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Guidelines for End-of-Life Care in the Catholic Tradition

Diocese of Bridgeport

Discover resources for learning more about End-of-Life Care as it pertains to the Catholic Traditions.

Even death is illumined and can be experienced as the ultimate call to faith, the ultimate "Go forth from your land" (Gen 12:1), the ultimate "Come!" spoken by the Father, to whom we abandon ourselves in the confidence that he will keep us steadfast even in our final passage.
—  Pope Francis,   The Light Of Faith, 56

Primary Principles and Norms

The Catholic Vision of Health Care: The Church’s mission has always included giving witness to Jesus Christ’s concern for the infirmed, the aged and the dying. Catholic health care services offer care to all people, of every faith, and concerns itself with the whole person: physical, emotional and spiritual.

The Dignity of the Human Person: The Church sees every man and woman as being made in the image and likeness of God, God’s plan is that every person from the moment of conception is created for eternal happiness. God created us as a composite of a mortal body animated with an immortal soul. He calls us to live in solidarity with one another, and to have a mutual respect for human dignity. Respect for the dignity of humanity requires that we be attentive to the needs of one another, especially to those of the weak. Therefore, every human person has a responsibility to tend to the needs of the infirmed, the aged and the dying; and every human person has the right to expect to be tended to in their infirmities.

The Mystery of Suffering and Death: God is all loving and desires that all men be happy. Yet all of us are confronted with the mystery of suffering and death. Jesus Christ shed light on this mystery by his life, death and resurrection. Suffering entered into creation as a consequence of Original Sin. Sin is the rejection of the fullness of life God offers us in His love. Suffering and death are a manifestation of the void sin places between us and the fullness of life. Yet, God did not abandon us. He sent his son, Jesus Christ, into the world to share in our humanity. Jesus took on all of our infirmities when he suffered and died on the Cross, and through his Crucifixion entered into the glory of his resurrection. Jesus calls for all of us to follow him. To unite our sufferings to his configures us into his work of redemption. This mystery provides us with a new outlook on sickness and death. In Jesus Christ suffering has a special value. As St. Paul wrote, “Now I rejoice in my suffering for your sake, and in my flesh I complete what is lacking in Christ’s afflictions for the sake of his body, the Church.” In the mystery of suffering we are invited to participate in the saving work of Jesus Christ. By sharing in his suffering for the salvation of the world we can also look forward to sharing in his victory over death and being restored to the fullness of eternal life in the glory of the resurrection.

The Sacramental Economy: The Catechism of the Catholic Church reminds us that at the center of the Christian life is the celebration of the sacramental economy by which, “Christ manifests, makes present, and communicates his work of salvation through the liturgy of his Church, until he comes again.” (CCC, 1076). The ready availability and reception of the Church’s sacraments is an integral part of the care the Church provides to the faithful, especially to the infirmed, the aged and the dying.

Primary Principles and Norms

The Catholic Vision of Health Care: The Church’s mission has always included giving witness to Jesus Christ’s concern for the infirmed, the aged and the dying. Catholic health care services offer care to all people, of every faith, and concerns itself with the whole person: physical, emotional and spiritual.

The Dignity of the Human Person: The Church sees every man and woman as being made in the image and likeness of God, God’s plan is that every person from the moment of conception is created for eternal happiness. God created us as a composite of a mortal body animated with an immortal soul. He calls us to live in solidarity with one another, and to have a mutual respect for human dignity. Respect for the dignity of humanity requires that we be attentive to the needs of one another, especially to those of the weak. Therefore, every human person has a responsibility to tend to the needs of the infirmed, the aged and the dying; and every human person has the right to expect to be tended to in their infirmities.

