Earlier today, the Congregation for the Doctrine of the Faith issued a letter on "the care of persons in the critical and terminal phases of life." I'm sitting down now to read it. Excerpts and comments incoming. #LivetweetingTheMagisterium
The first thing to notice is the letter's title: "Samaritanus bonus," or "The Good Samaritan." It signals that the letter focuses on the main character of Christ's famous parable (Lk 10:30-37), reflecting on how his example should be followed today by those who care for the sick.
The letter applauds advances in medical technology: "The Church regards scientific research and technology with hope, seeing in them promising opportunities to serve the integral good of life and the dignity of every human being."
But: "Advances in medical technology, though precious, cannot in themselves define the proper meaning and value of human life. In fact, every technical advance in healthcare calls for growth in moral discernment to avoid an unbalanced and dehumanizing use of the technologies."
This is especially true regarding technologies employed "in the critical or terminal stages of human life," when medical care can become overly "technical and impersonal."
"This danger arises particularly where governments have enacted legislation to legalize forms of assisted suicide and voluntary euthanasia among the most vulnerable of the sick and infirm." These laws undermine a society's ability to care properly for its sick and dying.
"In the face of challenges that affect the very way we think about medicine, the significance of the care of the sick, and our social responsibility toward the most vulnerable, the present letter seeks to enlighten pastors and the faithful . . ."
". . . regarding their questions and uncertainties about medical care, and their spiritual and pastoral obligations to the sick in the critical and terminal stages of life. All are called to give witness at the side of the sick person and to become a 'healing community.'"
The letter aims to apply timeless teaching to new questions, like the possibility of celebrating "the Sacraments for those who intend to bring an end to their own life." Reaffirming "the message of the Gospel," the letter lays out "precise and concrete pastoral guidelines."
There follows a profound meditation on the mystery of human frailty. As beings composed of body and soul, "we depend on material goods and on the mutual support of other persons," even in our quest for God. This is the foundation of an authentic "ethics of care."
Medical care should express "the principle of justice to promote human life and to avoid harming another." In other words, the golden rule: "Do unto others what you would have them do unto you" (Mt 7:12).
"Care for life is...the first responsibility that guides the physician in the encounter with the sick...This responsibility exists not only when the restoration to health is a realistic outcome, but even when a cure is unlikely or impossible."
This care reflects, too, the social nature of man: the therapeutic arts involve "robust relationships with the patient, with healthcare workers, with relatives, and with members of communities to which the patient is linked."
"To that end, especially in hospitals and clinics committed to Christian values, it is vital to create space for relationships built on the recognition of the fragility and vulnerability of the sick person."
"At work here is a contemplative gaze that beholds in one’s own existence and that of others a unique and unrepeatable wonder, received and welcomed as a gift."
"This is the gaze of the one who does not pretend to take possession of the reality of life but welcomes it as it is, with its difficulties and sufferings, and, guided by faith, finds in illness the readiness to abandon oneself to the Lord of life who is manifest therein."
"The impossibility of a cure where death is imminent does not entail the cessation of medical and nursing activity. Responsible communication with the terminally ill person should make it clear that care will be provided until the very end: 'to cure if possible, always to care.'"
"The judgement that an illness is incurable cannot mean that care has come at an end. The contemplative gaze calls for a wider notion of care."
"The objective of assistance must take account of the integrity of the person, and thus deploy adequate measures to provide the necessary physical, psychological, social, familial, and religious support to the sick."
"The pastoral care of all - family, doctors, nurses, and chaplains - can help the patient to persevere in sanctifying grace and to die in charity and the Love of God."
"The inevitability of illness, especially when chronic or degenerative, fear of suffering, death, and the discomfort they entail is the main factor driving the attempt to control and manage the moment of death, and indeed to hasten it through euthanasia or assisted suicide.
At this point, the letter reminds us of the special care and attention that the sick require. "Every sick person has the need not only to be heard, but to understand that caregivers 'know' what it means to feel alone, neglected, and tormented by the prospect of physical pain."
The sick can never be made to feel as if they are "a burden to others."
Here, the mystery of the cross enlightens the mystery of sickness: "In the Cross of Christ are concentrated and recapitulated all the sickness and suffering of the world..."
"...all the physical suffering, of which the Cross, that instrument of an infamous and shameful death, is the symbol; all the psychological suffering, expressed in the death of Jesus in the darkest of solitude, abandonment and betrayal..."
"...all the moral suffering, manifested in the condemnation to death of one who is innocent; all the spiritual suffering, displayed in a desolation that seems like the very silence of God."
"To contemplate the living experience of Christ’s suffering is to proclaim to men and women of today a hope that imparts meaning to the time of sickness and death. From this hope springs the love that overcomes the temptation to despair."
