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Letter “Samaritanus bonus” of the Congregation for the Doctrine of the Faith on the care of persons in the critical and terminal phases of life, 22.09.2020.

This new document from the Congregation of the Doctrine of the Faith (the Vatican watchdog on all matters to do with the defence and promotion of the Catholic Faith) deals with the thorny question of euthanasia and other end of life questions.

It is a long document, of which a very brief (but hardly adequate) summary of its main ideas can be found at: https://www.vaticannews.va/en/vatican-city/news/2020-09/the-good-samaritan-re-affirming-the-gospel-of-life.html

Here is the link to the full English text: http://press.vatican.va/content/salastampa/en/bollettino/pubblico/2020/09/22/200922a.html

Here is the outline of the document, which may whet your appetite to read it or parts of it. I would very much encourage you to read it, perhaps a few paragraphs at a time, and meditate on its content. Our culture and time have lost their way on a number of serious moral questions, so it’s good for Catholics to be well-informed of the Church’s doctrine on such matters. It is drawn from the Gospel and from the long Tradition of the Magisterium (the teaching office of the Church).

Introduction  
I. Care for One’s Neighbour  
II. The Living Experience of the Suffering Christ and the Proclamation of Hope  
III. The Samaritan’s “heart that sees”: human life is a sacred and inviolable gift  
IV. The Cultural Obstacles that Obscure the Sacred Value of Every Human Life  
V. The Teaching of the Magisterium 1. The prohibition of euthanasia and assisted suicide
  2. The moral obligation to exclude aggressive medical treatment
  3. Basic Care: the requirement of nutrition and hydration
  4. Palliative care
  5. The role of the family and hospice
  6. Accompaniment and care in prenatal and paediatric medicine
  7. Analgesic therapy and loss of consciousness
  8. The vegetative state and the state of minimal consciousness
  9. Conscientious objections on the part of healthcare workers and of Catholic healthcare institutions
  10. Pastoral accompaniment and the support of the sacraments.
  11. Pastoral discernment towards those who request Euthanasia or Assisted Suicide
  12. The reform of the education and formation of the healthcare workers
Conclusion  

 

There now follows a selection of some paragraphs from each section – Fr. Peter

Introduction

The Good Samaritan who goes out of his way to aid an injured man (cf. Lk 10:30-37) signifies Jesus Christ who encounters man in need of salvation and cares for his wounds and suffering with “the oil of consolation and the wine of hope.” … How to make this message concrete today? … In the face of challenges that affect the very way we think about medicine, the significance of the care of the sick, and our social responsibility toward the most vulnerable, the present letter seeks to enlighten pastors and the faithful regarding their questions and uncertainties about medical care, and their spiritual and pastoral obligations to the sick in the critical and terminal stages of life.

I. Care for One’s Neighbour

Despite our best efforts, it is hard to recognize the profound value of human life when we see it in its weakness and fragility. Far from being outside the existential horizon of the person, suffering always raises limitless questions about the meaning of life. hese pressing questions cannot be answered solely by human reflection, because in suffering there is concealed the immensity of a specific mystery that can only be disclosed by the Revelation of God.

The relationship of care discloses the twofold dimension of the principle of justice to promote human life and to avoid harming another. Jesus transformed this principle into the golden rule “Do unto others whatever you would have them do to you” (Mt 7:12). This rule is echoed in the maxim primum non nocere (“first, do no harm”) of traditional medical ethics.

Therapeutic artclinical procedures and ongoing care are inseparably interwoven in the practice of medicine, especially at the critical and terminal stages of life.

The Good Samaritan, in fact, not only draws nearer to the man he finds half dead; he takes responsibility for him. He invests in him, not only with the funds he has on hand but also with funds he does not have and hopes to earn in Jericho: he promises to pay any additional costs upon his return.

Weakness makes us conscious of our dependence on God and invites us to respond with the respect due to our neighbor. Every individual who cares for the sick (physician, nurse, relative, volunteer, pastor) has the moral responsibility to apprehend the fundamental and inalienable good that is the human person.

The impossibility of a cure where death is imminent does not entail the cessation of medical and nursing activity. Responsible communication with the terminally ill person should make it clear that care will be provided until the very end: “to cure if possible, always to care” (St. John Paul II).

The obligation always to take care of the sick provides criteria to assess the actions to be undertaken in an “incurable” illness: the judgement that an illness is incurable cannot mean that care has come at an end.

The pastoral care of all – family, doctors, nurses, and chaplains – can help the patient to persevere in sanctifying grace and to die in charity and the Love of God. Where faith is absent in the face of the inevitability of illness, especially when chronic or degenerative, fear of suffering, death, and the discomfort they entail is the main factor driving the attempt to control and manage the moment of death, and indeed to hasten it through euthanasia or assisted suicide.

