Struggling with end of life issues… what does the Church teach?

Q: Dear Father John, Recently my mother passed away. She suffered from an irregular heartbeat and congestive heart failure. A week before she passed, she was rushed to the hospital where the ER doctor counseled us to have her put on hospice care and let nature take its course. After that, she was put on morphine and a sedative and had no food or fluids. It took her 5 days to die and it was not a peaceful death. I can’t help thinking that, in a sense, we “pulled the plug” on her. While there appeared to be no hope, it still didn’t feel right. What does the Church counsel on matters such as these?

A: This question addresses a moral issue more than a spiritual issue. Yet it is the kind of difficulty that should be brought up in spiritual direction – a practical, where-the-rubber-meets-the-road kind of issue. It’s also happening more and more frequently. And so I think would be helpful to try and answer it.

The Church offers solid principles regarding end-of-life issues. But it is not always easy to apply those principles to particular situations. Let me review the principles, then reflect a little bit on how they may have applied to your mother’s final week.

Guiding Principles

Human life, because each of us is created in God’s image and invited to everlasting friendship with God, is sacred. Because of this human dignity, it is never justified to directly will or cause the death of an innocent person, nor is it justified to purposely try to damage or lessen the quality of a person’s life (through maiming or kidnapping, for example). To defend this sacred dignity of human life, the Church has always taught that abortion and euthanasia (direct killing in order to alleviate suffering) are morally wrong, just as wrong as any other form of murder.

Nevertheless, in this fallen world, death is inevitable. At some point, we all will die. When it becomes clear that someone is dying, therefore, we do not have a moral obligation to do everything possible to extend their life as long as possible. Now, in some cases, there may be a particular reason why we would indeed want to keep someone alive, even at great cost or pain. For example, take the case of a father and son who have been estranged for decades and live on different sides of the globe. The father is facing heart failure, and the doctors agree that intervention at this point would most likely be useless, though some extreme measures may keep the heart functioning for another couple of weeks or a month. The family members, or the father himself, may request that those extreme measures be taken, so that the estranged son can have time to travel to the hospital, in hopes of a final reconciliation. That particular family may decide to use aggressive treatments, whereas a family already at peace may not. Each would be justified.

Accepting the inevitable, however, does not mean abandoning a dying person or hastening their death. That would constitute willing that a person die, just to “get it over with,” rather than humbly accepting death as a natural end of life. Therefore, if someone is dying, it would be immoral to willingly deny them the fundamental necessities that we owe to every human being, for example: shelter and room temperature, clothing, basic nutrition and hydration. In many cases, as a person is dying, their system will no longer accept nutrition and hydration. If that’s the case, it would most often be futile and disproportionate to try and force-feed them. In some cases, the dying process is so painful that the amount or type of palliative medicine required to relieve the pain may actually hasten the death. Nevertheless, such palliative care is acceptable (indeed, even an expression of love), if the person truly is dying. Again, however, if the dying person wants to remain alert in order to be able to converse with his estranged son, for example, they may choose to forego the pain-relievers.

Those are the basic principles: the sacredness of human life, the inevitability of death, the moral duty to provide basic necessities, when possible, but not to provide futile or disproportionate treatments. Here is how the Catholic Catechism summarizes the issue (#s 2278, 2279):

Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of “over-zealous” treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.

Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted. The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable. Palliative care is a special form of disinterested charity. As such it should be encouraged.

This Specific Case

From the brief description of your mother’s case, it seems that she was truly dying. This is an important factor. She was not in a persistent vegetative state, for example, in which a person’s system can still sustain itself with basic nutrition (in those cases, “pulling the plug” constitutes actually killing them). Your attitude towards the situation was one of acceptance – you were accepting her death, not striving to hasten it. It seems that your conscience is unclear on one point, however: Did you unjustifiably deny her basic nutrition? I cannot make a judgment on that, as it would depend on specific medical factors. If in the doctor’s estimation, her system was no longer accepting hydration and nutrition, then it may have been futile to force her. But if she was still accepting basic nutrition, it probably would have been better to continue supplying it. If the doctors did not make these distinctions with you (and, sad to say, most doctors are not given careful formation in these ethical issues), you may not know even now what the situation really was. In fact, even in the face of these medical distinctions, theologians and ethicists sometimes disagree about the best way to proceed. If you would like to read a thorough treatment of the moral complexities, you may find this recent article useful.

