Etymologically, the term euthanasia comes from two Greek words eu (well) and thanasia (dying). Therefore, euthanasia, from its root words, means dying well, easy death without severe suffering, mercy killing, and ending a human life for the purpose of putting an end to extreme suffering. In its medical application, euthanasia involves the intentional killing of a tormented incurable patient by the use of lethal means (e.g., sedatives, narcotics, poison) or through the omission or withdrawal/discontinuation of life-sustaining means (Peschke, 1999). Similarly, the Church understands euthanasia as an action or omission, which is of itself and by intention causes the death of another person to eliminate all suffering (John Paul II, 1995). All forms of euthanasia can be active or passive. In both definitions, euthanasia terms of reference are to be found in the intention of the will and the method used. Euthanasia is active when positive means (e.g., injecting poison into the sick person) result in the termination of human life. On the other hand, euthanasia is passive when there is an omission or a withdrawal/discontinuation of life-sustaining means (e.g., food, water, and medications). The purpose of this paper is to examine the position of the Church on withholding or withdrawing life-sustaining means in relation to euthanasia.
The General Position of the Church on Euthanasia
The Church teaches that the life of the human person, who is an image of God, is sacred and inviolable at all stages because, from its beginning, it involves the creative action of God and remains forever in a special relationship with the Creator, who is its sole end (John Paul II, 1995). Therefore, the Church asserts that it belongs only to God to take life. Precisely, the Church emphasizes that no one in any way is permitted to kill an innocent human being, including a fetus or embryo, an infant, an adult, an older adult, one suffering from an incurable disease, or a person who is dying (John Paul II, 1995). No one is permitted to ask for euthanasia either for oneself or for another person or consent to it either explicitly or implicitly. Also, no authority can legitimately recommend or permit euthanasia (John Paul II, 1995). Engaging in euthanasia is a violation of the divine law, an offense against the dignity of the human person, a crime against life, and an attack on humanity (John Paull II. 1995). So, euthanasia is murder and intrinsically evil.
However, the fundamental problem is that some acts that terminate human life can be clearly categorized as euthanasia (e.g., actively poising a sick person), whereas several other acts that terminate human life are not easily categorized as euthanasia. In other words, specific grey areas abound regarding actively or passively causing another person’s death to end the person’s suffering. For instance, a doctor can give a patient a pain relief medication, and it eventually results in the patient’s death. Can such treatment be categorized as euthanasia or not? Also, withdrawing life-sustaining means can lead to death. When is withholding or withdrawing life-sustaining euthanasia, and when is it not euthanasia? As indicated earlier, I will examine the teaching of the Church on withholding or withdrawing life-sustaining means in relation to euthanasia.
Debates Over Withholding or Discontinuing Life-Sustaining Means
Several means exist to sustain human life. Some of these means are easily obtainable (e.g., food, water, exercise, and sleep), and others are not easily obtainable and often carry a lot of burden on family members (e.g., life-sustaining machines). Often, circumstances exist when family members are overwhelmed by the burden of expensive life-sustaining means and tend to discontinue their support. Given the position of the Church on euthanasia, several ethical questions abound regarding life-sustaining means and medical treatments. Among these questions, two are paramount for our discussion. Are there conditions when withholding or withdrawing life-sustaining means is no longer euthanasia? Or must one always have recourse to all remedies in all circumstances to sustain human life? To answer these questions, moralists have distinguished between ordinary and extraordinary means.
Ordinary and Extraordinary Means
Ordinary means are all medical procedures that offer a reasonable hope of benefits for the patient and can be obtained and used without excessive expenses. Moralists hold that one is obliged to use ordinary means unless they are no longer useful, such as in the case of unconscious imminently dying patients (Pazayampallil, 2004). So, withholding or discontinuing ordinary means is without any doubt euthanasia, unless they are no more useful as in the case of unconscious, imminently dying patients. Additionally, a patient who refuses ordinary means and dies has committed suicide.
On the contrary, extraordinary means do not offer a reasonable hope of benefits and cannot be used or obtained without excessive expenses, pain, or other inconveniences. According to moral scholars, one is never obliged to use extraordinary means. However, medical techniques have undergone rapid progress, such that medical procedures considered extraordinary in the past (e.g., major surgeries) are seen as ordinary today. Similarly, several forms of treatment considered extraordinary in one country are considered ordinary in another country. Additionally, medical treatment considered ordinary by one family might be seen as extraordinary by another family. So, the distinction between ordinary and extraordinary means lacks precision and so carries ambiguities. Consequently, the question of obligation to use a means or not is imprecise. Therefore, for the sake of precision, moral theologians today prefer to use the distinction proportionate and disproportionate means.