II. The Living Experience of the Suffering Christ and the Proclamation of Hope.

If the figure of the Good Samaritan throws new light on the provision of healthcare, the nearness of the God made man is manifest in the living experience of Christ’s suffering, of his agony on the Cross and his Resurrection: his experience of multiple forms of pain and anguish resonates with the sick and their families during the long days of infirmity that precede the end of life. … Christ’s experience resonates with the sick who are often seen as a burden to society; their questions are not understood; they often undergo forms of affective desertion and the loss of connection with others.

… Added to this is the suffering caused when society equates their value as persons to their quality of life and makes them feel like a burden to others. In this situation, to turn one’s gaze to Christ is to turn to him who experienced in his flesh the pain of the lashes and nails, the derision of those who scourged him, and the abandonment and the betrayal of those closest to him.

In the Cross of Christ are concentrated and recapitulated all the sickness and suffering of the world: all the physical suffering, of which the Cross, that instrument of an infamous and shameful death, is the symbol; all the psychological suffering, expressed in the death of Jesus in the darkest of solitude, abandonment and betrayal; all the moral suffering, manifested in the condemnation to death of one who is innocent; all the spiritual suffering, displayed in a desolation that seems like the very silence of God.

Christ is aware of the painful shock of his Mother and his disciples who “remain” under the Cross and who, though “remaining”, appear impotent and resigned, and yet provide the affective intimacy that allows the God made man to live through hours that seem meaningless. … During his passion Christ was always sustained by his confident trust in the Father’s love, so evident in the hours of the Cross, and also in his Mother’s love. The Love of God always makes itself known in the history of men and women, thanks to the love of the one who never deserts us, who “remains,” despite everything, at our side.

In this manner, although marked by a painful passing, death can become the occasion of a greater hope that, thanks to faith, makes us participants in the redeeming work of Christ. Pain is existentially bearable only where there is hope. The hope that Christ communicates to the sick and the suffering is that of his presence, of his true nearness. Hope is not only the expectation of a greater good, but is a gaze on the present full of significance.

To contemplate the living experience of Christ’s suffering is to proclaim to men and women of today a hope that imparts meaning to the time of sickness and death. From this hope springs the love that overcomes the temptation to despair.

While essential and invaluable, palliative care in itself is not enough unless there is someone who “remains” at the bedside of the sick to bear witness to their unique and unrepeatable value. For the believer, to look upon the Crucified means to trust in the compassionate love of God. In a time when autonomy and individualism are acclaimed, it must be remembered that, while it is true that everyone lives their own suffering, their own pain and their own death, these experiences always transpire in the presence of others and under their gaze. Nearby the Cross there are also the functionaries of the Roman state, there are the curious, there are the distracted, there are the indifferent and the resentful: they are at the Cross, but they do not “remain” with the Crucified.

In intensive care units or centers for chronic illness care, one can be present merely as a functionary, or as someone who “remains” with the sick.

III. The Samaritan’s “heart that sees”: human life is a sacred and inviolable gift

Whatever their physical or psychological condition, human persons always retain their original dignity as created in the image of God. They can live and grow in the divine splendor because they are called to exist in “the image and glory of God” (1 Cor11:7; 2 Cor 3:18). Their dignity lies in this vocation. God became man to save us, and he promises us salvation and calls us to communion with Him: here lies the ultimate foundation of human dignity.

“A heart that sees” is central to the program of the Good Samaritan. He “teaches that it is necessary to convert the gaze of the heart, because many times the beholder does not see. Why? Because compassion is lacking […] Without compassion, people who look do not get involved with what they observe, and they keep going; instead people who have a compassionate heart are touched and engaged, they stop and show care” (Pope Francis).

Human life is a highest good, and society is called to acknowledge this. Life is a sacred and inviolable gift and every human person, created by God, has a transcendent vocation to a unique relationship with the One who gives life. … For this reason, the Church is always happy to collaborate with all people of good will, with believers of other confessions or religions as well as non-believers, who respect the dignity of human life, even in the last stages of suffering and death, and reject any action contrary to human life. God the Creator offers life and its dignity to man as a precious gift to safeguard and nurture, and ultimately to be accountable to Him.

The uninfringeable value of life is a fundamental principle of the natural moral law and an essential foundation of the legal order. Just as we cannot make another person our slave, even if they ask to be, so we cannot directly choose to take the life of another, even if they request it. Therefore, to end the life of a sick person who requests euthanasia is by no means to acknowledge and respect their autonomy, but on the contrary to disavow the value of both their freedom, now under the sway of suffering and illness, andof their life by excluding any further possibility of human relationship, of sensing the meaning of their existence, or of growth in the theologal life. Moreover, it is to take the place of God in deciding the moment of death. For this reason, “abortion, euthanasia and wilful self-destruction (…) poison human society, but they do more harm to those who practice them than those who suffer from the injury. Moreover, they are a supreme dishonor to the Creator”.

