Ethicists, doctors and governments in the West continue to support physician-assisted suicide as a medical option – sparking heated debates about human dignity, the nature of human life and what Pope Francis has repeatedly called a “throw-away culture”.
As part of this discussion, the Vatican’s Pontifical Academy for Life has published a new text entitled “A Small Dictionary on the End of Life” to provide clarity on terminology and concepts on a morally sensitive issue in an increasingly “secular” context.
The text, prepared by a study group within the Academy and published last month and distributed to all members of the Italian Bishops’ Conference, addresses some of the most controversial issues at the end of life, including euthanasia and the moral norms surrounding the provision – and in some cases the withdrawal – of food and water.
According to the Academy’s president, Archbishop Vincenzo Paglia, the text is not intended to offer new teachings, but rather to clear up confusion about important concepts and provide clarity to those who must navigate the most complicated and delicate situations.
But when it comes to the issue of basic care for unresponsive patients, the 88-page booklet raises real questions about its understanding of and consistency with previous Church teaching documents, and the Church’s mandate, as articulated by the Second Vatican Council, to recognize and respond to the signs of the times.
In some cases, it even seems to lag behind secular thinkers’ understanding of the need to protect vulnerable human life.
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Practices such as physician-assisted suicide and so-called physician-assisted dying are now well advanced in countries such as Canada, Belgium, the Netherlands and Switzerland; Spain and Italy are well on their way to following suit.
In France, the UK and the US – where physician-assisted suicide is legal in nine states – there have been ethical, legal and political debates about the nature of human life and human dignity for some time.
Viewed from the perspective of what Pope Francis calls the “throw-away culture,” there are also clear social and structural factors that push Western cultures to place less value on human life at the end of its lifespan.
In Canada, for example, assisted suicide has increased dramatically – it is now the fifth leading cause of death there – which puts people with disabilities at considerable risk. At the same time, social support for people with disabilities is known to be completely inadequate.
Sometimes, in this context, people who are already suicidal are pressured to give meaning and value to their lives after death through organ donation. One woman even reported being contacted by an organ donation organization before she had scheduled her assisted suicide.
The social and structural pressure to end one’s life in this way will soon lead to a dementia crisis.
Western countries already treat this population terribly, often confining them to tiny, lonely rooms with only televisions and robots for company. With the number of people suffering from dementia expected to rise in the coming decades, the pressure on resources on this culture will be enormous.
In this context, the Pontifical Academy for Life (PAL) recently published its “Small Dictionary on the End of Life”.
The Small Dictionary of the End of Life is not available in English translation, but its content has already been covered in numerous media worldwide.
Its publication has been eagerly awaited, especially since the president of the PAL, Archbishop Vincenzo Paglia, declared that he wanted to take a bold stand and raise new questions in moral theology in general. He even called for a “paradigm shift” in which older approaches would be dismissed as a simplistic “manual of formulas”.
Paglia has previously raised questions from prominent Catholic commentators such as Bishop Robert Barron and others when he said, “Personally, I would not provide euthanasia, but I understand that legal mediation may be the greatest concrete good possible under the conditions in which we find ourselves.”
Some warned that this could lead to a return to “proportionalism” – a version of Catholic moral theology explicitly condemned in St. John Paul II’s encyclical. Vertiatis Splendorin which the long-standing principle and assumption of nonviolence (that it is always wrong to kill innocents) would be thrown overboard as too rigid and formulaic.
Although the new document addresses a number of bioethical issues and reiterates a “blanket” opposition to euthanasia and assisted suicide, the newer parts of the text seem to focus on what constitutes so-called “aggressive” treatment – and “in particular, the requirement to provide nutrition and fluids to patients in a vegetative state.”
The Kleine Lexikon refers to the DDF’s letter from 2020, Samaritan Bonuswhich also addressed end-of-life issues.
This document reaffirms the Church’s long-standing teaching that it may be morally legitimate to withhold or forego extraordinary, disproportionate or “aggressive” medical treatments unless death is the primary concern.
However, the text of the DDF limited cases in which these treatments could be lawfully stopped or discontinued to situations “in which death is imminent”. The teaching dicastery also stressed that “it is not lawful to suspend treatments necessary to maintain vital physiological functions as long as the body can benefit from them”, citing examples such as hydration and nutrition.
“The cessation of hopeless treatments,” the DDF teaches, “must not mean the cessation of therapeutic care.” This teaching was also reaffirmed almost word for word in the declaration. Dignitas Infinita beginning of the year.
In contrast, the Pontifical Academy’s new text seems to suggest that the food and fluids given to disabled, so-called “vegetative” patients are prepared in a laboratory and administered using technology, and that the administration of this food and fluids to these patients are not “simple care measures.”
It could therefore be viewed more as a medical treatment that can in principle be discontinued, rather than as a type of basic care that can never be refused.
From a bioethical perspective, this would seem to many ethicists a strange presentation of the problem, to say the least.
The food given to these disabled people is not made in a laboratory any more than protein shake powder. And feeding tubes are extremely simple devices that do not require machinery or other special technology.
Many Catholic bioethicists would find feeding a disabled person through a tube little different from feeding them with a spoon. Both are “technology” in the strictest sense, but both are examples of basic Christian care for the needy (“feeding the hungry”), not medical treatment.
Another important point concerns the status of disabled people who are sometimes described as “vegetative.” Such people have a very serious brain injury, but they are by no means “dying.”
Many doctors today use completely different terms and prefer to refer to these patients as having various types of disorders of consciousness – rather than vegetables – which understandably meets with great resistance in the disability rights movement.
In fact, even the concept of “brain death” is increasingly being questioned by physicians and ethicists.
We have known since at least 2006 that a significant proportion of patients classified in the imprecise and offensive category of “vegetative state” were actually conscious and able to respond to some simple commands.
But it is only in the last decade that we have learned from numerous secular sources that, with proper therapy, a significant percentage of these patients can improve and even learn to communicate.
Renowned physician and bioethicist Joe Fins (who is generally considered no friend of the pro-life movement) therefore stated that this new research would require a new civil rights movement for people with these disorders of consciousness.
In fact, Fins and many others conclude that those who seek to withhold food and water from these patients do so not because it would be disproportionate treatment or burdensome care, but because they believe it would be better if these disabled people died.
Given that even secular bioethicists like Fins have such concerns, it is urgent to ask why and how the PAL came to look at the same problem—providing food and water to this vulnerable population—from a very different angle.
In some contexts, aggressive treatment and the pursuit of life at any cost pose real ethical problems. Our Lord and the great martyrs, while never seeking their own death, clearly understood that certain goods are more important than the pursuit of more life. There is no question about that.
However, many Catholic moral theologians and bioethicists will wonder whether the PAL refuses to follow the Second Vatican Council’s instruction to recognize the signs of the times and respond to them in accordance with the witness of Christ.
Instead of addressing the greatest danger posed by the current end-of-life debate – a consumerist, throwaway culture that seeks to conceal the value of disabled people with disorders of consciousness and to facilitate their death – the Academy seems to be focusing on other issues.
And these points – such as withholding food and water from the medically most vulnerable – are worded in a way that seems to at least contradict the teachings of the Vatican’s Doctrine Department in two recent documents.
Of course, the “Small Encyclopedia of the End of Life” has so far only been published in one language and is neither intended to be a definitive text nor a comprehensive answer to a comprehensive debate.
But according to Archbishop Paglia’s introduction, the text aims to provide clergy with the tools they need to navigate the “jungle of complicated questions” surrounding the end of life.
This seems to create confusion at best in some of the most sensitive cases.