The Mystery of Suffering and Death: God is all loving and desires that all men be happy. Yet all of us are confronted with the mystery of suffering and death. Jesus Christ shed light on this mystery by his life, death and resurrection. Suffering entered into creation as a consequence of Original Sin. Sin is the rejection of the fullness of life God offers us in His love. Suffering and death are a manifestation of the void sin places between us and the fullness of life. Yet, God did not abandon us. He sent his son, Jesus Christ, into the world to share in our humanity. Jesus took on all of our infirmities when he suffered and died on the Cross, and through his Crucifixion entered into the glory of his resurrection. Jesus calls for all of us to follow him. To unite our sufferings to his configures us into his work of redemption. This mystery provides us with a new outlook on sickness and death. In Jesus Christ suffering has a special value. As St. Paul wrote, “Now I rejoice in my suffering for your sake, and in my flesh I complete what is lacking in Christ’s afflictions for the sake of his body, the Church.” In the mystery of suffering we are invited to participate in the saving work of Jesus Christ. By sharing in his suffering for the salvation of the world we can also look forward to sharing in his victory over death and being restored to the fullness of eternal life in the glory of the resurrection.

The Sacramental Economy: The Catechism of the Catholic Church reminds us that at the center of the Christian life is the celebration of the sacramental economy by which, “Christ manifests, makes present, and communicates his work of salvation through the liturgy of his Church, until he comes again.” (CCC, 1076). The ready availability and reception of the Church’s sacraments is an integral part of the care the Church provides to the faithful, especially to the infirmed, the aged and the dying.


Selected Topics and Norms
In Caring for the Sick and Dying

Proportional (Ordinary) Care and Disproportional (Extraordinary) Care:

Proportionate care is any treatment that offers a reasonable hope of benefit to a patient without entailing an excessive burden. There is a moral obligation to provide and accept proportionate care as a means of preserving and restoring health; or in providing comfort. Disproportionate care is any treatment that places a disproportionate burden on the patient in relation to any reasonably hoped for benefit. There is no moral obligation to provide or accept disproportionate care, and at times it may be either optional or contraindicated.

Nutrition and Hydration:

The provision of food and water is ordinary and proportionate care. It is therefore morally obligatory so long as it accomplishes its intended purpose, the proper hydration and nutrition of a patient. “The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act” (Pope John Paul II). There should be a strong presumption in favor of providing nutrition and hydration to patients. However there are exceptions when the use of a feeding tube may be reevaluated, such as when: the patient is no longer able to assimilate food and water, the tube is causing repeated infections, agitation, repeated aspirations, or when death is imminent.

The Persistent Vegetative State:

Neither a coma or a permanent vegetative state is considered a terminal illness. These patients are entitled to all ordinary and proportionate care, including the provision of medically assisted nutrition and hydration. It is reasonable to expect such patients to live indefinitely if given such care. Therefore, the provision of nutrition and hydration to these patients is morally obligatory.

Palliative and Supportive Care (Pain Mgmt):

Palliative care encompasses comprehensive non-curative plans for the prevention and relief of pain and other forms of discomfort. It is designed to affirm and respect human dignity, hygiene and comfort. Patients should be kept as free of pain as possible. Pain relief medications should be administered in proportion to the intensity of the pain, and patients should not be deprived of consciousness without a compelling reason. When death is imminent medicines capable of alleviating or suppressing pain may be given, even if the therapy may shorten a person’s life so long as the intent is not to hasten death.

Hospice Care:

Hospice refers to an interdisciplinary approach to care for a patient with a terminal prognosis of six months or less for end-stage diseases. Treatments and medicines are aimed primarily at relieving symptoms rather than curing the underlying illness. Hospice provides the necessary palliative care to bring comfort to all the dimensions of the patient’s life: physical, emotional and spiritual. There should be a very strong presumption that hospice residents will receive nutrition and hydration even when provided by medical assistance.

Do Not Resuscitate Orders (DNR):

A DNR is a written order by an attending physician that cardiopulmonary resuscitation, defibrillation, intubation or other specified interventions to sustain or restore life are not to be initiated in the event of a cardiac or respiratory arrest. The DNR must reflect the written directive/consent of a patient or his health care representative. A DNR is appropriate when a patient has an incurable illness from which death is anticipate in a relatively short period of time.