IV. The Cultural Obstacles that Obscure the Sacred Value of Every Human Life

Among the obstacles that diminish our sense of the profound intrinsic value of every human life, the first lies in the notion of “dignified death” as measured by the standard of the “quality of life,” which a utilitarian anthropological perspective sees in terms “primarily related to economic means, to ‘well-being,’ to the beauty and enjoyment of physical life, forgetting the other, more profound, interpersonal, spiritual and religious dimensions of existence”. In this perspective, life is viewed as worthwhile only if it has, in the judgment of the individual or of third parties, an acceptable degree of quality as measured by the possession or lack of particular psychological or physical functions, or sometimes simply by the presence of psychological discomfort. According to this view, a life whose quality seems poor does not deserve to continue. Human life is thus no longer recognized as a value in itself.

A second obstacle that obscures our recognition of the sacredness of human life is a false understanding of “compassion” … In reality, human compassion consists not in causing death, but in embracing the sick, in supporting them in their difficulties, in offering them affection, attention, and the means to alleviate the suffering.

A third factor that hinders the recognition of the value of one’s own life and the lives of others is a growing individualism within interpersonal relationships, where the other is viewed as a limitation or a threat to one’s freedom.

Individualism, in particular, is at the root of what is regarded as the most hidden malady of our time: solitude or privacy.  It is thematized in some regulatory contexts even as a “right to solitude”, beginning with the autonomy of the person and the “principle of permission-consent” which can, in certain conditions of discomfort or sickness, be extended to the choice of whether or not to continue living. This “right” underlies euthanasia and assisted suicide. The basic idea is that those who find themselves in a state of dependence and unable to realize a perfect autonomy and reciprocity, come to be cared for as a favour to them.

This way of thinking about human relationships and the significance of the good cannot but undermine the very meaning of life, facilitating its manipulation, even through laws that legalize euthanistic practices, resulting in the death of the sick. Such actions deform relationships and induce a grave insensibility toward the care of the sick person. In such circumstances, baseless moral dilemmas arise regarding what are in reality simply mandatory elements of basic care, such as feeding and hydration of terminally ill persons who are not conscious.

V. The Teaching of the Magisterium

1.     The prohibition of euthanasia and assisted suicide

With her mission to transmit to the faithful the grace of the Redeemer and the holy law of God already discernible in the precepts of the natural moral law, the Church is obliged to intervene in order to exclude once again all ambiguity in the teaching of the Magisterium concerning euthanasia and assisted suicide, even where these practices have been legalized.

In particular, the dissemination of medical end-of-life protocols such as the Do Not Resuscitate Order or the Physician Orders for Life Sustaining Treatment – with all of their variations depending on national laws and contexts – were initially thought of as instruments to avoid aggressive medical treatment in the terminal phases of life. Today these protocols cause serious problems regarding the duty to protect the life of patients in the most critical stages of sickness.

For these reasons, the Church is convinced of the necessity to reaffirm as definitive teaching that euthanasia is a crime against human life because, in this act, one chooses directly to cause the death of another innocent human being. The correct definition of euthanasia depends, not on a consideration of the goods or values at stake, but on the moral object properly specified by the choice of “an action or an omission which of itself or by intention causes death, in order that all pain may in this way be eliminated” … The moral evaluation of euthanasia, and its consequences does not depend on a balance of principles that the situation and the pain of the patient could, according to some, justify the termination of the sick person. Values of life, autonomy, and decision-making ability are not on the same level as the quality of life as such.

Euthanasia, therefore, is an intrinsically evil act, in every situation or circumstance. In the past the Church has already affirmed in a definitive way “that euthanasia is a grave violation of the Law of God, since it is the deliberate and morally unacceptable killing of a human person. This doctrine is based upon the natural law and upon the written Word of God, is transmitted by the Church’s Tradition and taught by the ordinary and universal Magisterium. Depending on the circumstances, this practice involves the malice proper to suicide or murder”. Any formal or immediate material cooperation in such an act is a grave sin against human life: “No authority can legitimately recommend or permit such an action. For it is a question of the violation of the divine law, an offense against the dignity of the human person, a crime against life, and an attack on humanity”. Therefore, euthanasia is an act of homicide that no end can justify and that does not tolerate any form of complicity or active or passive collaboration. Those who approve laws of euthanasia and assisted suicide, therefore, become accomplices of a grave sin that others will execute. They are also guilty of scandal because by such laws they contribute to the distortion of conscience, even among the faithful.

