A Catholic understanding of death and dying

(OSV News) -- If you ask people today how they hope to die, many will say, "In my sleep, painlessly and suddenly, without noticing." Yet, there is a prayer, long forgotten now, that Catholics prayed regularly: "Oh Lord, deliver me from a sudden death!"

When it comes to dying, Catholics used to pray to God for the exact opposite of what many today hope for. Why? What happened?

I think it's safe to say that most of us Catholics have lost a sense of a Catholic approach to death and dying. That approach reveals that properly living through one's dying is one of the most important acts of one's entire life, and it's worth preparing for ahead of time. As we prepare to enter into eternity to meet God, there is potential for profound depth in prayer and a fuller experience of the sacraments, as well as for deepening, healing and reconciling within human relationships.

In the world at large, there is not merely a loss of the meaning of dying but a death-averse culture in which we hide the sick and dying away from view and simultaneously enact a plethora of laws allowing physician-assisted suicide and euthanasia. We have turned away from natural death surrounded by loved ones and the sacraments, and we have instead turned toward abandonment and killing as an acceptable way to leave this world, or to allow others to leave it.

There are many wonderful Catholic apostolates that help others live a truly Catholic approach to death and dying. Yet, for the most part, the church needs to regain an explicit awareness of a Catholic ethos in this area, as well as a deeper understanding of the immorality of physician-assisted suicide and euthanasia. In fact, the only way to truly end these tragic practices will be not only by our arguments, but also by our witness, which could show the world a better way.

According to Pope St. John Paul II's encyclical "Evangelium Vitae" ("The Gospel of Life"): "Euthanasia in the strict sense is understood to be an action or omission which of itself and by intention causes death, with the purpose of eliminating all suffering. 'Euthanasia's terms of reference, therefore, are to be found in the intention of the will and in the methods used.'"

The method used in physician-assisted suicide and euthanasia by action is a lethal overdose of a drug. The overdose can be administered by a doctor or, in some jurisdictions, by other health care providers (euthanasia) or taken by the patient (assisted suicide). In the latter case, the patient must obtain a prescription from a health care provider. With physician-assisted suicide and euthanasia by omission, the method used is starvation and dehydration. The intention in both cases is the deliberate ending of the life of the patient.

Two famous cases illustrate the difference between action and omission. In voluntary assisted suicide or euthanasia by action, both the doctor and the patient have the intention to deliberately end the life of the patient to bring about an end to suffering; this was the case with Brittany Maynard in 2014. The Terri Schiavo case in 2005 was euthanasia by omission. Though she was disabled, she was not dying; she just needed help with eating and drinking. Her source of nutrition and hydration was removed by court order, and she died by starvation and dehydration.

Euthanasia is legal in a handful of countries, the most well-known being the Netherlands and Belgium. It might surprise some Americans that Canada has also legalized euthanasia. In countries where euthanasia is legal, physician-assisted suicide is also legal. Assisted suicide is legal in nine U.S. states and Washington, D.C. Euthanasia is illegal throughout the U.S., perhaps because the probability of medical malpractice lawsuits is much higher if the doctor injects the lethal dose than if the patient takes it.

The "pro-choice" and pro-life sides are in agreement that physician-assisted suicide and euthanasia is death by deliberate killing. The disagreement between them is whether that should be legal or not. They also disagree on the morality of physician-assisted suicide and euthanasia. In fact, the moral issues at play are the underlying basis for the disagreement on the legal question.

In words such as "homicide," "suicide" and "genocide" the common ending comes from the Latin verb "occidere," which means "to kill." Of late, the pro-choice side has dropped the terms physician-assisted suicide and euthanasia, and refers instead to medical assistance or aid in dying (MAiD). The purpose of this euphemism is to distance the concept of killing from physician-assisted suicide and euthanasia.

"To kill" is to do something on purpose to a being that is alive in order to make it be dead. This is happening in physician-assisted suicide and euthanasia; in fact, that is the whole point of those initiatives. Since killing the innocent is immoral, there are a slew of long-standing laws already on the books related to it. Some cases of killing have been allowed, but this has always required justification. Traditionally, examples were self-defense, just war and capital punishment, though the latter has been deemed "inadmissible" according to a recent change in the catechism as directed by Pope Francis. Whenever self-defense and just war are justified, it remains nonetheless tragic, and so we strive to avoid them, and it is best if they are never needed.

