Q. Please tell me how Catholics justify hospice care, especially withholding food and water from the patient. Doesn’t this starve the patient to death? And doesn’t the heavy medication they use actually cause death? (Illinois)
A. Patients are typically admitted into hospice care when curative treatment has been deemed futile and the prognosis is that death will occur within six months if the disease takes its normal course. The primary medical goal in caring for the dying person then becomes the relief of pain and suffering.
Catholic moral principles for the treatment of the dying are set forth in a document (available online) published by the U.S. Conference of Catholic Bishops titled "Ethical and Religious Directives for Catholic Health Care Services."
Those directives provide that "in principle, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally," because, as you rightly state, it would be morally wrong to "starve the patient to death" (No. 58).
But that same section of the directives goes on to explain that medically assisted nutrition and hydration become "morally optional" when there is no reasonable expectation of prolonging life or when such means would be "excessively burdensome" for the patient or cause significant physical discomfort.
As for medication, the directives address your question directly: "Medicine capable of alleviating or suppressing pain may be given to a dying person, even if this therapy may indirectly shorten the person’s life so long as the intent is not to hasten death" (No. 61).
Since hospice care is offered both by religious and secular institutions, it would be best to seek that care in a Catholic facility, thus ensuring that Catholic moral guidelines would be observed.
An important aspect, too — and sometimes families and even physicians might overlook this — is that, when possible, dying patients themselves should be consulted about the morally legitimate treatment options available.
Q. Two years ago, my daughter was diagnosed with stage 4 breast cancer. We understand that the disease is considered terminal but pray for a healing. Two of her friends died of cancer, so she has witnessed firsthand the stages of dying and the profound sadness which that leaves in its wake. Based on those experiences, my daughter has said more than once that, when her own death draws near, assisted suicide is her wish. (And her husband has promised her that he will comply.)
I have prayed about this but don’t know how to approach my daughter without alienating her. (She believes in God but doesn’t worship formally.) Please give me your thoughts. (Upstate New York)
A. Life comes to us as a gift from God, and God alone has the right to decide when it is time for us to return that gift. This is the fundamental reason why I, along with the church, oppose assisted suicide. It violates the sacredness of human life.
But even without that theological basis, there are many who find the notion discomforting. Among them are a host of physician groups, including the American Medical Association, because it violates a doctor’s oath, which is to heal and to do no harm.
Disability advocates also are strongly opposed because it seems to equate human worth with social utility. (One danger is that people who are seriously ill might feel "obliged to die" because they have become a burden to their family, either emotionally or financially.)
Palliative care and, in the final stages, the merciful ministry of hospice, can do much to relieve a patient’s pain while also providing emotional and spiritual support. You might assure your daughter of that, along with the pledge that you will be with her all the way through, helping to ease her burden.
I can only imagine how difficult it must be for you to speak with her about this matter. The New York State Catholic Conference in Albany has some helpful material that you might want to pass on to her, perhaps with the comment that you have come across this information and wondered what she might think of it.
Be sure that she understands, too, that the church does not require burdensome treatment that offers little benefit and would simply prolong the agony of dying.
Please know that I will pray for your daughter and for the healing you so fervently desire.
Questions may be sent to Father Doyle at firstname.lastname@example.org.