Each life has the same value and dignity for everyone: the respect of the life of another is the same as the respect owed to one’s own life. One who choses with full liberty to take one’s own life breaks one’s relationship with God and with others, and renounces oneself as a moral subject. Assisted suicide aggravates the gravity of this act because it implicates another in one’s own despair. … Assisting in a suicide is an unjustified collaboration in an unlawful act that contradicts the theologal relationship with God and the moral relationship that unites us with others who share the gift of life and the meaning of existence.

When a request for euthanasia rises from anguish and despair, “although in these cases the guilt of the individual may be reduced, or completely absent, nevertheless the error of judgment into which the conscience falls, perhaps in good faith, does not change the nature of this act of killing, which will always be in itself something to be rejected”. The same applies to assisted suicide. Such actions are never a real service to the patient, but a help to die. Euthanasia and assisted suicide are always the wrong choice.

In fact, since there is no right to dispose of one’s life arbitrarily, no health care worker can be compelled to execute a non-existent right”. This is why euthanasia and assisted suicide are a defeat for those who theorize about them, who decide upon them, or who practice them.

For this reason, it is gravely unjust to enact laws that legalize euthanasia or justify and support suicide, invoking the false right to choose a death improperly characterized as respectable only because it is chosen.[45] Such laws strike at the foundation of the legal order: the right to life sustains all other rights, including the exercise of freedom. The existence of such laws deeply wound human relations and justice, and threaten the mutual trust among human beings. The legitimation of assisted suicide and euthanasia is a sign of the degradation of legal systems.

Experience confirms that “the pleas of gravely ill people who sometimes ask for death are not to be understood as implying a true desire for euthanasia; in fact, it is almost always a case of an anguished plea for help and love. What a sick person needs, besides medical care, is love, the human and supernatural warmth with which sick persons can and ought to be surrounded by all those close to him or her, parents and children, doctors and nurses”. A sick person, surrounded by a loving human and Christian presence, can overcome all forms of depression and need not succumb to the anguish of loneliness and abandonment to suffering and death.

2.     The moral obligation to exclude aggressive medical treatment

The Magisterium of the Church recalls that, when one approaches the end of earthly existence, the dignity of the human person entails the right to die with the greatest possible serenity and with one’s proper human and Christian dignity intact. To precipitate death or delay it through “aggressive medical treatments” deprives death of its due dignity.

It is not lawful to suspend treatments that are required to maintain essential physiological functions, as long as the body can benefit from them (such as hydration, nutrition, thermoregulation, proportionate respiratory support, and the other types of assistance needed to maintain bodily homeostasis and manage systemic and organic pain). The suspension of futile treatments must not involve the withdrawal of therapeutic care. This clarification is now indispensable in light of the numerous court cases in recent years that have led to the withdrawal of care from – and to the early death of–critically but not terminally ill patients, for whom it was decided to suspend life-sustaining care which would not improve the quality of life.

Every medical action must always have as its object—intended by the moral agent—the promotion of life and never the pursuit of death. The physician is never a mere executor of the will of patients or their legal representatives, but retains the right and obligation to withdraw at will from any course of action contrary to the moral good discerned by conscience.

3.     Basic Care: the requirement of nutrition and hydration

A fundamental and inescapable principle of the assistance of the critically or terminally ill person is the continuity of care for the essential physiological functions. In particular, required basic care for each person includes the administration of the nourishment and fluids needed to maintain bodily homeostasis, insofar as and until this demonstrably attains the purpose of providing hydration and nutrition for the patient.

When the provision of nutrition and hydration no longer benefits the patient, because the patient’s organism either cannot absorb them or cannot metabolize them, their administration should be suspended. In this way, one does not unlawfully hasten death through the deprivation of the hydration and nutrition vital for bodily function, but nonetheless respects the natural course of the critical or terminal illness.

The withdrawal of this sustenance is an unjust action that can cause great suffering to the one who has to endure it. Nutrition and hydration do not constitute medical therapy in a proper sense, which is intended to counteract the pathology that afflicts the patient. They are instead forms of obligatory care of the patient, representing both a primary clinical and an unavoidable human response to the sick person.

4.     Palliative care

ontinuity of care is part of the enduring responsibility to appreciate the needs of the sick person: care needs, pain relief, and affective and spiritual needs. As demonstrated by vast clinical experience, palliative medicine constitutes a precious and crucial instrument in the care of patients during the most painful, agonizing, chronic and terminal stages of illness. Palliative care is an authentic expression of the human and Christian activity of providing care, the tangible symbol of the compassionate “remaining” at the side of the suffering person.