And so, while tragic, killing people because they are bad and dangerous is sometimes justified. But there is no justification to kill someone because they are sick and weak; doing so is intrinsically immoral and a crime. The pro-choice side must know that there is no justification for physician-assisted suicide and euthanasia, and so they want to remove the use of the term "killing" altogether, so that people's minds don't go looking around for a justification and realize the horror of what we are doing.

With passage of a law permitting assisted suicide, a 180-degree shift is achieved -- namely, going from a situation in which doctors never use their skills and training to participate in killing patients to one where doctors do participate in killing patients. After that change, tussling over requirements becomes a relatively minor matter. Proposed restrictions just put a figurative fence around which sick people we have decided to kill, masking the intrinsic immorality of physician-assisted suicide and euthanasia in ways that give the appearance of being sensible. But after legalization, the fence is easy to expand and eventually to knock down completely, as the restrictions begin to seem unfair to those who do not meet one or more of them and one by one they are removed. This is referred to as the slippery slope, and it always happens.

For example, in the Netherlands and Belgium, euthanasia is now legal for mental illness. In 2020, a widely reported story told of an elderly Canadian woman with no terminal condition or serious pain who, during the lockdowns, was legally euthanized due to loneliness.

We must argue for the dignity and preciousness of every person and the wrongness of abandoning any person. We should not allow our shock at the slippery slope in Canada to cause us to forget the very first person who was legally killed via physician-assisted suicide in Oregon.

With respect to the ethics of death and dying from a Catholic perspective, there is another error to avoid: overzealous treatment. Since death is inevitable, there comes a time when the disease or physical condition is ending the life of the patient, and at that point it is morally legitimate to withhold or withdraw extraordinary or disproportionate treatment. This is not to kill the patient, as the disease is why the patient dies; and therefore, this is properly understood as the humble acceptance of the approach of death. But even in this situation, all ordinary care remains morally obligatory.

Ordinary care is care that, if removed, would either cause the death of a patient who is not dying or, in a patient who is dying, would amount to deliberately increasing the speed of their death for reasons unrelated to the disease. Simple examples would be to deliberately discontinue bed care to prevent bed sores or to refuse to give an insulin shot to provide comfort. The case of Terri Schiavo, mentioned above, is an example when nutrition and hydration via a feeding tube was ordinary care, since she was not dying and her body was assimilating food and water normally. There are some situations in which assisted nutrition and hydration may be withdrawn.

Many people want to know whether there is a list of all the things that count as ordinary care. Abstractly speaking, there is no such list because this will depend on the unique situation of each patient. Some think that this fact introduces an element of moral relativism into the teaching, but it does not. This is because, in each unique case, it can be determined which treatments are extraordinary and which are ordinary. Once that is clear, the patient or health care proxy can decide whether or not to remove the extraordinary treatment, but they may never stop ordinary care.

In many cases, it can take careful, difficult discernment and discussion with doctors and spiritual directors to determine whether a treatment is extraordinary or ordinary. As long as the intention is not to kill, but always to care, then the family should pray, discern and then act, trusting God with the final decision. There are many helpful Catholic guides to aid discernment in these situations.

The Catholic view includes the humble acceptance of the approach of death, which is completely different than assisted suicide and euthanasia laws, which are about legalizing the killing of patients with an overdose.

In a poignant piece against euthanasia, French novelist Michel Houellebecq recently wrote, "I can easily imagine myself asking to die in the hope that others reply: 'Oh no, no. Please stay with us a little longer.'" The society-wide suggestion that the legalization of assisted suicide represents preempts that precious thought and replaces it with a sense of abandonmentand the implication that one should be dead. Insofar as coercion is the opposite of freedom, the term "pro-choice" is a misnomer, as the so-called right to die cramps rather than frees.

In a place where physician-assisted suicide and euthanasia are illegal, on the other hand, vulnerable persons rest assured that everyone is committed to caring for them until they die a natural death, which frees them to die with true dignity, the dignity of a child of God.

Facing suffering and death can be overwhelming; John Paul II wrote about this profoundly and sensitively in Salvifici Doloris ("On the Christian Meaning of Human Suffering"). With the advent of modern medicine, coupled with our death-averse culture, we can say that the fear of dying alone connected to machines is a legitimate fear. To address this, we need to reevaluate our priorities as a society.

A long-forgotten and beautiful Catholic tradition is the "ars moriendi," which means "the art of dying." It included methods of preparing for a holy death, and it emphasized making the sick person the center of attention, surrounded by family, friends, health care providers and the priest. This is beautifully depicted in many medieval paintings.

We should build a society that surrounds the vulnerable with loving care until they die a natural death -- an ars moriendi for the 21st century.