are talking of a “euthanistic practice” (cf SB V, 11).
WALKING THE TALK
We all know that the basic and essential principle regarding life is this: Human life must be defended from the moment of conception to natural death. How come many Catholic leaders and legislators, some Catholic ethicists, bioethicists and theologians, and Catholic families are in favor of abortion, euthanasia and assisted suicide, and the death penalty? The teaching on life ought to become a commitment of faith in favor 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. “Every Christian must feel as called personally to bear witness to love in suffering” (SB, Conclusion).
In a partly hopeless world, we believers in hope are asked to give a reason for our hope – of our hope in eternal life: “The greatest misery consists in the loss of hope in the face of death” (SB, V, and Conclusion). We hope and pray that Jesus will tell each one of us: “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). Let us ask Jesus, “Help us be good Samaritans to all!” (Photo by Francis Miel Velasco)
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