End-of-Life Care for the Catholic Patient - Palliative Care Network of Wisconsin (2023)

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  • MC Sullivan RN, MTS, JD1
  • Darren Henson PhD, STL2
  • Denise Hess MDiv, BCC-PCHAC3

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Background:Given that one in five US adults and 16% of the global population identify asCatholic, a basic understanding of the Catholic Church’s end-of-life teachings is important for clinicians caring for seriously ill patients (1,2). ThisFast Factprovides a general overview of Catholic Church teachings related to care of those near the end-of-life (3,4).

“Ordinary” (orproportionate) vs. “Extraordinary” (ordisproportionate) means of care:Following from a belief in the sacred dignity of every human life, Catholic patients have a duty to make reasonable efforts to restore health (5). Yet this duty is not absolute. Decisions about what kinds of care and treatments are appropriate are made by an understanding of the following distinction:

  • Ordinarymeans of care(orproportionate) is medical care thatin the patient’s judgmentprovides a reasonable chance of benefit and does not involveexcessive burden(excessive pain, risk, expense, etc.) on the patient, family or community (6). In the Catholic tradition there is a moral obligation to use ordinary medical treatments aimed at prolonging life.
  • Extraordinarymeans ofcare(ordisproportionate) is medical care that imposes excessive burden and/or is unlikely to provide the desired benefit (7). Catholic patients are under no obligation to receive medical treatments that in their judgment are extraordinary or disproportionate.

General End-of-life Medical Decision-Making Principals:

  • Standard palliative interdisciplinary care, including pain management, is consistent with Catholic Church teaching (8). This includes the use of high-dose opioids or sedatives at the end of life (even if life-shortening) as long as the palliative therapies were proportionate and used to treat refractory symptoms in a terminally ill patient (see reference #9 for information onthe principle of double effect).
  • Decisions to forgo, withdraw or continue other life-supporting medical interventions such as mechanical ventilation, dialysis, implantable cardiac devices, extracorporeal membrane oxygenation, vasopressors, and others are guided by, as discussed above, consideration of the patient’s wishes in the context of the expected benefit and burden.
  • When navigating the complexities of decision-making with patients and families, the medical team should involve a Catholic priest and professionals well versed in Catholic medical ethics as needed and if available.

Use of Medically-Assisted Nutrition and Hydration/MANH:According to Catholic Church leadership, there is a general obligation to provide food and water to patients who are unable to ingest nutrition by mouth (e.g. patients in a persistent vegetative state) (10). Circumstances when this principle does not apply include:

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  1. When the patient suffers with an underlying progressive/fatal condition and is imminently dying.
  2. When MANH cannot reasonably be expected to prolong life.
  3. When there is no reasonable hope of benefit from MANH.
  4. When the burdens of MANH would be excessive as deemed by the patient (10).

Physician-Assisted Dying:Any medical intervention that seeks to hasten death (including all forms of physician-assisted dying) is morally impermissible according to Catholic Church teaching (11,12). Such interventions are not provided in Catholic health care settings.

Catholic Rites & Rituals:

  • Eucharist (orCommunion) is a sacrament (a special ritual in the Catholic Church) celebrated by a Catholic priest in which Catholics believe bread and wine through consecration become thebody and blood of Jesus Christ.While Catholics are obligated to go to Mass every Sunday, those whose illness makes this burdensome or impossible are dispensed from this obligation. Many, however, may still desire to participate in this sacrament. Every effort should be made to enable the patient who desires to receive the Eucharist and to do so as frequently as they like. Ministers of the Eucharist (either Catholic chaplains or volunteer ministers) may be found through a medical center’s spiritual care department.
  • Anointing of the Sickis a sacrament celebrated by a Catholic priest for anyone experiencing illness. It consists of prayer, scripture readings, laying on of hands, and anointing with oil. Anointing of the Sick can be paired with the sacrament of Penance (also known as Reconciliation), the latter of which entails a confession of sins. A patient does not need to be actively dying to receive this anointing and may receive it more than once over the course of an illness.
  • The Prayers of Commendation for the DyingandPrayers for the Deadare for patients nearing or at the time of death. These prayers can be offered by anyone (not just a Catholic priest) and can be a source of solace to the patient and loved ones.
  • Some may hear the term “last rites” used to refer collectively to the prayers and sacraments administered to a person near death. While still used by some, this term is less common today.