Experience teaches us that the employment of palliative care reduces considerably the number of persons who request euthanasia.

Palliative care should include spiritual assistance for patients and their families. Such assistance inspires faith and hope in God in the terminally ill as well as their families whom it helps to accept the death of their loved one. It is an essential contribution that is offered by pastoral workers and the whole Christian community.

“The wine of hope” is the specific contribution of the Christian faith in the care of the sick and refers to the way in which God overcomes evil in the world. In times of suffering, the human person should be able to experience a solidarity and a love that takes on the suffering, offering a sense of life that extends beyond death. All of this has a great social importance: “A society unable to accept the suffering of its members and incapable of helping to share their suffering, and to bear it inwardly through ‘com-passion’ is a cruel and inhuman society” (Pontifical Council for the Pastoral Car elf Health-Workers).

t should be recognized, however, that the definition of palliative care has in recent years taken on a sometimes equivocal connotation. In some countries, national laws regulating palliative care (Palliative Care Act) as well as the laws on the “end of life” (End-of-Life Law) provide, along with palliative treatments, something called Medical Assistance to the Dying (MAiD) that can include the possibility of requesting euthanasia and assisted suicide. Such legal provisions are a cause of grave cultural confusion: by including under palliative care the provision of integrated medical assistance for a voluntary death, they imply that it would be morally lawful to request euthanasia or assisted suicide.

In addition, palliative interventions to reduce the suffering of gravely or terminally ill patients in these regulatory contexts can involve the administration of medications that intend to hasten death, as well as the suspension or interruption of hydration and nutrition even when death is not imminent. In fact, such practices are equivalent to a direct action or omission to bring about death and are therefore unlawful. The growing diffusion of such legislation and of scientific guidelines of national and international professional societies, constitutes a socially irresponsible threat to many people, including a growing number of vulnerable persons who needed only to be better cared for and comforted but are instead being led to choose euthanasia and suicide.

5.     The role of the family and hospice

he role of the family is central to the care of the terminally ill patient.[69] In the family a person can count on strong relationships, valued in themselves apart from their helpfulness or the joy they bring. It is essential that the sick under care do not feel themselves to be a burden, but can sense the intimacy and support of their loved ones. The family needs help and adequate resources to fulfil this mission. Recognizing the family’s primary, fundamental and irreplaceable social function, governments should undertake to provide the necessary resources and structures to support it. In addition, Christian-inspired health care facilities should not neglect but instead integrate the family’s human and spiritual accompaniment in a unified program of care for the sick person.

Next to the family, hospice centers which welcome the terminally sick and ensure their care until the last moment of life provide an important and valuable service. After all, “the Christian response to the mystery of death and suffering is to provide not an explanation but a Presence” that shoulders the pain, accompanies it, and opens it to a trusting hope.

6.     Accompaniment and care in prenatal and pediatric medicine

Regarding the care of neo-natal infants and children suffering from terminal chronic-degenerative diseases, or are in the terminal stages of life itself, it is necessary to reaffirm what follows, aware of the need for first-rate programs that ensure the well-being of the children and their families.

Beginning at conception, children suffering from malformation or other pathologies are little patients whom medicine today can always assist and accompany in a manner respectful of life. Their life is sacred, unique, unrepeatable, and inviolable, exactly like that of every adult person.

Children suffering from so-called pre-natal pathologies “incompatible with life” – that will surely end in death within a short period of time – and in the absence of fetal or neo-natal therapies capable of improving their health, should not be left without assistance, but must be accompanied like any other patient until they reach natural death. Prenatal comfort carefavors a path of integrated assistance involving the support of medical staff and pastoral care workers alongside the constant presence of the family. The child is a special patient and requires the care of a professional with expert medical knowledge and affective skills. The empathetic accompaniment of a child, who is among the most frail, in the terminal stages of life, aims to give life to the years of a child and not years to the child’s life.

Prenatal Hospice Centers, in particular, provide an essential support to families who welcome the birth of a child in a fragile condition. In these centers, competent medical assistance, spiritual accompaniment, and the support of other families, who have undergone the same experience of pain and loss, constitute an essential resource. It is the pastoral duty of the Christian-inspired healthcare workers to make efforts to expand the accessibility of these centers throughout the world.

Maintaining the emotional bond between the parent and the child is an integral part of the process of care. The connection between caregiving and parent-child assistance that is fundamental to the treatment of incurable or terminal pathologies should be favored as much as possible. In addition to emotional support, the spiritual moment must not be overlooked. The prayer of the people close to the sick child has a supernatural value that surpasses and deepens the affective relationship.

