Question 3 About the use of analgesics for the dying
It remains for Us now to examine your third question: “Is the use of analgesics, of which the use always blunts consciousness, allowed in general, and for the postoperative period in particular, even among the dying and patients in danger of death, when there is a clinical indication for that? Is it allowed even in certain cases (inoperable cancers, incurable diseases), to attenuate intolerable pain even if it entails the shortening of life? “.
This third question in reality is only an application of the first two with to the special case of the dying and with the particular effect of shortening life.
That the dying may have more than others a moral natural or Christian obligation to accept pain or to refuse its diminution, arises neither from the nature of things nor from the sources of revelation. But as the suffering according to the spirit of the Gospel, contributes to the expiation of personal sins and the acquisition of greater merits, those whose life is in danger have certainly a special reason to accept it, because, with death so close, this possibility of gaining new merits may likely disappear soon. But this motive interests the patient directly, not the doctor who practices analgesia, tsupposing that the patient has agreed or even has asked for it expressly. It would be obviously illicit to practice anesthesia against the express will of the dying (when he is sui iuris).
Some clarifications are necessary here; because it is not rare that one puts forward this reason incorrectly. Sometimes one tries to prove that the sick and the dying are obliged to support physical pains to acquire more merits, according to the counsel to seek perfection, that the Lord addresses to all: Estote ergo vos perfecti, sicut et Pater vester coelestis perfectus est” (Matth. v, 48), or on the words of the Apostle: Haec est voluntas Dei, sanctificatio vestra (I Thess. IV, 3). Sometimes a principle of reason is put forward, according to which no indifference would be allowed with regard to the attainment (even gradual and progressive) of the last end, towards which man tends; or the precept of the well ordered love of self, which would impose to seek the eternal goods insofar as the circumstances of everyday life make it possible; or even the first and greatest commandment that of the love of God above all, which would not leave any choice in profiting from the concrete occasions offered by His Providence. However, the increase of the love of God and the abandonment to His will do not proceed from the sufferings themselves, that one accepts, but from the voluntary intention supported by grace. This intention, for the dying, can be strengthened and become more vivid and alive, if their sufferings are attenuated, for the pains worsen the state of weakness and physical exhaustion, block the impulse of the heart and undermine the moral courage instead of supporting it. On the other hand, the suppression of pain gives organic and psychic relief, facilitates prayer and makes possible a more generous gift of oneself. If the dying embraces suffering as a means of expiation and source of merits in order to progress in the love of God and in the abandonment to His will, let anesthesia be not applied; let him be helped rather to follow his own way. In the contrary dispositions, it would not be convenient to suggest to the dying the ascetic considerations stated above remembering that instead of contributing to the expiation and merit, the pain can also be an occasion of new faults.
Let us add some words on the suppression of consciousness in the dying, insofar as it is not motivated by the pain. Since the Lord wanted to undergo death in full knowledge, the Christian desires to imitate Him in that. Besides, the Church gives to priests and faithful alike the Ordo commendationis animae, a series of prayers, which must help the dying at the very portal of eternity. But if these prayers preserve their value and their meaning, even when one pronounces them close to an unconscious patient, they normally bring to him who can understand them light, consolation and strength. Thus the Church asks that the dying should not be deprived of consciousness even if they fall into the state of unconsciousness. When nature does it, men must accept it; but they must not do it in their own initiative, unless they have serious reasons for that. It is also the desire of the dying who have the faith to have their loved ones, a friend, a priest near them to help them die well. They want to avail the chance of making their ultimate provisions, of saying a last prayer, a last word to those present. To frustrate them is an act repugnant to Christian sentiments. It is even simply inhuman. The anesthesia employed at the moment of death with a sole aim of avoiding from the patient a conscious death, would be a remarkable acquisition of therapeutic modern, but a really deplorable practice.