Practical Conclusions

As you can see, moral decisions are not always clear, and they are not always easy. This is one reason it is so important for the mature Catholic to make a strong commitment to ongoing formation. What we learned in CCD and what we hear on Sundays is simply insufficient for the battles of life in the modern world. Our Church has a vast treasure of wisdom and the most dependable moral guidance available on earth, but it doesn’t translate well into sound bites. We need to keep ourselves informed. We need to be as responsible and proactive in this area as we are with our professional life, or with our favorite hobbies. As a priest, I can honestly say that it can be nothing less than heart-wrenching to see adult Catholics – intelligent, well-adjustment human beings – facing life’s major crises with only a rudimentary knowledge of their faith.

If you are looking for more ways to inform yourself and gradually go deeper in your understanding of Catholic wisdom and teaching, I can recommend our own biweekly, national newspaper as an excellent starting place. The National Catholic Register is designed to help intelligent, active Catholics be able to see current issues and events from a truly Catholic perspective. You may want to sign up for three free issues to test it out. God bless you!

Yours in Christ, Father John Bartunek, LC

Is “Catholic guilt” bad? What about those who use it to criticize the Church?

Q: Dear Father John, I know more than a few people who are fallen-away Catholics. They make fun the Church sometimes, or they make fun of me. But my question has to do with “Catholic guilt.” They mention this sometimes and smirk, like it’s some kind of inside joke on me. I am not sure what they mean by this, but I have a sense that it’s holding them back living their faith. I would like to be able to help them. Can you give me any direction?

A: This is not uncommon, and I think your instinct is right; their joking about “Catholic guilt” may actually be a providential opportunity. I will share some thoughts, hoping that you can use them to spark a fruitful, healing conversation the next time one of your friends takes refuge behind this rhetorical shield.

A Critique of the Critique

Some people who have left the Church (actively or passively) use the concept of Catholic guilt to help justify their exit. They explain that as they grew up in the Catholic Church, they were constantly badgered about sin, and were taught that God is angry and vindictive, watching over our every move, just waiting for a chance to catch us doing wrong and condemn us. This negative view of God and religion stifled their spiritual growth, they go on to say. They didn’t think it was healthy, or fair, and they didn’t like it, so one Sunday they walked out the doors of their parish Church after Mass and simply didn’t come back.

In one sense, this evaluation of the Church’s view on sin is correct: the Catholic Church is energetically against sin. We believe that sin is real, destructive, and to be avoided at all costs. Jesus even said we should cut off our hand or gouge out our eye if they caused us to sin (see Mark 9:38-50). (By the way, he didn’t mean that literally – after all, how can our hand or eye “cause” us to sin? Sin is always a free choice of our will against God’s will, and those choices stem from our heart.) Sin is the number one enemy of God and the human race, and so it is also the number one enemy of each one of our lives, the biggest obstacle to the happiness and fulfillment we crave.

But the next part of the fallen away Catholic’s critique isn’t so obvious – the part about God being constantly angry and our spiritual lives being stunted by guilt. In fact, that critique comes from a misunderstanding of what the Church teaches about guilt. If we can have in our minds the right understanding of guilt, we may be able to avoid straying off the good path ourselves, and help our wandering brethren come back into friendship with Christ.

Good Guilt

Basically, there are two kinds of guilt: good guilt and bad guilt. To use a rather clumsy analogy, good guilt is like a spiritual nervous system. Our physical nervous system is designed (at least in part) to help us recognize and avoid physical danger. So, for example, when we touch a hot piece of metal, our immediate reaction is to pull away, so we don’t get burned or damaged by it. Or, to take another example, if smoke from a fire seeps into a room, we start finding it hard to breathe; we start coughing. These are signs from our physical nervous system that we better get out of that room before we suffocate. Imagine if your nervous system was malfunctioning, and it wasn’t able to warn you about these kinds of bodily threats – you would be in an extremely dangerous situation.

Well, good guilt, healthy guilt, performs this same function for our souls. Physical health is good for our bodies in the same way as moral health is good for our souls. And moral health means doing good actions and avoiding evil actions. If our conscience is in good condition, it will register guilt when we commit, or toy with committing, evil actions. That guilt is a warning against performing or persisting in evil actions, because committing evil strains or breaks our friendship with God and damages our interior peace and integrity, just as a hot piece of metal will damage our skin and breathing smoke will damage our lungs. In this sense, the Bible’s and the Church’s warnings against sin are not the expressions of an angry and vindictive God. On the contrary, they are a sign of God’s infinite love; he knows that committing evil, even though it sometimes appears to give us a short term benefit, is destructive, both for ourselves and for others.