Proportionate and Disproportionate Means
Determining whether a means is proportionate or disproportionate involves weighing the risk or burden the means will impose on the patient, its complexity, its costs, and the possibility of using it against the benefits of the means. The procedure is proportionate if the benefits outweigh the burden (Negri, 2018; Sacred Congregation for the Doctrine of the Father, 1980). However, some moralists have argued that the distinction between proportionate means and proportionate means is not without ambiguities. In other words, this distinction does seem to offer a more precise criterion for judging the morality of medical treatments than the old distinction between ordinary and extraordinary means. For instance, some means used on one person can be proportionate (e.g., yielding promising results) in one perspective but disproportionate (e.g., producing a high cost) from another perspective.
Church’s Clarifications
To facilitate a proper application of the general principles of proportionate and disproportionate means, Sacred Congregation for the Doctrine of the Faith (1980) made specific clarifications on the criteria for the moral permissibility regarding withholding or withdrawing life-sustaining means. First and foremost, it is permissible to manage the normal means of medical treatment. Therefore, no one is obliged to use medical procedures that are already in use but carry a risk or are burdensome to patients. Refusing such medical procedures should not be seen as suicide or euthanasia. On the contrary, such refusal means that one has accepted the condition of being human, wishes to avoid the application of a medical procedure that is disproportionate to the expected results or desires not to impose excessive expense on the family or community.
Furthermore, if there are no other remedies, using available advanced medical procedures is permissible, even if these means are still at the trial stage and may carry specific risks. However, having recourse to such advanced medical techniques must be done with the patient’s consent. When the result falls short of the expectation, it is permitted to interrupt these means. However, the reasonable wishes of the patient and the patient’s family must be put into consideration before the interruption. Also, the interruption must involve putting into account the advice of doctors who are competent to judge whether the means and personnel are disproportionate to the foreseen results (e.g., the techniques impose on the patient strain or suffering, which are far higher than its benefits).
Additionally, when inevitable death is imminent despite the means used, it is permissible in conscience to decide to refuse forms of treatment that would only secure a prolongation of death (i.e., a precarious and burdensome extension of life), so long as the regular care is not interrupted. In such a circumstance, no one has any reason to blame oneself for failing to help the person in danger. Elaborating on the imminence of death and withdrawal or omission of life-sustaining means, Pazhayampallil (2004) presented the specific criteria. For an unconscious, imminently dying person, providing nutrition, hydration, or any other form of treatment is useless. For a conscious, imminently dying patient, nutrition, hydration, and treatments are also useless and possibly constitute a burdensome prolongation of life. For an unconscious, non-dying patient, nutrition, hydration, and medications are neither useless nor a burden for the patient unless clear evidence indicates that they are burdensome. Finally, for a conscious, irreversible ill, but not imminently dying patient, nutrition, hydration, and medications are also neither useless nor burdensome to the patient unless clear evidence shows that they are burdensome.
Conclusion
From this discussion, it is clear that withdrawing or withholding life-sustaining means when death is imminent is not euthanasia. Also, death due to withholding or withdrawing burdensome or disproportionate treatments is not euthanasia. However, certifying when death is imminent and when procedures are burdensome or disproportionate is a responsibility incumbent upon competent physicians. Finally, although death is part of the human condition and is neither evil nor defeat, hastening death, suicide, and murder through euthanasia is intrinsically evil.
References
John Paull. (1995). Evangelium vitae [Encyclical letter] Retrieved from http://www.vatican.va/content/john-paul-ii/en/encyclicals/documents/hf_jp-ii_enc_25031995_evangelium-vitae.html `
Negri, S. (2018, May 3). The duty to preserve life. [Blog post]. Retrieved from https://www.catholic.com/magazine/online-edition/the-duty-to-preserve-life
Pazhayampallil, T. (2004). Pastoral guide: Fundamental theology and virtues (4th ed.). New Delhi: Rekha Printers Private Ltd.
Peschke, K. H. (1999). Christian ethics: Moral theology in the light of Vatican II. (Vol. 2). Bangalore: Theological Publications.
Sacred Congregation for the Doctrine of the Faith (1980) Declaration on euthanasia. Retrieved from http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19800505_euthanasia_en.html
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