End of Life Decisions: What is Our Moral Responsibility?

Written by Fr. Thomas Nairn, OFM, PhD

The experience of serious illness and dying is often ambiguous, even for Catholics. We know that Christians are called to face the reality of death and dying with the hope and confidence that our faith brings. We hear in the preface of the funeral liturgy that “life is changed, not ended.” Yet our natural feeling toward death often remains as one of loss, separation, and fear. Ambiguity can also surround our experience of medicine and health care. We accept cures that are commonplace today that were unheard of as little as a generation ago, but we also know the story of medicine as one of outcomes that are poorer than promised, of partial cures that create further difficulties, and of continuing decline. The same technology that changed the face of medicine has also made decisions at this stage of life more complicated. What is our moral responsibility as Christians?

How can we look to our faith and the Catholic moral tradition as resources to help us make decisions for ourselves or for those who are dear to us as we face end-of-life decisions? Our Changing Experience of Serious Illness and Dying End-of-life decisions have become more complicated. At least three factors account for this greater complexity: (1) the kinds of serious illness that most people face today, (2) our increased use of medical technology, and (3) a greater emphasis on patient autonomy in medical decisions.

First of all, the kinds of serious illnesses that confront people have changed over the past fifty years. We have moved from a time when most people died relatively quickly from medical situations such as heart attacks, infectious disease, or injuries to a situation where most people die from progressive chronic diseases like cancer, dementia, and chronic pulmonary or heart disease. These diseases, which account for almost eighty percent of deaths today, develop more slowly and kill more slowly. Therefore, patients and their families are called upon more often to make decisions about the use of medical technology to prolong life, including what kinds of medical technology to use and whether and when to discontinue usage. Furthermore, the use of technology can now delay death seemingly indefinitely. This dependence upon technology, often seen as good, can also blur our understanding of what constitutes dying and even what causes death. Is the underlying disease the cause of death or is it our decision not to use all the technology at our disposal to keep the person alive? What is our moral responsibility as Catholics in a technological age where we need to decide about end-of-life care for ourselves and loved ones?