In fact, the “punishment” for sin isn’t something that God adds on, the way a judge in a court of law sentences a criminal. Rather, it consists precisely in the pain and misery caused by the sin itself; it is the result of the sin – just as the child who plays with knives even when his parents warn him not to suffers pain and misery when he cuts himself. It would be a mean and selfish God that didn’t warn us about the destructive consequences of evil actions. But it is a good and wise God who has given us the gift of a conscience, which helps us experience good guilt to warn us against committing sins, and to move us to repent if we have committed them.

Bad Guilt

The second kind of guilt is bad guilt. This occurs when we feel guilty without having done anything wrong. This is the kind of unhealthy guilt that can stifle our spiritual and emotional maturity by leading to moral confusion. Unhealthy guilt makes us blame ourselves for things that are not blameworthy, or for things outside the purview of our responsibility. When we do that, we become emotionally and spiritually tangled up, almost paralyzed, because escape from this feeling of false guilt is impossible: we cannot be forgiven for something we were not responsible for, or for something that wasn’t a sin.

Bad guilt becomes like a cul-de-sac; we go round and round in our minds trying to find mercy and a fresh start, but we can’t. It drains our energy and inhibits us from growing in our friendship with God and others, because we don’t feel worthy of their love, and so we keep them at a distance.

Bad guilt can come from at least two sources. First, it can come from not distinguishing between sins and simple mistakes. For example, if I sincerely forget to send my mom a mother’s day card, I may have strong feelings of regret, but I shouldn’t feel morally guilty about it (even if she tries to make me feel guilty) – it was just a mistake, an oversight, not a morally evil act. If, on the other hand, I purposely avoid calling my mom on her birthday because I’m nursing resentment about something she said five years ago and I actually want to make her suffer, then I should to feel guilty; Christians honor their parents, they don’t hold grudges against them.

Second, bad guilt can result from experiencing a defective authority figure (authority figures are supposed to help form our consciences, our ability to identify moral good and evil). This happens often in families that go through a divorce. The pain and conflict between the parents inhibit them from giving proper love and discipline to the children. As a result, the children begin to feel responsible for the problems their parents are having; they blame themselves for the neglect they are experiencing.

Or take the example of an unhappy, angry priest who is in charge of teaching the faith to the children of his parish. Every week he rants and raves about how sinful and evil people are, and how painful the punishments of hell will be. He never speaks about the unlimited mercy of God, which is always ready to forgive us. He never speaks about the goodness of our heavenly Father, who has prepared a place for each one of us in heaven. He never speaks about the wonderful mission that each one of us has received in this life, a mission that only we can accomplish. Instead, he focuses over and over again, week after week, on the fires of hell and the selfish tendencies of our hearts, drilling into the children a lopsided and distorted conception of God, and of themselves. Over time, that can feed bad guilt, an unhealthy feeling of guilt simply for being alive, as if our existence itself were some kind of sin. Nothing is worse for our relationship with God than that. And if someone leaves the Catholic Church because of this kind of experience, it would be unwise, but understandable.

Seeking a Solution

In either case, whether we are dealing with good guilt or bad guilt, the remedy is the same: returning to the loving embrace of God our Father and Christ our Lord. If we are experiencing good guilt, we need to repent and ask for forgiveness and mercy, which Jesus Christ won for us by suffering on the cross. God never runs out of mercy; he is always eager to dish it out. In fact, he invented the sacrament of confession in order to make dishing out his mercy as tangible a thing as possible. If we are experiencing bad guilt, then we need to go to God in prayer, reading and reflecting on the Bible, God’s own Word, which assures us, over and over again, that we are infinitely valuable in God’s eyes, that he is always thinking of us, that we have nothing to fear. Sin is real, and it matters; but God’s mercy is even more real, and it matters more. As the Catechism puts it, “The victory that Christ won over sin has given us greater blessings than those which sin had taken from us” (#420).

I pray that the next time a friend or acquaintance jibes you about Catholic guilt, these ideas will help you speak to them about what they really need to hear: the transforming power of Christ’s saving grace.

Yours in Christ, Father John Bartunek, LC