NOTE:There is diversity in the way people who self-identify as “Catholic” relate to the Catholic faith. While the principles and rituals explained above reflect Catholic Church teaching, it is important to explore the preferences of each patient in order to understand the extent to which the patient seeks to uphold the Catholic Church’s principles and rituals in their care.

For further reading:The Ethical and Religious Directives for Catholic Health Care Services, 6thEdition

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References:

  1. Pew Research Centerhttps://www.pewforum.org/2015/05/12/americas-changing-religious-landscape/Accessed 11/25/2019.
  2. Pew Research Centerhttps://www.pewforum.org/2013/02/13/the-global-catholic-population/Accessed 11/25/19.
  3. The Catholic Health Association of the USA.https://www.chausa.org/docs/default-source/ethics/3058_cha_end-of-life-guide_tcc_lores.pdf?sfvrsn=6Accessed 11/25/19.
  4. Supportive Care Coalition.https://supportivecarecoalition.org/mission-and-ethics-blog/2017/10/31/palliative-care-a-hallmark-of-catholic-health-care-key-messages-for-health-care-ministry-leadersAccessed 11/25/19.
  5. Congregation for the Doctrine of the Faith.http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.htmlAccessed 11/25/19.
  6. United States Conference of Catholic Bishops. Ethical and religious directives for Catholic health care services, 6thed. Directive 56. USCCB: Washington, DC. 2018.
  7. United States Conference of Catholic Bishops. Ethical and religious directives for Catholic health care services, 6thed. Directive 57. USCCB: Washington, DC. 2018.
  8. United States Conference of Catholic Bishops. Ethical and religious directives for Catholic health care services, 6thed. Directive 61. USCCB: Washington, DC. 2018.
  9. Keenan, J. F. (1993). The Function of the Principle of Double Effect.Theological Studies,54(2), 294–315.https://doi.org/10.1177/004056399305400205.
  10. United States Conference of Catholic Bishops. Ethical and religious directives for Catholic health care services, 6thed. Directive 58. USCCB: Washington, DC. 2018.
  11. United States Conference of Catholic Bishops. Ethical and religious directives for Catholic health care services, 6thed. Introduction to part five. USCCB: Washington, DC. 2018.
  12. Sacred Congregation for the Doctrine of Faith.http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19800505_euthanasia_en.html Accessed 11/25/19.

Conflicts of Interest:None to report

Author Affiliations:1Initiative for Palliative Care and Advance Care Planning for the Roman Catholic Archdiocese of Boston, MA;2AHA Institute for Diversity and Health Equity;3Supportive Care Coalition, Hillsboro, OR.

Version History:Originally edited by Christopher W Lawton MD; first electronically published May 2020.

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Fast Facts and Concepts are edited by Sean Marks MD (Medical College of Wisconsin) and associate editor Drew A Rosielle MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact’s content. The full set of Fast Facts are available at Palliative Care Network of Wisconsin with contact information, and how to reference Fast Facts.

Copyright: All Fast Facts and Concepts are published under a Creative Commons Attribution-NonCommercial 4.0 International Copyright (http://creativecommons.org/licenses/by-nc/4.0/). Fast Facts can only be copied and distributed for non-commercial, educational purposes. If you adapt or distribute a Fast Fact, let us know!

Disclaimer: Fast Facts and Concepts provide educational information for health care professionals. This information is not medical advice. Fast Facts are not continually updated, and new safety information may emerge after a Fast Fact is published. Health care providers should always exercise their own independent clinical judgment and consult other relevant and up-to-date experts and resources. Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

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FAQs

What does Catholic Church say about palliative care? ›

The Catholic Church considers analgesics and palliative care as being important to restore or preserve the dignity of a person in the final stages of illness People often think that inadequate pain treatment in Italy is a result of Catholic Church doctrine regarding pain and suffering.

