POSITION PAPER OF THE ABRAHAMIC MONOTHEISTIC RELIGIONS ON MATTERS CONCERNING THE END OF LIFE

28. Oktober 2019

Vatican City, October 28th, 2019

PDF öffnen / herunterladen

  • Preamble
    The moral, religious, social and legal aspects of the treatment of the dying
    patient are among the most difficult and widely discussed topics in modern
    medicine. They have generated intense intellectual and emotional arguments
    and a very large body of various publications throughout all cultures and
    societies.
    The issues concerning end-of-life decisions present difficult dilemmas, which
    are not new, but they have intensified greatly in recent years due to several
    factors and developments:
    • The enormous scientific-technological advances enable significant
    prolongation of life in ways and situations never previously possible.
    However, often prolonged survival is accompanied by pain and
    suffering due to various organic, mental and emotional dysfunctions.
    • The fundamental change in the patient-physician relationship from a
    paternalistic approach to an autonomous one.
    • The fact that most people in developed countries nowadays die in
    hospitals or nursing homes, which are frequently strange and
    unfamiliar surroundings for them. Many patients are attached to
    machines, surrounded by busy people unknown to them. This situation
    contrasts with that in the past when people usually died at home,
    surrounded by their loved ones in their customary and recognized
    environment.
    • The greater involvement of various professionals in the treatment of the
    dying patient, as well as the involvement of the media, the judicial
    system and the public at large. These often reflect different cultural
    backgrounds, outlooks, and varying and even conflicting opinions as to
    what should or should not be done for the dying patient.
    • Cultural changes, particularly in Western societies.
    • The growing scarcity of resources due to expensive diagnostic and
    therapeutic options.
    The dilemmas concerning the care and treatment of the dying patient are not
    primarily medical or scientific ones, but rather social, ethical, religious, legal
    and cultural dilemmas. While physicians make decision based on the facts,
    most of the decisions concerning the dying patient are not of a medical-
    scientific nature. Rather, they are based on personal values and ethics. Hence,
    caring for the dying patient by families and health-care providers within
    societal norms is a challenging task.
    The principles and practices of the Abrahamic monotheistic religions, and
    particularly their understanding of the proper balance between conflicting
    values, are not always in accord with the current secular humanistic values
    and practices.
    The aims of this position paper are:
    • To present the position of the Abrahamic monotheistic religions
    regarding the values and the practices relevant to the dying patient, for
    the benefit of patients, families, health-care providers and policy
    makers who are adherents of one of these religions.
    • To enhance the capacity of healthcare professionals to better
    understand, respect, guide, help, and comfort the religious patient and
    the family at life’s end. Respecting the religious or cultural values of the
    patient is not only a religious concern but is an ethical requirement for
    staff at hospitals and other facilities where there are patients of diverse
    faiths.
    • To promote a reciprocal understanding and synergies of different
    approaches between the monotheistic religious traditions and secular
    ethics concerning beliefs, values, and practices relevant to the dying
    patient.
    Definition
    A dying patient is defined as a person suffering from a fatal, incurable and
    irreversible disease, at a stage when death will in all probability occur within
    the space of a few months as a result of the disease or its directly related
    complications, despite the best diagnostic and therapeutic efforts.
    Suffering and Dying
    While we applaud medical science for advances to prevent and cure disease,
    we recognize that every life will ultimately experience death.
    Care for the dying is both part of our stewardship of the Divine gift of life
    when a cure is no longer possible, as well as our human and ethical
    responsibility toward the dying (and often) suffering patient. Holistic and
    respectful care of the person must recognize the uniquely human, spiritual
    and religious dimension of dying as a fundamental objective. This approach to
    death requires compassion, empathy and professionalism on the part of every
    person involved in the care of the dying patient, especially from care workers
    responsible for the psycho-sociological and emotional welfare of the patient.
    The Use of Medical Technology at the End of Life
    Human interventions by medical treatments and technologies are only
    justified in terms of the help that they can provide. Therefore, their use
    requires responsible judgment about when life-sustaining and life-prolonging
    treatments truly support the goals of human life, and when they have reached
    their limits. When death is imminent despite the means used, it is justified to
    make the decision to withhold certain forms of medical treatments that would
    only prolong a precarious life of suffering. Nonetheless, even when
    persistence in seeking to stave off death seems unreasonably burdensome, we
    must do whatever is possible to offer comfort, effective pain and symptoms
    relief, companionship, emotional and spiritual care and support to the patient
    and his/her family in preparation for death.
    The medical team and society at large should respect an authentically
    independence wish of a dying patient to prolong or preserve his/her life even
    for an additional short period of time by clinically appropriated medical
    measures. This includes the continuation of respiratory support, artificial
    nutrition and hydration, chemotherapy or radiotherapy, antibiotics, pressors
    and the like. This wish can be expressed either by the patient him/herself, in
    „real time“; or, if not competent at the time, by advance medical directive, by
    a surrogate, or by testimony of close family members. This approach
    represents both the respect for life as well as the respect for independence,
    which should not only be respected when it is in agreement with the health-
    care provider. Clergy are often consulted by the family to aid in this decision.
    In cases of religiously practicing/devout patients or where the immediate
    next-of-kin are religiously observant/devout, a relevant member of the clergy
    should be consulted.
    The Rejection of Euthanasia and Physician-Assisted Suicide
    Matters pertaining to the duration and meaning of human life should not be
    in the domain of health care providers whose responsibility is to provide the
