V. The Teaching of the Magisterium - 1. The prohibition of euthanasia and assisted suicide

With her mission to transmit to the faithful the grace of the Redeemer and the holy law of God already discernible in the precepts of the natural moral law, the Church is obliged to intervene in order to exclude once again all ambiguity in the teaching of the Magisterium concerning euthanasia and assisted suicide, even where these practices have been legalized. In particular, the dissemination of medical end-of-life protocols such as the Do Not Resuscitate Order or the Physician Orders for Life Sustaining Treatment – with all of their variations depending on national laws and contexts – were initially thought of as instruments to avoid aggressive medical treatment in the terminal phases of life. Today these protocols cause serious problems regarding the duty to protect the life of patients in the most critical stages of sickness. On the one hand, medical staff feel increasingly bound by the self-determination expressed in patient declarations that deprive physicians of their freedom and duty to safeguard life even where they could do so. On the other hand, in some healthcare settings, concerns have recently arisen about the widely reported abuse of such protocols viewed in a euthanistic perspective with the result that neither patients nor families are consulted in final decisions about care. This happens above all in the countries where, with the legalization of euthanasia, wide margins of ambiguity are left open in end-of-life law regarding the meaning of obligations to provide care. For these reasons, the Church is convinced of the necessity to reaffirm as definitive teaching that euthanasia is a crime against human life because, in this act, one chooses directly to cause the death of another innocent human being. The correct definition of euthanasia depends, not on a consideration of the goods or values at stake, but on the moral object properly specified by the choice of “an action or an omission which of itself or by intention causes death, in order that all pain may in this way be eliminated”.[36]“Euthanasia’s terms of reference, therefore, are to be found in the intention of the will and in the methods used”.[37] The moral evaluation of euthanasia, and its consequences does not depend on a balance of principles that the situation and the pain of the patient could, according to some, justify the termination of the sick person. Values of life, autonomy, and decision-making ability are not on the same level as the quality of life as such.

Euthanasia, therefore, is an intrinsically evil act, in every situation or circumstance. In the past the Church has already affirmed in a definitive way “that euthanasia is a grave violation of the Law of God, since it is the deliberate and morally unacceptable killing of a human person. This doctrine is based upon the natural law and upon the written Word of God, is transmitted by the Church’s Tradition and taught by the ordinary and universal Magisterium. Depending on the circumstances, this practice involves the malice proper to suicide or murder”.[38]Any formal or immediate material cooperation in such an act is a grave sin against human life: “No authority can legitimately recommend or permit such an action. For it is a question of the violation of the divine law, an offense against the dignity of the human person, a crime against life, and an attack on humanity”.[39]Therefore, euthanasia is an act of homicide that no end can justify and that does not tolerate any form of complicity or active or passive collaboration. Those who approve laws of euthanasia and assisted suicide, therefore, become accomplices of a grave sin that others will execute. They are also guilty of scandal because by such laws they contribute to the distortion of conscience, even among the faithful.[40] Each life has the same value and dignity for everyone: the respect of the life of another is the same as the respect owed to one’s own life. One who choses with full liberty to take one’s own life breaks one’s relationship with God and with others, and renounces oneself as a moral subject. Assisted suicide aggravates the gravity of this act because it implicates another in one’s own despair. Another person is led to turn his will from the mystery of God in the theological virtue of hope and thus to repudiate the authentic value of life and to break the covenant that establishes the human family. Assisting in a suicide is an unjustified collaboration in an unlawful act that contradicts the theologal relationship with God and the moral relationship that unites us with others who share the gift of life and the meaning of existence. When a request for euthanasia rises from anguish and despair,[41]“although in these cases the guilt of the individual may be reduced, or completely absent, nevertheless the error of judgment into which the conscience falls, perhaps in good faith, does not change the nature of this act of killing, which will always be in itself something to be rejected”.[42] The same applies to assisted suicide. Such actions are never a real service to the patient, but a help to die.