"In a time when autonomy and individualism are acclaimed, it must be remembered that, while it is true that everyone lives their own suffering, their own pain and their own death, these experiences always transpire in the presence of others and under their gaze."
"In intensive care units or centers for chronic illness care, one can be present merely as a functionary, or as someone who 'remains' with the sick."
"To those who care for the sick, the scene of the Cross provides a way of understanding that even when it seems that there is nothing more to do there remains much to do, because 'remaining' by the side of the sick is a sign of love and of the hope that it contains."
"The proclamation of life after death is not an illusion nor merely a consolation, but a certainty lodged at the center of love that death cannot devour."
From this meditation on human fragility and the cross, the letter turns to the vocation of the Church to defend and promote life.
"The Church is always happy to collaborate with all people of good will, with believers of other confessions or religions as well as nonbelievers, who respect the dignity of human life, even in the last stages of suffering and death, and reject any action contrary to human life."
"The Church affirms that the positive meaning of human life is something already knowable by right reason, and in faith is confirmed and understood in its inalienable dignity. This criterion is neither subjective nor arbitrary but is founded on a natural inviolable dignity."
"Just as we cannot make another person our slave, even if they ask to be, so we cannot directly choose to take the life of another, even if they request it."
Herein lies the human and Christian opposition to euthanasia: "To end the life of a sick person who requests euthanasia is by no means to acknowledge and respect their autonomy..."
"...but on the contrary to disavow the value of both their freedom, now under the sway of suffering and illness, and of their life by excluding any further possibility of human relationship, of sensing the meaning of their existence, or of growth in the theologal life."
"Moreover, it is to take the place of God in deciding the moment of death. For this reason, 'abortion, euthanasia and wilful self-destruction (…) poison human society, but they do more harm to those who practice them than those who suffer from the injury.'"
At this point, the letter tackles mistaken notions of "dignified death," "quality of life," "compassion," and "autonomy" that lend to the mistaken notion that euthanasia and assisted suicide represent authentic forms of care.
The letter has choice words for the "individualism" that underlies today's "throw-away culture." "A confusion between good and evil materializes in an area where every personal life should instead be understood to possess a unique and unrepeatable value..."
"...with a promise of and openness to the transcendent. In this culture of waste and death, euthanasia and assisted suicide emerge as erroneous solutions to the challenge of the care of terminal patients."
Then follows an extended restatement of the Church's recent teachings regarding the evil of euthanasia and assisted suicide, the need to avoid excessive medical treatments, and the necessity of basic care like hydration and nutrition. These restatements are strong and clear.
The letter also recalls the good of palliative care, the need for families to attend to their sick (especially those in hospice), the proper care of sick children, and the special care required by the unconscious and comatose.
The letter concludes by offering guidance for the pastoral/sacramental care of the sick and dying. The Good Samaritan is the icon of proper care and accompaniment. All are involved here, but especially pastors who provide not only the sacraments of healing but also the Eucharist.
Given the moral gravity of their choice, the sick who request euthanasia or assisted suicide cannot be admitted to the sacraments until they indicate a change of mind and heart in this regard, and take the necessary steps--if required--to reverse their decision.
"The position of the Church here does not imply a non-acceptance of the sick person. It must be accompanied by a willingness to listen and to help, together with a deeper explanation of the nature of the sacrament..."
"...in order to provide the opportunity to desire and choose the sacrament up to the last moment. The Church is careful to look deeply for adequate signs of conversion, so that the faithful can reasonably ask for the reception of the sacraments."
"To delay absolution is a medicinal act of the Church, intended not to condemn, but to lead the sinner to conversion."
"It is necessary to remain close to a person who may not be in the objective condition to receive the sacraments, for this nearness is an invitation to conversion, especially when euthanasia, requested or accepted, will not take place immediately or imminently."
"Here it remains possible to accompany the person whose hope may be revived and whose erroneous decision may be modified, thus opening the way to admission to the sacraments."
"Nevertheless, those who spiritually assist these persons should avoid any gesture, such as remaining until the euthanasia is performed, that could be interpreted as approval of this action. Such a presence could imply complicity in this act."
"This principle applies in a particular way, but is not limited to, chaplains in the healthcare systems where euthanasia is practiced, for they must not give scandal by behaving in a manner that makes them complicit in the termination of human life."
After offering advice on how medical workers might be trained after the example of the Good Samaritan, the letter ends by exhorting all the faithful, and everyone of good will, to accompany the sick, in all stages of life, in truth and in love.
There is a lot in this letter. It will take a while to digest all of its parts, especially the theological sections on life and suffering. Its pastoral and sacramental guidelines are clear, however. They offer immediate clarity to difficult questions.

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