The ethical/juridical concept of “the best interest of the child” – when used in the cost-benefit calculations of care– can in no way form the foundation for decisions to shorten life in order to prevent suffering if these decisions envision actions or omissions that are euthanistic by nature or intention. As already mentioned, the suspension of disproportionate therapies cannot justify the suspension of the basic care, including pain relief, necessary to accompany these little patients to a dignified natural death, nor to the interruption of that spiritual care offered for one who will soon meet God.

7.     Analgesic therapy and loss of consciousness

To mitigate a patient’s pain, analgesic therapy employs pharmaceutical drugs that can induce loss of consciousness (sedation). While a deep religious sense can make it possible for a patient to live with pain through the lens of redemption as a special offering to God, the Church nonetheless affirms the moral liceity of sedation as part of patient care in order to ensure that the end of life arrives with the greatest possible peace and in the best internal conditions. This holds also for treatments that hasten the moment of death (deep palliative sedation in the terminal stage), always, to the extent possible, with the patient’s informed consent. From a pastoral point of view, prior spiritual preparation of the patients should be provided in order that they may consciously approach death as an encounter with God. The use of analgesics is, therefore, part of the care of the patient, but any administration that directly and intentionally causes death is a euthanistic practice and is unacceptable. The sedation must exclude, as its direct purpose, the intention to kill, even though it may accelerate the inevitable onset of death.

8.     The vegetative state and the state of minimal consciousness

Other relevant situations are that of the patient with the persistent lack of consciousness, the so-called “vegetative state” or that of the patient in the state of “minimal consciousness”. It is always completely false to assume that the vegetative state, and the state of minimal consciousness, in subjects who can breathe autonomously, are signs that the patient has ceased to be a human person with all of the dignity belonging to persons as such[78]. On the contrary, in these states of greatest weakness, the person must be acknowledged in their intrinsic value and assisted with suitable care. The fact that the sick person can remain for years in this anguishing situation without any prospect of recovery undoubtedly entails suffering for the caregivers.

One must never forget in such painful situations that the patient in these states has the right to nutrition and hydration, even administered by artificial methods that accord with the principle of ordinary means. In some cases, such measures can become disproportionate, because their administration is ineffective, or involves procedures that create an excessive burden with negative results that exceed any benefits to the patient.

9.     Conscientious objections on the part of healthcare workers and of Catholic healthcare institutions

n the face of the legalization of euthanasia or assisted suicide – even when viewed simply as another form of medical assistance – formal or immediate material cooperation must be excluded. Such situations offer specific occasions for Christian witness where “we must obey God rather than men” (Acts 5:29). 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. The one authentic right is that the sick person be accompanied and cared for with genuine humanity. Only in this way can the patient’s dignity be preserved until the moment of natural death. “No health care worker, therefore, can become the defender of a non-existing right, even if euthanasia were requested by the subject in question when he was fully conscious.”

n this regard, the general principles regarding cooperation with evil, that is, with unlawful actions, are thus reaffirmed: “Christians, like all people of good will, are called, with a grave obligation of conscience, not to lend their formal collaboration to those practices which, although allowed by civil legislation, are in contrast with the Law of God. In fact, from the moral point of view, it is never licit to formally cooperate in evil. This cooperation occurs when the action taken, either by its very nature or by the configuration it is assuming in a concrete context, qualifies as direct participation in an act against innocent human life, or as sharing the immoral intention of the principal agent. This cooperation can never be justified neither by invoking respect for the freedom of others, nor by relying on the fact that civil law provides for it and requires it: for the acts that each person personally performs, there is, in fact, a moral responsibility that no one can ever escape and on which each one will be judged by God himself (cf. Rm 2:6; 14:12)”.

Governments must acknowledge the right to conscientious objection in the medical and healthcare field, where the principles of the natural moral law are involved and especially where in the service to life the voice of conscience is daily invoked. Where this is not recognized, one may be confronted with the obligation to disobey human law, in order to avoid adding one wrong to another, thereby conditioning one’s conscience. Healthcare workers should not hesitate to ask for this right as a specific contribution to the common good.

Likewise, healthcare institutions must resist the strong economic pressures that may sometimes induce them to accept the practice of euthanasia. If the difficulty in finding necessary operating funds creates an enormous burden for these public institutions, then the whole society must accept an additional liability in order to ensure that the incurably ill are not left to their own or their families’ resources. All of this requires that episcopal conferences and local churches, as well as Catholic communities and institutions, adopt a clear and unified position to safeguard the right of conscientious objection in regulatory contexts where euthanasia and suicide are sanctioned.