    best possible cure for disease and maximal care of the sick.
    We oppose any form of euthanasia – that is the direct, deliberate and
    intentional act of taking life – as well as physician assisted suicide – that is
    the direct, deliberate and intentional support of committing suicide – because
    they fundamentally contradict the inalienable value of human life, and
    therefore are inherently and consequentially morally and religiously wrong,
    and should be forbidden without exceptions.
    The Nurturing Community
    We emphasize the importance of community support in the decision-making
    process faced by the dying patient and his/her family. The duty to care for the
    sick, demands of us also to reform the structures and institutions by which
    health and religious care are delivered. We, as a society, must assure that
    patients’ desire not to be a financial burden does not tempt them to choose
    death rather than receiving the care and support that could enable them to
    live their remaining lifetime in comfort and tranquility. For religiously
    observant/devout patients and families there are several possible forms of
    communal support facilitating thoughtful and prayerful consideration by the
    parties involved, with medical, religious, and other appropriate counsel. This
    is a religious duty of the faith community to all its members, according to
    each one’s responsibilities.
    Spiritual Care
    The greatest contribution to humanizing the dying process that health care
    workers and religious persons can offer is the provision of a faith-and-hope-
    filled presence. Spiritual and religious assistance is a fundamental right of the
    patient and a duty of the faith community. It is also acknowledged as an
    important contribution by palliative care experts. Because of the necessary
    interaction between the physical, psychological and spiritual dimensions of
    the person, together with the duty of honoring personal beliefs and faith,; all
    health care providers are duty-bound to create the conditions by which
    religious assistance is assured to anyone who asks for it, either explicitly or
    implicitly.
    The Promotion of Palliative Care
    Any dying patient should receive the best possible comprehensive palliative
    care – physical, emotional, social, religious and spiritual. The relatively new
    field in medicine of palliative care has made great advances and is capable of
    providing comprehensive and efficient support to dying patients and their
    families. Hence, we encourage palliative care for the patient and for her/his
    family at the end of life. Palliative care aims at achieving the best quality of
    life for patients suffering from an incurable and progressive illness, even
    when their illness cannot be cured, thus expressing the noble human devotion
    of taking care of one another, especially of those who suffer. Palliative care
    services, provided by an organized and highly structured system for delivering
    care, are critical for realizing the most ancient mission of medicine: “to care
    even when there is no cure.” We encourage professionals and students to
    specialize in this field of medicine.
    Conclusion
    Based on the arguments and justifications articulated in this position paper,
    the three Abrahamic monotheistic religions share common goals and are in
    complete agreement in their approach to end-of-life situations. Accordingly,
    we affirm that:
    ➢ Euthanasia and physician-assisted suicide are inherently and
    consequentially morally and religiously wrong and should be forbidden
    with no exceptions. Any pressure upon dying patients to end their lives
    by active and deliberate actions is categorically rejected.
    ➢ No health care provider should be coerced or pressured to either
    directly or indirectly assist in the deliberate and intentional death of a
    patient through assisted suicide or any form of euthanasia, especially
    when it is against the religious beliefs of the provider. It has been well
    accepted throughout the generations that conscientious objection to
    acts that conflict with a person’s ethical values should be respected.
    This also remains valid even if such acts have been accepted by the
    local legal system, or by certain groups of citizens. Moral objections
    regarding issues of life and death certainly fall into the category of
    conscientious objection that should be universally respected.
    ➢ We encourage and support validated and professional palliative care
    everywhere and for everyone. Even when efforts to continue staving off
    death seems unreasonably burdensome, we are morally and religiously
    duty-bound to provide comfort, effective pain and symptoms relief,
    companionship, care and spiritual assistance to the dying patient and
    to her/his family.
    ➢ We commend laws and policies that protect the rights and the dignity of
    the dying patient, in order to avoid euthanasia and promote palliative
    care.
    ➢ We, as a society, must assure that patients’ desire not to be a burden
    does not inspire them the feeling of being useless and the subsequent
    unawareness of the value and dignity of their life, which deserves care
    and support until its natural end.
    ➢ All health care providers should be duty-bound to create the conditions
    by which religious assistance is assured to anyone who asks for it,
    either explicitly or implicitly.
    ➢ We are committed to use our knowledge and research to shape policies
    that promote socio-emotional, physical and spiritual care and
    wellbeing, by providing the utmost information and care to those
    facing grave illness and death.
    ➢ We are committed to engage our communities on the issues of bioethics
    related to the dying patient, as well as to acquaint them with
    techniques of compassionate companionship for those who are
    suffering and dying.
    ➢ We are committed to raising public awareness about palliative care
    through education and providing resources concerning treatments for
    the suffering and the dying.
    ➢ We are committed to providing succor to the family and to the loved
    ones of dying patients.
    ➢ We call upon all policy-makers and health-care providers to familiarize
    themselves with this wide-ranging Abrahamic monotheistic perspective
    and teaching in order to provide the best care to dying patients and to
    their families who adhere to the religious norms and guidance of their
    respective religious traditions.
    ➢ We are committed to involving the other religions and all people of
    goodwill.
#printfriendly #pf-src-url { display: none !important; } /* Use the Roboto Font */ @import url("https://fonts.googleapis.com/css2?family=Roboto:ital,wght@0,100;0,300;0,400;0,500;0,700;0,900;1,100;1,300;1,400;1,500;1,700;1,900&display=swap"); #printfriendly { font-family: 'Roboto', sans-serif !important; }