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Sharing the Truth in Love — End of life

The church distinguishes between ordinary and extraordinary care

By Ben McCullough

Many of us have had to experience the pain and sorrow of being with a loved one who is dying. Or perhaps you are experiencing a sudden and new diagnosis that requires medical treatment. Due to the advances of modern medicine, humans are living longer and longer, and having to deal ethically with the variety of interventions that medicine offers can be overwhelming. 

As Catholics, how are we supposed to know when we should refuse or accept a medical intervention for ourselves or our loved ones?

Before we can answer this question, we must understand a few foundational concepts that the church, in her wisdom, gives us. 

First, our soul is more important than our body. We should always do the best thing for our soul, even if that entails bodily harm. For example, a martyr sacrifices bodily health for his witness to the faith. In doing so, he does not sin by knowingly putting his body in harm’s way, but does something virtuous by witnessing to the fact that the good of his soul is more important than the good of his body.

Second (and this follows from the first point), we do not have to do everything possible to keep ourselves alive. If the soul is more important than the body, then it follows that we should do things that prioritize the soul over the body, even when the body would be gravely harmed or killed in the process. If this were not true, no one would ever be a martyr or a soldier who dies in battle. The soldier prioritizes his love of country and family over his own bodily life, and that prioritization is right and proper. If he had to do everything possible to keep himself alive, he wouldn’t be going to war in the first place!

Third (and this is perhaps the most important point), we should do those things that offer a hope of benefit and are not overly difficult to maintain and preserve our lives, and we can forgo those things that are overly burdensome or do not offer a hope of benefit. Say that you have a rare form of cancer, and there is a treatment for it, but it costs 100 million dollars, and your insurance won’t cover it. You want to live, but the treatment is well beyond what you could afford. Now, you could start a GoFundMe and raise 100 million dollars from your community. However, we should ask: is that reasonable to take 100 million dollars from the community? Wouldn’t that be a great burden on the community? The answer, of course, is yes. Does that mean we shouldn’t pursue the treatment? Wouldn’t that be suicide?

Our faith in Jesus Christ tells us that choosing not to pursue a treatment that would overly burden oneself, one’s family or community, financially or otherwise, is not suicide. Further, refusing treatment that offers no hope of benefit would likewise not be suicide. The church calls care like this extraordinary, which just means that it does not have to be done.

For example, many people get a Do Not Resuscitate (DNR) order towards the end of life. Often the doctor will explain the sorts of things that the medical staff will need to do to your body to resuscitate you, which often convinces people to get a DNR. This is because resuscitation involves breaking ribs, bruising the chest, injecting various medications, all of which cause a lot of pain and discomfort if you are resuscitated. If you judge that resuscitation would not be worth it, that the burdens of it outweigh the benefits, then it could be morally licit to have a DNR.

Similarly, if you can afford the treatment and it clearly will assist you with your medical issue, and it won’t cause undue burden to you or the community around you, the church guides the faithful by pointing out that you are obligated to pursue that treatment. For example, say you have an infection and your doctor prescribes you antibiotics. You can afford the antibiotics and easily deal with any side effects. The antibiotics will certainly treat the infection effectively. Care like this is ordinary, which just means that it should be done.

What about when you have to make decisions for another person, a loved one? What is the church’s guidance  about that? 

The short story is that a surrogate decision maker (a person who is legally allowed to make medical decisions for a patient) should make decisions for the patient in accordance with what they think the patient would want, so long as what the patient would want is not contrary to the Catholic faith. 

Sometimes it is difficult to know what the patient would want, so every decision should be made in intimate discussion with family, friends who knew the patient and the healthcare team. The important point I would like to make here is that refusing or removing life sustaining care that is judged extraordinary is not murdering the patient. Instead, it is allowing them to die, which can be very difficult, but may be morally acceptable.

Putting these ideas together, the church distinguishes between ordinary and extraordinary care. The difference is that with ordinary care the benefits outweigh the burdens of the intervention, while with extraordinary, the burdens outweigh the benefits. 

To be clear, to choose to do extraordinary care is not immoral, but morally optional. Remember, we don’t have to do everything possible to keep ourselves alive, and sometimes in choosing not to take extraordinary care we choose the good of our soul over the good of our body. 

As Catholics we believe life is a good, but not the highest good, and so we can choose higher goods even at the expense of our own life. In doing so, we choose to pass into the next life to live with Christ.

McCullough works in Catholic healthcare giving. He holds a master’s in sacred theology from the International Theological Institute in Austria.

Now and at the Hour of Our Death

The Bishops of the State of Wisconsin released the fourth revision of their pastoral letter Now and at the Hour of Our Death on All Souls’ Day, Nov. 2, 2024.

This fourth revision is designed to give Catholics the church’s moral guidance, helpful resources and practical tools to prepare for the end of life and to relieve some of the pain, sadness and anxiety that dying entails. It also seeks to provide guidance to those in the health care profession who face these questions daily, as they strive to serve those who are experiencing suffering and death.

The need for a fourth revision stems from new developments in the disposition of human remains (especially alkaline hydrolysis and human composting) and from church teaching that has been issued since the third revision was published in 2013. This new edition also contains new resources, such as a new legal document entitled the “Catholic Authorization for Final Disposition,” which can ensure that believers receive a Catholic funeral and are laid to rest in a sacred space.

The pastoral letter and all the Now and at the Hour of Our Death resources and forms are available at wisconsincatholic.org/endoflife.

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