10.     Pastoral accompaniment and the support of the sacraments

Death is a decisive moment in the human person’s encounter with God the Saviour. The Church is called to accompany spiritually the faithful in the situation, offering them the “healing resources” of prayer and the sacraments. Helping the Christian to experience this moment with spiritual assistance is a supreme act of charity. Because “no believer should die in loneliness and neglect”, it encompasses the patient with the solid support of human, and humanizing, relationships to accompany them and open them to hope.

The parable of the Good Samaritan shows what the relationship with the suffering neighbor should be, what qualities should be avoided – indifference, apathy, bias, fear of soiling one’s hands, totally occupied with one’s own affairs – and what qualities should be embraced – attention, listening, understanding, compassion, and discretion.

The invitation to imitate the Samaritan’s example— “Go and do likewise” (Lk 10:37)—is an admonition not to underestimate the full human potential of presence, of availability, of welcoming, of discernment, and of involvement, which nearness to one in need demands and which is essential to the integral care of the sick.

The quality of love and care for persons in critical and terminal stages of life contributes to assuaging the terrible, desperate desire to end one’s life. Only human warmth and evangelical fraternity can reveal a positive horizon of support to the sick person in hope and confident trust.

Such accompaniment is part of the path defined by palliative care that includes the patients and their families.

The family has always played an important role in care, because their presence sustains the patient, and their love represents an essential therapeutic factor in the care of the sick person. Indeed, recalls Pope Francis, the family “has always been the nearest ‘hospital’ still today, in so many parts of the world, a hospital is for the privileged few, and is often far away. It is the mother, the father, brother, sisters and godparents who guarantee care and help one to heal”.

Taking care of others, or providing care for the suffering of others, is a commitment that embraces not just a few but the entire Christian community. Saint Paul affirms that when one member suffers, it is the whole body that suffers (cf. 1 Cor12:26) and all bend to the sick to bring them relief. Everyone, for his or her part, is called to be a “servant of consolation” in the face of any human situation of desolation or discomfort.

Pastoral accompaniment involves the exercise of the human and Christian virtues of empathy (en-pathos), of compassion(cum-passio), of bearing another’s suffering by sharing it, and of the consolation (cum-solacium), of entering into the solitude of others to make them feel loved, accepted, accompanied, and sustained.

The ministry of listening and of consolation that the priest is called to offer, which symbolizes the compassionate solicitude of Christ and the Church, can and must have a decisive role. In this essential mission it is extremely important to bear witness to and unite truth and charity with which the gaze of the Good Shepherd never ceases to accompany all of His children. Given the centrality of the priest in the pastoral, human and spiritual accompaniment of the sick at life’s end, it is necessary that his priestly formation provide an updated and precise preparation in this area. It is also important that priests be formed in this Christian accompaniment. Since there may be particular circumstances that make it difficult for a priest to be present at the bedside, physicians and healthcare workers need this formation as well.

Being men and women skilled in humanity means that our way of caring for our suffering neighbor should favor their encounter with the Lord of life, who is the only one who can pour, in an efficacious manner, the oil of consolation and the wine of hope onto human wounds.

Every person has the natural right to be cared for, which at this time is the highest expression of the religion that one professes.

The sacramental moment is always the culmination of the entire pastoral commitment to care that precedes and is the source of all that follows.

The Church calls Penance and the Anointing of the Sick sacraments “of healing”, for they culminate in the Eucharist which is the “viaticum” for eternal life. Through the closeness of the Church, the sick person experiences the nearness of Christ who accompanies them on their journey to his Father’s house (cf. Jn 14:6) and helps the sick to not fall into despair, by supporting them in hope especially when the journey becomes exhausting.

11.     Pastoral discernment towards those who request Euthanasia or Assisted Suicide

The pastoral accompaniment of those who expressly ask for euthanasia or assisted suicide today presents a singular moment when a reaffirmation of the teaching of the Church is necessary. With respect to the Sacrament of Penance and Reconciliation, the confessor must be assured of the presence of the true contrition necessary for the validity of absolution which consists in “sorrow of mind and a detestation for sin committed, with the purpose of not sinning for the future”. In this situation, we find ourselves before a person who, whatever their subjective dispositions may be, has decided upon a gravely immoral act and willingly persists in this decision. Such a state involves a manifest absence of the proper disposition for the reception of the Sacraments of Penance, with absolution, and Anointing, with Viaticum. Such a penitent can receive these sacraments only when the minister discerns his or her readiness to take concrete steps that indicate he or she has modified their decision in this regard. Thus a person who may be registered in an association to receive euthanasia or assisted suicide must manifest the intention of cancelling such a registration before receiving the sacraments. It must be recalled that the necessity to postpone absolution does not imply a judgment on the imputability of guilt, since personal responsibility could be diminished or non-existent. The priest could administer the sacraments to an unconscious person sub condicione if, on the basis of some signal given by the patient beforehand, he can presume his or her repentance.

