The Congregation for the Doctrine of the Faith (CDF) recently issued a letter, Samaritanus bonus: on the care of persons in the critical and terminal phases of life. This document from the Church provides important guidance about the Catholic view of end of life care. It notes with regret that we live in an age when euthanasia and assisted suicide are growing threats and temptations to people all over the world.

In fact, Samaritanus bonus takes its title from the Parable of the Good Samaritan whom Our Savior held up as a model. The Catholic approach to health care during the final phases of life has always been to provide a truly compassionate embrace for the dying, even if curing them is beyond our abilities, and never to directly kill a patient. This letter from the CDF reaffirms the important Hippocratic maxim, primum non nocere, first do no harm. It goes on to say that euthanasia and assisted suicide are crimes against life and intrinsic evils as taught by the ordinary and universal magisterium of the Church.

This is an incredibly important truth with many consequences.

It means that any formal or immediate material cooperation with euthanasia and assisted suicide are gravely sinful matters, as noted in the document. The letter quotes Iura et bona, the CDF’s Declaration on Euthanasia from 1980, to drive home this point. “No authority can legitimately recommend or permit such an action. For it is a question of the violation of the divine law, an offense against the dignity of the human person, a crime against life, and an attack on humanity.”

Legislators can never support in good conscience the “legalization” or the depenalization of these crimes. Health care workers and hospitals cannot cooperate with requests or demands for euthanasia or assisted suicide and must exercise their right and duty to conscientious objection. Clergy and chaplains have the grave responsibility to dissuade people from making this terrible choice. Persons with the firm intention to end their own lives cannot receive absolution, the Sacrament of the Anointing of the Sick, or viaticum, which is the final Holy Communion traditionally given to those about to die a holy death. These are sacraments of healing and hope that stand in sharp contrast to the despair inherent in euthanasia and suicide.

A main purpose of this document is to provide “precise and concrete pastoral guidelines” for priests, religious, and the faithful accompanying persons at the end of life. God can forgive any sins except for the ones the sinner refuses to acknowledge and repent of with true contrition. For the Sacrament of Penance and Reconciliation (confession) to be valid the penitent has to ask forgiveness for his/her sins and firmly intend to avoid the same in the future. A classic example where absolution cannot be granted is when a person in an adulterous relationship refuses to break it off. They must be serious about correcting their future behavior to benefit from the sacrament. It is scandalous for a priest to anoint or grant absolution to persons about to commit suicide or be euthanized. Delaying absolution, anointing or the reception of Holy Communion until the person is spiritually prepared to receive them is an act of mercy and a call to conversion, not a punishment, as noted in the text. In fact, Samaritanus bonus directs all those who spiritually assist the sick, and hospital chaplains in particular, to “avoid any gesture, such as remaining until the euthanasia is performed, that could be interpreted as approval of this action. Such a presence could imply complicity in this act.” 

A terrible scandal in the small number of countries that permit euthanasia or assisted suicide is that these acts are sometimes carried out by persons who identify themselves as Catholics. At other times they occur in Catholic institutions. Samaritanus bonus clearly points out the total incompatibility between the mission of Catholic health care ministry and euthanasia or assisted suicide. An institution cannot proclaim itself to be Catholic and violate the right to life. This magisterial document does well to remind us that the Church, usually through the direct action of the local bishop, can remove the Catholic status or designation of an institution that gravely and obstinately violates church teaching. It can be necessary to do this if a “Catholic” hospital permits or condones euthanasia, assisted suicide, or other grave evils such as abortion or direct sterilization. If this is not done, people could be led into error and believe that the Church can approve these sins because they are taking place in a “Catholic” institution.

Other key points made in Samaritanus bonus are the importance of morally sound advanced directives and end of life care. Catholics cannot ask to be killed in living wills or other advanced directives, nor can they direct that basic ordinary care be withdrawn. “It is not lawful to suspend treatments that are required to maintain essential physiological functions, as long as the body can benefit from them (such as hydration, nutrition, thermoregulation, proportionate respiratory support, and the other types of assistance needed to maintain bodily homeostasis and manage systemic and organic pain). The suspension of futile treatments must not involve the withdrawal of therapeutic care.” It is essential that the practice of palliative and hospice care follow these principles. We must distinguish between morally required ordinary care and extraordinary care that may be chosen or declined. “When death is imminent, and without interruption of the normal care the patient requires in such cases, it is lawful according to science and conscience to renounce treatments that provide only a precarious or painful extension of life.”

Before I came to The National Catholic Bioethics Center (NCBC) I wrote and spoke extensively about the rights of conscience of health care workers. Samaritanus bonus provides a robust and needed reminder of conscience rights. “Governments must acknowledge the right to conscientious objection in the medical and healthcare field, where the principles of the natural moral law are involved and especially where in the service to life the voice of conscience is daily invoked. Where this is not recognized, one may be confronted with the obligation to disobey human law, in order to avoid adding one wrong to another, thereby conditioning one’s conscience.” An abusive interpretation of patient’s rights leads some to approve of forcing health care professionals or institutions to carry out the immoral wishes of patients as long as it is legal. “The physician is never a mere executor of the will of patients or their legal representatives, but retains the right and obligation to withdraw at will from any course of action contrary to the moral good discerned by conscience.”

I strongly urge Catholics, particularly those involved in health care, to read Samaritanus bonus and to advance the Church’s vision of care especially in those momentous times when death approaches. We are a people who respect human life and dignity. We progress through this earthly existence in the hope of eternal life with our loving God.