End-of-life issues

One type of question I’ve already been required to address has been the difficult issue of pain management at the end of life, when the administration of pain medication will result in the side-effect of shortening a person’s life. To help a particular family deal with the question, I wrote the following letter, both for them and to share with any medical staff they might encounter. I thought it might be worth sharing here, as it might provoke some worthwhile discussion.

Thank you for sharing with me your concerns regarding the level of pain your grandfather is experiencing. As we both know, he is approaching the end of his life, and end-of-life issues always contain ethically complex elements. As he is a faithful Catholic man, I would like to share with you some of the principles which govern end-of-life concerns within the Catholic Tradition.

The Catholic Church strikes a balance between two principles:

  1. Life is sacred. It is a gift from God, and so we cannot directly choose to kill another person (or ourselves), or to take means to shorten their life.
  2. No one is obliged to suffer. If it comes to us, we may choose to bear it with patience, offering it up as a spiritual sacrifice, but we do not need to chase after it, and we are permitted to seek licit means to reduce it. Even Jesus, in the garden, prayed to his Father asking that the suffering he was to undergo be removed from him -- if it were possible.

In practical terms, this means following: A person IS allowed to seek medication to reduce and even eliminate pain. If this medication will also have the side-effect of reducing lifespan, it is permissible if (1) the reduction of life-span is not directly intended, and (2) the negative impact of reduction of life-span is proportional to the positive result of reduction of pain. For example, if the life-span of a young person was being reduced by 10 years for the alleviating of a pain that was merely transitory, it would not be proportional. For a person of advanced age or suffering from some other imminently terminal illness, however, the proper proportionality is easier to determine.

With regards to the practical dimension of administering pain medication, we must make our best efforts to not go beyond the required dose, or else we really are committing an act of directly killing the person. This being said, it is not always easy to determine the exact amount of pain medication to have administered. We must do our best, informed by the sick person himself (if possible) as well as by those persons of good faith who are attending to him most closely, who obviously would be the most sensitive to any immediate needs. Again, the principle of proper proportionality is evident here.

In the case of your grandfather, certain facts are clearly in evidence: (1) He is seriously ill, such that barring a miracle we can expect that he does not have long to live. (2) He has been prepared, through his life of faith and the sacraments of the Church, to encounter God. (3) He is in pain to at least some degree. Unless there are elements here which I am missing, it would therefore seem to me that pain medication could be administered to allow him to be comfortable, even if it will have the side-effect of shortening his life by a few days. Again, we do not want to administer an overdose, such that the medication itself would become a poison that kills him, but if the exact dose is difficult to determine we could, in this case, take a risk in favour of pain reduction and still be within the Catholic principles I have outlined above.

I hope this helps you clarify the situation with your grandfather. If we can be of any assistance, please don't hesitate to call on Pastoral Services.