Your question was rather on the case of a serious clinical indication (for example, violent pains, morbid states of depression and anguish). The dying cannot allow and even less ask the doctor to give him the state of unconsciousness, if by that he puts himself incapable of accomplishing serious moral duties, for example, to transact important affaires, to make his testament, to confess himself. We have already said that the reason for the acquisition of greater merits is not enough in itself to make illicit the use of narcotics. To judge its liceity, it should be asked whether the narcosis is relatively short (for a night or a few hours) or is prolonged (with or without interruption). Also one should ask whether the use of higher faculties will come back at certain moments, for a few minutes at least or for a few hours, and whether the dying has the possibility of complying with his duty imposed on him (for example to reconcile himself with God). In addition to this, a conscientious doctor, even if he is not Christian, must never yield to the pressures of him who would like, against the will of the dying, to make the dying lose his lucidity in order to prevent him from making certain decisions.
When in spite of the obligations which fall on him, the dying demands the narcosis for which there are serious reasons, a conscientious doctor cannot give it to him, especially if he is a Christian, without having asked him first to fulfill beforehand his duties either by himself or better still by the intermediary of others. If the patient refuses obstinately and persists in asking for a narcosis, the doctor can give his consent to it without making himself guilty of formal collaboration to the fault. This, indeed, does not depend on the narcosis, but on the immoral will of the patient; to give it or not, does not make any difference; his behavior will be the same: he will not do his duty. If the possibility of repentance is not excluded, there is however no serious probability of it; moreover who knows if he will not become hardened in evil?
But if the dying has done all his duties and received the last sacraments, if clear medical indications suggest anesthesia, if one does not exceed in the quantity of the dose, if one carefully measures the intensity and the duration and that the patient consents to it, nothing then is opposed to it: the anesthesia is morally allowed.
… and on the inoperable or incurable patients
Would it be necessary to give it up, even if the action of the narcotics would shorten life? Let Us say firstly that any form of direct euthanasia, i.e. the application of narcotics in order to cause or hasten death is illicit, because one then pretends to have dominion over one’s life. It is one of the fundamental principles of natural and Christian morality that man is not a master and owner, but only usufructuary of his body and of its existence. He pretends to have a direct dominion every time he wants to shorten his life as an end or a means. In the case that you consider, it is only a question of parrying from the patient unbearable pains, for example, in the event of inoperable cancers or incurable diseases.
If between the narcosis and the shortening of life there is no direct causal bond, decided by the will of the parties or by the nature of the things (what would be the case, if the suppression of pain could be obtained only by the shortening of life), and if on the contrary the administration of narcosis has by itself two distinct effects, on the one hand the relief of pain, and on the other hand the shortening of life, it is licit; however there it would remain to be seen whether there were between these two effects a reasonable proportion, and if the advantages of the one compensate for the disadvantages of the other. It is also important to ask whether the current state of science does not allow to obtain the same result, by employing other means, then, not to exceed, in the use of norcosis, the limits of what is practically necessary.
Conclusion and answer to the third question
In short, you ask Us: “is the suppression of pain and of the consciousness by the means of narcosis (when it is demanded by a medical indication), allowed by the religion and morals to the doctor and to the patient (even with death approaching, and with the knowledge that the use of narcosis will shorten life)? ”
The answer will be: “If there are no other means and, if, in the given circumstances, that does not prevent the fulfillment of other religious and moral duties: Yes “
As We already explained, the ideal of Christian heroism does not impose, at least generally, the refusal of a justified narcosis, not even with the approach of death; all depends on the concrete circumstances. The more perfect and more heroic resolution can be as well in the acceptance as in the refusal.
Final exhortation
We dare to hope that these considerations on analgesia, considered from the moral and religious point of view, will help you to discharge your professional duties with an even acuter sense of your responsibilities. You wish to remain entirely faithful to the requirements of your Christian faith and to conform to it in all your activity. But far from considering these requirements as restrictions, or obstacles to your freedom and to your initiatives, see rather in them the call to infinitely higher and more beautiful a life, which cannot be conquered without efforts nor self-denials, but of which plenitude and joy are already felt here below for whomever can enter in communion with the person of Christ living his Church, animating it of his Spirit, spreading in all its members his redeeming love which alone will definitively triumph over suffering and death.
That the Lord may fill you with his gifts, We beseech it for yourselves, for your families and your collaborators and, of wholeheartedly, We grant you Our paternal apostolic blessing.
