Vatican City, October 28th, 2019
- 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.