The position of the Church here does not imply a non-acceptance of the sick person. It must be accompanied by a willingness to listen and to help, together with a deeper explanation of the nature of the sacrament, in order to provide the opportunity to desire and choose the sacrament up to the last moment. The Church is careful to look deeply for adequate signs of conversion, so that the faithful can reasonably ask for the reception of the sacraments. To delay absolution is a medicinal act of the Church, intended not to condemn, but to lead the sinner to conversion.

It is necessary to remain close to a person who may not be in the objective condition to receive the sacraments, for this nearness is an invitation to conversion, especially when euthanasia, requested or accepted, will not take place immediately or imminently. Here it remains possible to accompany the person whose hope may be revived and whose erroneous decision may be modified, thus opening the way to admission to the sacraments.

Nevertheless, those who spiritually assist these persons should avoid any gesture, such as remaining until the euthanasia is performed, that could be interpreted as approval of this action. Such a presence could imply complicity in this act. This principle applies in a particular way, but is not limited to, chaplains in the healthcare systems where euthanasia is practiced, for they must not give scandal by behaving in a manner that makes them complicit in the termination of human life.

12.     The reform of the education and formation of the healthcare workers

In today’s social and cultural context, with so many challenges to the protection of human life in its most critical stages, education has a critical role to play. Families, schools, other educational institutions and parochial communities must work with determination to awaken and refine that sensitivity toward our neighbour and their suffering manifested by the Good Samaritan of the Gospel.

n addition, healthcare and assistance organizations must arrange for models of psychological and spiritual aid to healthcare workers who care for the terminally ill. To show care for those who care is essential so that healthcare workers and physicians do not bear all of the weight of the suffering and of the death of incurable patients (which can result in burn out for them). They need support and therapeutic sessions to process not only their values and feelings, but also the anguish they experience as they confront suffering and death in the context of their service to life. They need a profound sense of hope, along with the awareness that their own mission is a true vocation to accompany the mystery of life and grace in the painful and terminal stages of existence.

Conclusion

The mystery of the Redemption of the human person is in an astonishing way rooted in the loving involvement of God with human suffering. That is why we can entrust ourselves to God and to convey this certainty in faith to the person who is suffering and fearful of pain and death.

Christian witness demonstrates that hope is always possible, even within a “throwaway culture”. “The eloquence of the parable of the Good Samaritan and of the whole Gospel is especially this: every individual must feel as if called personally to bear witness to love in suffering”.

The Church learns from the Good Samaritan how to care for the terminally ill, and likewise obeys the commandment linked to the gift of life: “respect, defend, love and serve life, every human life!”.  The gospel of life is a gospel of compassion and mercy directed to actual persons, weak and sinful, to relieve their suffering, to support them in the life of grace, and if possible to heal them from their wounds.

It is not enough, however, to share their pain; one needs to immerse oneself in the fruits of the Paschal Mystery of Christ who conquers sin and death, with the will “to dispel the misery of another, as if it were his own”. The greatest misery consists in the loss of hope in the face of death. This hope is proclaimed by the Christian witness, which, to be effective, must be lived in faith and encompass everyone—families, nurses, and physicians. It must engage the pastoral resources of the diocese and of Catholic healthcare centers, which are called to live with faith the duty to accompany the sick in all of the stages of illness, and in particular in the critical and terminal stages of life as defined in this letter.

The Good Samaritan, who puts the face of his brother in difficulty at the center of his heart, and sees his need, offers him whatever is required to repair his wound of desolation and to open his heart to the luminous beams of hope.

The Samaritan’s “willing the good” draws him near to the injured man not just with words or conversation, but with concrete actions and in truth (cf. 1 Jn 3:18). It takes the form of care in the example of Christ who went about doing good and healing all (cf. Acts 10:38).

Healed by Jesus, we become men and women called to proclaim his healing power to love and provide the care for our neighbors to which He bore witness.

That the vocation to the love and care of another  brings with it the rewards of eternity is made explicit by the Lord of life in the parable of the final judgment: inherit the kingdom, for I was sick and you visited me. When did we do this, 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).

The Sovereign Pontiff Francis, on 25 June 2020, approved the present Letter, adopted in the Plenary Session of this Congregation, the 29th of January 2020, and ordered its publication.

Rome, from the Offices of the Congregation for the Doctrine of the Faith, the 14th of July 2020, liturgical memorial of Saint Camille de Lellis.

Luis F. Card. LADARIA, S.I.
Prefect

 Giacomo MORANDI
Archbishop tit. of Cerveteri
Secretary

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