Models used for illustrative purposes only.Copyright © 2010, United States Conference of Catholic Bishops, Washington, D.C. 1042

Secretariat of Pro-Life Activities United States Conference of Catholic Bishops 3211 Fourth Street NE • Washington, DC 20017-1194Tel: (202) 541-3070 • Fax: (202) 541-3054Website: www.usccb.org/prolife

precarious and burdensome prolongationof life, so long as the normal care due tothe sick person in similar cases is notinterrupted’” (n. 65).

It is clear that there is no moral require-ment to utilize burdensome treatmentsthat merely prolong the dying process.Unless the patient is very near death, how-ever, the provision of nutrition and hydra-tion, even by artificial means, should beadministered as long as they can sustainlife and alleviate suffering without impos-ing serious risks or side effects to thepatient.

Today active interventions or omissions ofbasic care are proposed for ending thelives of not only the dying, but alsopatients suffering from a long-term cogni-tive disability, such as advanced dementia

or a so-called persistent “vegetative” state.Some argue that patients who cannot con-sciously respond have lost their “human digni-ty.” This view is dangerously wrong: Humanbeings never lose their dignity, that is, theirinherent and inestimable worth as unique per-sons loved by God and created in His image.People can be denied respect affirming thatdignity, but they never lose their God-givendignity.

What does the Church teach about ourduty to care for dying or vulnerable familymembers?

When a family or health care providers refuseto provide basic care (nutrition, hydration,cleanliness, warmth, and prevention of compli-cations from confinement to bed), finding it“inconvenient” to accompany the loved one onthe final journey, the assault on human dignityis grave. When such abandoning of the dis-abled or unconscious patient is codified in statelaws, the implications for society are frighten-ing. Pope Benedict XVI states in his encyclicalIn Hope We are Saved (Spe Salvi), Nov. 20,2007: “The true measure of humanity is essen-tially determined in relationship to sufferingand to the sufferer…. A society unable toaccept its suffering members and incapable ofhelping to share their suffering and to bear itinwardly through ‘com-passion’ is a cruel andinhuman society” (no. 38).

Christ calls us to love one another: “This is mycommandment: love one another as I loveyou” (John 15:12). He loved us unto death,even death on the cross. Few are called to such

a sacrifice; but we are called to be com-panions to each other, especially to thosesuffering on life’s journey. “Companion”is taken from the word “cum-panis,”meaning “with bread.” Thus, we arecalled to share the bread of Eucharist witheach other, responding with Christ’s sacri-ficial love. We are asked not only to carefor each other, but to nourish each other,even unto death.

Dr. Hilliard is the director of bioethicsand public policy for The NationalCatholic Bioethics Center. She is a canonlawyer and a registered nurse.

1 The National Catholic Bioethics Center provides a 24 hourethics consultation service, free of charge: 215-877-2660.

2 United States Conference of Catholic Bishops, Ethical andReligious Directives for Catholic Health Care Services, 5thEd. (2009) n. 61.

3 John Paul II, Encyclical The Gospel of Life (EvangeliumVitae), March 25, 1995, n. 65.

4 Pope John Paul II, Allocution “On Life-SustainingTreatment and the Vegetative State”, March 20, 2004, n. 4.

5 Congregation for the Doctrine of the Faith, Responses toCertain Questions of the United States Conference ofCatholic Bishops Concerning Artificial Nutrition andHydration, 2008.

“The true measure of humanityis essentially determined in

relationship to suffering andto the sufferer…. A society

unable to accept its sufferingmembers and incapable of

helping to share their sufferingand to bear it inwardly

through ‘com-passion’ is acruel and inhuman society.”

Pope Benedict XVI,In Hope We are Saved, no. 38

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Recently the daughter of a mandying of cancer called the NationalCatholic Bioethics Center’s consul-tation line.1 Her father, while stillable to swallow, was ingesting lessand less as death approached. Hehad received the Anointing of theSick and Viaticum (i.e., theEucharist given to the dying). Thedaughter asked if there was a moralobligation to provide assisted nutri-tion and hydration as death drewnear. After determining that herfather’s vital organs no longer couldassimilate food and water, causingthe decreased appetite, the moraldecision was made not to initiate assistednutrition and hydration.

The next day the daughter called, statingthat her father had died, and expressinggratitude for the advice. It was obviousthat the underlying pathology, noteuthanasia through starvation and dehy-dration, had caused his death.

Families also get advice from othersources. Tragically, some have beenwrongly advised by the medical commu-nity that preserving their loved one’s“dignity” and ending their sufferingrequire ending their life—by active inter-vention, or more frequently, by omittingbasic care.

Many families are unsure about moraloptions for the care of their loved ones.Fortunately, the popes and bishops of theCatholic Church have provided invaluableguidance concerning end-of-life decisions,including issues of pain control and con-sciousness, the provision of food and waterto dying or unconscious patients, the right torefuse certain treatments, and the duty tocare, even when a cure is no longer possible.

In a pamphlet, one can only highlight theseteachings, so readers are encouraged to readthe entire statements and directives men-tioned below, which are available online.

What does the Church teach about paincontrol and consciousness?

The Ethical and Religious Directives forCatholic Health Care Services2 (ERDs) state,“Patients should be kept as free of pain aspossible so that they may die comfortablyand with dignity, and in the place where theywish to die. Since a person has the right toprepare for his or her death while fully con-scious, he or she should not be deprived ofconsciousness without a compelling rea-son….” In some cases, pain control mayrequire brief or prolonged periods of uncon-sciousness. Pain control can be provided evenif, in rare cases, the needed doses may havean anticipated, but unintended effect of has-tening death.3 The intention is to controlextreme pain, not to hasten death. Witheuthanasia, however, there is an explicitintent to terminate the patient’s life, repre-senting a grave evil with eternal conse-quences.

Currently, three states allow physician-assist-ed suicide. Some states practice a more covertform of euthanasia, providing patients whosuffer from physical or even psychologicalpain with high doses of sedation, when othereffective relief is available. Then assistednutrition and hydration are withheld, causingdeath by dehydration or starvation, not theunderlying pathology. This is sometimes called“terminal sedation,” distinguishable from thelegitimate use of sedation as a last resort totreat patient suffering in their last days. Thedifference is in the physician’s intent, whetherit is to end life or control pain.

What does the Church teach about pro-viding food and water to unconscious ordying patients?

Pope John Paul II taught: “I should like par-ticularly to underline how the administrationof water and food, even when provided byartificial means, always represents a naturalmeans of preserving life, not a medical act.Its use, furthermore, should be considered, inprinciple, ordinary and proportionate, andas such morally obligatory, insofar as anduntil it is seen to have attained its properfinality, which in the present case consists inproviding nourishment to the patient andalleviation of his suffering.”4 This principlehas been affirmed by the Congregation forthe Doctrine of the Faith5 and incorporatedinto the Ethical and Religious Directives in2009 (n. 58).

What does the Church teach about thepatient’s right to refuse or forego certainmedical treatments?

The papal encyclical The Gospel of Lifecondemns euthanasia, drawing a key distinc-tion between euthanasia and the decision toforego “medical procedures which no longercorrespond to the real situation of thepatient, either because they are by now dis-proportionate to any expected results orbecause they impose an excessive burden onthe patient and his family. In such situations,when death is clearly imminent andinevitable, one can in conscience ‘refuseforms of treatment that would only secure a

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