What does the Catholic Church say about euthanasia and end of life care? ›

Catholicism. The Roman Catholic Church strongly opposes physician-assisted suicide and euthanasia. The church teaches that life should not be prematurely shortened because it is a gift from God, says John A. Di Camillo, staff ethicist at the National Catholic Bioethics Center in Philadelphia, Pa.

What do Catholics do when someone dies? ›

Often, Catholic end-of-life planning involves the family contacting a priest as soon as a family member grows seriously ill. The priest then administers the Holy Communion and reads the Last Rites directly before they pass. The Last Rites' purpose it to prepare the soul of the individual for death.

Is hospice against Catholic religion? ›

The Catholic Church does not believe in euthanasia or in taking away life-sustaining care to allow a life to end. We strive to create a balance between providing life-sustaining care and avoiding prolonging suffering.

Does the Catholic Church allow palliative care? ›

Beyond the Death of Jesus, what guidance does the Church offer? The Catechism of the Catholic Church says that “palliative care is a special form of disinterested charity. As such it should be encouraged” (§2279). Palliative care is the name given to the care of the dying by the medical profession.

Why do Catholics support palliative care? ›

The Catechism of the Catholic Church (2276) affirms that "those whose lives are diminished or weakened deserve special respect." As such, the Catechism views palliative care as a "special form of disinterested charity [that] should be encouraged" (2279).

What is passive euthanasia? ›

Types of euthanasia

Passive euthanasia: intentionally letting a patient die by withholding artificial life support such as a ventilator or feeding tube. Some ethicists distinguish between withholding life support and withdrawing life support (the patient is on life support but then removed from it).

What are 2 arguments in support of euthanasia? ›

Those who would deny patients a legal right to euthanasia or assisted suicide typically appeal to two arguments: a “slippery slope” argument, and an argument about the dangers of abuse.

What are the good things about euthanasia? ›

Proponents of euthanasia and PAS identify three main benefits to legal- ization: (1) realizing individual autonomy, (2) reducing needless pain and suffering, and (3) providing psychological reassurance to dying pa- tients.

What is the last Sacrament before death? ›

“The Last Rites”

The proper celebration for those about to die is Viaticum, the last time that person receives the Body and Blood of Christ. This is a special Eucharistic service celebrated near the time of death. Viaticum may be administered by a priest, deacon or a trained layperson.

What happens if a Catholic does not receive last rites? ›

Nothing physically happens to a person who dies without having the last rites administered to them. These are the final prayers and blessings a person receives that give spiritual comfort and a renewed faith that they will walk with Christ to meet their maker.

What happens at the hour of death Catholic? ›

Individual judgement, sometimes called particular judgement, happens at the moment of death when each individual will be judged on how they have lived their life. The soul will then go to Heaven, Hell or Purgatory depending on whether their actions have been judged as being in accordance with God's teachings or not.

What two principles of Catholic social teaching are right to life issues? ›

The principles of Catholic Social Teaching: Human Dignity. Solidarity.

Does hospice support VSED? ›

VSED often is part of hospice care, especially if the person receives those services at home. Some hospice care facilities do not allow their residents to use VSED on site. Federal regulations mandate that people have a diagnosis of six months or less to live in order to qualify for hospice.

What are Last Rites in the Catholic religion? ›

“The Last Rites”

The proper celebration for those about to die is Viaticum, the last time that person receives the Body and Blood of Christ. This is a special Eucharistic service celebrated near the time of death. Viaticum may be administered by a priest, deacon or a trained layperson.

What happens at the hour of death Catholic? ›

Individual judgement, sometimes called particular judgement, happens at the moment of death when each individual will be judged on how they have lived their life. The soul will then go to Heaven, Hell or Purgatory depending on whether their actions have been judged as being in accordance with God's teachings or not.

What does the Catholic Church say about disabilities? ›

'The needs of people with disabilities remind us of the respect that must be accorded to the most vulnerable. The ministry we share with Christ reminds us of the sacredness of life from conception until death and the innate human dignity of each person throughout their life.

What two principles of Catholic social teaching are right to life issues? ›

The principles of Catholic Social Teaching: Human Dignity. Solidarity.

Videos

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