Life Support:

Patients are intubated and attached to ventilator life support in the event they stop breathing. Life support constitutes ordinary care when there is reasonable expectation a patient will eventually succeed in breathing on his own. The decision to withhold or withdraw life support can be difficult. The initiation of life support should be accompanied by an on-going dialogue between the physician, patient, appointed health care representative, family and pastoral counseling. Any decision must be made with regard to the sanctity and dignity of human life.

Dying with Dignity:

There is no obligation to initiate or continue any therapy: which uses mechanical or other artificial means to sustain, restore or supplant a vital function for life when by reasonable medical standards it is anticipated death is imminent; or when the benefit of a procedure is outweighed by the burden the procedure will bring to bear on the patient; or when a therapy has high risks or adverse side effects contraindicated to the patient’s well-being.

Competency:

Decisions on medical treatment, therapy and intervention are to be made by competent patients. A competent patient is defined as one who has reached the legal age of maturity, has not been declared incompetent by a court of competent jurisdiction and who has demonstrated to the resident physician the requisite cognitive and communication skills to exercise the free and informed consent to proposed treatments. Decisions are made in accord with an advanced medical directive or by the patient’s designated health care representative when a patient is either incapacitated or incompetent to make well informed reasonable decisions, than.

Free and Informed Consent:

Free and informed consent requires that the patient or the patient’s surrogate receive all reasonable information about the essential nature of proposed treatments and their benefits, risks, side effects and cost; as well as any reasonable and morally legitimate alternatives, including no treatment at all. Every patient and their appointed medical representative should have access to the necessary medical and moral information, and seek out pastoral and spiritual counseling in order to exercise the right to self determination in the light of a well formed conscience. Catholic patients’ health care decisions should not contradict Catholic principles, Church law or moral teachings. Consultation with local clergy, pastoral care departments, facility chaplains and spiritual directors is highly encouraged.

Advanced Medical Directives:

An advanced medical directive is a written document indicating a competent patient’s decisions concerning future treatment should the patient be incapacitated or deemed incompetent. They should be in compliance with both federal and state law, and advice should be sought to assure they are in compliance with Catholic moral teachings. Catholic health care institutions will not honor an advance directive that is contrary to the Church’s principles and values regarding the dignity of human life.

Health Care Representative:

A representative designated by a patient to make medical decisions on behalf of a patient if the patient becomes incapacitated or incompetent. The representative should seek out pastoral guidance in implementing a patient’s expressed desires or advanced directives, to insure they respect the dignity of the patient and the sanctity of life, in accord with Catholic moral teachings.

Organ Donation:

Organ donation is a praiseworthy example of self giving when done in an ethically acceptable manner, where the donor has voluntarily given informed consent with a drop out option, and there is no accrual of economic gain.

Euthanasia:

Catholics and Catholic Health Care providers may neither condone nor participate in euthanasia or assisted suicide in any way.

Pastoral and Sacramental Care:

Always seek out competent and appointed representatives of the Church for moral and spiritual guidance in making end-of-life care decisions; Patients should have access to the sacraments of the Church, uniting them with the peaceful presence of Christ here on earth, as we prepare ourselves to enter into his glorious kingdom.

Financial Support:

The Diocese of Bridgeport is able to provide pastoral care to the dying and their families due to the generosity of the faithful, many of whom have benefited directly from that care. Donations to the Diocese of Bridgeport’s Department of Pastoral Care are much needed and greatly appreciated. Please see the enclosed envelope for instructions on how you can make your charitable contribution in support of Pastoral Care.


Additional Resources

Catholic Cemeteries

Learn More

FreeWill Estate Planning Tool

Learn More

Catholic Appointment of Health Care Representative

Download

Catholic Advanced Medical Directive

English

Directiva Médica Por Adelantado

Spanish

For more information please contact:

The Catholic Center
Institute for Catholic Formation
238 Jewett Avenue
Bridgeport, CT 06606
Phone: 203-416-1680