Euthanasia and assisted suicide are always the wrong choice: “the medical personnel and the other health care workers – faithful to the task ‘always to be at the service of life and to assist it up until the very end’ – cannot give themselves to any euthanistic practice, neither at the request of the interested party, and much less that of the family. In fact, since there is no right to dispose of one’s life arbitrarily, no health care worker can be compelled to execute a non-existent right”.[43] This is why euthanasia and assisted suicide are a defeat for those who theorize about them, who decide upon them, or who practice them.[44] For this reason, it is gravely unjust to enact laws that legalize euthanasia or justify and support suicide, invoking the false right to choose a death improperly characterized as respectable only because it is chosen.[45]Such laws strike at the foundation of the legal order: the right to life sustains all other rights, including the exercise of freedom. The existence of such laws deeply wound human relations and justice, and threaten the mutual trust among human beings. The legitimation of assisted suicide and euthanasia is a sign of the degradation of legal systems. Pope Francis recalls that “the current socio-cultural context is gradually eroding the awareness of what makes human life precious. In fact, it is increasingly valued on the basis of its efficiency and utility, to the point of considering as ‘discarded lives’ or ‘unworthy lives’ those who do not meet this criterion. In this situation of the loss of authentic values, the mandatory obligations of solidarity and of human and Christian fraternity also fail. In reality, a society deserves the status of ‘civil’ if it develops antibodies against the culture of waste; if it recognizes the intangible value of human life; if solidarity is factually practiced and safeguarded as a foundation for living together”.[46]In some countries of the world, tens of thousands of people have already died by euthanasia, and many of them because they displayed psychological suffering or depression. Physicians themselves report that abuses frequently occur when the lives of persons who would never have desired euthanasia are terminated. The request for death is in many cases itself a symptom of disease, aggravated by isolation and discomfort. The Church discerns in these difficulties an occasion for a spiritual purification that allows hope to become truly theological when it is focused on God and only on God.

Rather than indulging in a spurious condescension, the Christian must offer to the sick the help they need to shake off their despair. The commandment “do not kill” (Ex 20:13; Dt 5:17) is in fact a yes to life which God guarantees, and it “becomes a call to attentive love which protects and promotes the life of one’s neighbor”.[47] The Christian therefore knows that earthly life is not the supreme value. Ultimate happiness is in heaven. Thus the Christian will not expect physical life to continue when death is evidently near. The Christian must help the dying to break free from despair and to place their hope in God. From a clinical perspective, the factors that largely determine requests for euthanasia and assisted suicide are unmanaged pain, and the loss of human and theological hope, provoked by the often inadequate psychological and spiritual human assistance provided by those who care for the sick.[48] Experience confirms that “the pleas of gravely ill people who sometimes ask for death are not to be understood as implying a true desire for euthanasia; in fact, it is almost always a case of an anguished plea for help and love. What a sick person needs, besides medical care, is love, the human and supernatural warmth with which sick persons can and ought to be surrounded by all those close to him or her, parents and children, doctors and nurses”.[49]A sick person, surrounded by a loving human and Christian presence, can overcome all forms of depression and need not succumb to the anguish of loneliness and abandonment to suffering and death. One experiences pain not just as a biological fact to be managed in order to make it bearable, but as the mystery of human vulnerability in the face of the end of physical life—a difficult event to endure, given that the unity of the body and the soul is essential to the human person.

Therefore, the “end of life”, inevitably presaged by pain and suffering, can be faced with dignity only by the re-signification of the event of death itself—by opening it to the horizon of eternal life and affirming the transcendent destiny of each person. In fact, “suffering is something which is still wider than sickness, more complex, and at the same time still more deeply rooted in humanity itself”.[50]With the help of grace this suffering can, like the suffering of Christ on the Cross, be animated from within with divine charity. Those who assist persons with chronic illnesses or in the terminal stages of life must be able to “know how to stay”, to keep vigil, with those who suffer the anguish of death, “to console” them, to be with them in their loneliness, to be an abiding with that can instil hope.[51] By means of the faith and charity expressed in the intimacy of the soul, the caregiver can experience the pain of another, can be open to a personal relationship with the weak that expands the horizons of life beyond death, and thus can become a presence full of hope. “Weep with those who weep” (Rm 12:15): for blessed is the one whose compassion includes shedding tears with others (cf. Mt 5:4). Love is made possible and suffering given meaning in relationships where persons share in solidarity the human condition and the journey to God, and are joined in a covenant[52] that enables them to glimpse the light beyond death. Medical care occurs within the therapeutic covenant between the physician and the patient who are united in the recognition of the transcendent value of life and the mystical meaning of suffering. In the light of this covenant, good medical care can be valued, while the utilitarian and individualistic vision that prevails today can be dispelled.

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