Question:

Dear Father:

Our elderly mother has been ill for years and has now entered a stage that doctors consider terminal. Her pain is truly enormous, and the painkillers they give her have only a minimal effect. She has been unconscious most of the time for months now. It causes us great sorrow to see her suffer so much, and the doctors attending her have suggested that we should increase the dose of the drugs she receives to relieve her pain and maintain this medication until God calls her, but this would lead to her permanently losing consciousness. We, her children, are perplexed. Is it lawful to do this? Some of my brothers and sisters say they see no problem, but I am not sure. Could you guide me in making the right decision?

Answer:

Dear Reader,

The problem of using painkillers that dull consciousness and the lawfulness of their use was already presented to Pope Pius XII at the end of the 1950s. The dilemma arises because, as you say, on the one hand, pain is alleviated, but in many cases this comes at the cost of life expectancy, thereby shortening life.

I. Pain and merits for eternal life

The Pope gave a very balanced and highly relevant response at that time. It is true that suffering and pain are a great source of merit and that the pains of terminal illness are the last that can be offered in this life to attain eternal life. But it is also true that “growth in God’s love and abandonment in his will does not come from the sufferings that are accepted, but from voluntary  intention, sustained by grace; this intention, in many dying, can take hold and become more alive if their sufferings are lessened, because these aggravate the state of weakness and physical exhaustion, hinder the impulse of the soul and undermine the moral forces, instead of sustaining them.”

For this reason, sometimes “the suppression of pain seeks an organic and psychic relaxation, facilitates prayer and makes possible a more generous self-giving.”

Hence, “When some dying people consent to suffer as a means of atonement and a source of merit to progress in the love of God and in abandonment to their will, anesthesia is not imposed on them; help them rather to follow their own path.”

II. The suppression of consciousness when there are no serious clinical reasons

Is it lawful to suppress the consciousness of a dying person, not to relieve pain but to prevent him from suffering psychologically by knowing the gravity of his condition? On this point, we must say, with the same Pontiff: “Since the Lord wanted to suffer death with full consciousness, the Christian wishes to imitate him in this as well. The Church, on the other hand, gives priests and the faithful an «Ordo commendationis animae», A series of prayers to help the dying to leave this world and enter eternity. If these prayers retain their value and meaning, even when they are told to an unconscious patient, they usually provide light, consolation, and strength to those who can take part in them. That is why the Church implies that, without grave reasons, the dying person should not be deprived of knowledge. When nature does, men must accept it; but they should not do it on their own initiative, unless there are serious reasons for doing so.”

Pius XII added that this is usually the desire of the interested parties themselves: “when they have faith: they long for the presence of their own, of a friend, of a priest, to help them to die well. They want to preserve the possibility of adopting their last dispositions, of saying a last sentence, one last word to the attendees. Preventing it disgusts the Christian and even simply human feeling. The anesthesia used to approach death, with the sole purpose of avoiding the patient a conscious end, would be no longer a remarkable conquest of modern therapy, but a truly deplorable practice.”

III. The suppression of consciousness when there are serious reasons

What happens when, on the contrary, there is a serious clinical indication (for example, violent pain, morbid states of depression and anguish)?

In these cases, “The dying person can not allow, let alone ask the doctor, to procure unconsciousness if he thereby becomes incapable of fulfilling serious moral duties, for example, fixing important matters, making his will, confessing.”

But the Pope added: “To judge this lawfulness, it will also be necessary to ask whether the narcosis will be relatively brief (for one night or for a few hours) or prolonged (with or without interruptions) and consider whether the use of higher faculties will return at certain times, for some minutes even or for a few hours, so that he gives the dying the possibility of doing what his duty imposes on him (for example, reconciling with God). For the rest, a conscientious doctor, even if he is not a Christian, will never yield to the pressure of whoever wishes, against the will of the dying person, to make him lose his lucidity so as to prevent him from making certain decisions.”

“When, in spite of the obligations that concern him, the dying man asks for narcosis, for which there are serious reasons, a doctor aware of his duty will not lend himself to it, especially if he is a Christian, without inviting him before, or by himself. , or better yet, through another, to previously fulfill their obligations. If the patient stubbornly refuses to do so and persists in asking for the narcotic, the doctor can give it to him without becoming guilty of formal cooperation to the fault committed. This, in fact, does not depend on the narcosis, but on the immoral will of the patient; whether the analgesia is given or not, his behavior will be identical: he will not fulfill his duty. There remains, yes, the possibility of repentance, but there is no serious likelihood of it; and who knows if it will not harden even more in evil? But if the dying man has fulfilled all his duties and received the last sacraments, if the clear medical indications suggest anesthesia, if in the fixation of the doses the amount allowed is not exceeded, if its intensity and duration are carefully measured and the patient he is satisfied, then there is nothing that opposes it: anesthesia is morally licit.”

IV. When anesthesia shortens the duration of life

Should one renounce the narcotic if its action shortens the duration of life?

It is clear that “any form of direct euthanasia, that is, the administration of narcotics in order to provoke or accelerate death, is illicit, because then it is intended to directly dispose of life. One of the fundamental principles of natural and Christian morality is that man does not own and own his body and his existence, but only usufructuary. It arrogates a right of direct disposition how many times one intends to shorten life as an end or as a means.”

The case is different when “it is only about avoiding the patient unbearable pain: for example, in cases of inoperable cancer or incurable diseases.” In these cases, “If between the narcosis and the shortening of life there is no direct causal link, put by the will of the interested parties or by the nature of things (as it would be the case, if the suppression of pain could not be obtained but by shortening of life), and if, on the contrary, the administration of narcotics produced by itself two distinct effects, on the one hand the relief of pains and on the other hand the abbreviation of life, then it is lawful; One would still have to see if between these two effects there is a reasonable proportion and if the advantages of one compensate the disadvantages of the other. It is also important, first of all, to ask whether the current state of science does not allow us to obtain the same result using other means, and then not to transfer the limits of what is practically necessary in the use of narcotics.”

V. Conclusion

Therefore, in summary, I must answer your question as follows: if there are no other means and if, given the circumstances, this does not prevent the fulfillment of other religious and moral duties, it is lawful to give the patient the painkillers that the gravity of his condition requires, even if this indirectly entails the loss of his consciousness.

Fr. Miguel A. Fuentes, IVE

NOTE: Pius XII, Answers to three religious and moral questions concerning analgesia, formulated during the IX National Congress of the Italian Society of Anesthesiology (February 24, 1957). This is the third question and answer. The Pope said, specifying the perspective of the question: “the dying have more than others the moral, natural or Christian obligation to accept pain or to reject its mitigation, this does not depend on the nature of things or the sources of revelation. But as, according to the spirit of the Gospel, suffering contributes to the expiation of personal sins and the acquisition of greater merits, those whose lives are in danger certainly have a special reason to accept it, because, with death already close, this possibility to obtain new merits runs the risk of disappearing soon. But this motive is of direct interest to the patient, not to the doctor, who practices analgesia, assuming that the patient consents to it or has even asked for it expressly. It would obviously be unlawful to practice anesthesia against the express will of the dying person (when he “issui iuris [legal issues]).”

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