During the month of November, we honor and pray for our cherished departed and reflect on the lives of the saints who came before us. This month, thus, serves as an opportune moment to consider the significance of death from a Catholic viewpoint, as well as to meditate on and spiritually ready ourselves for our own certain mortality.

If you inquire among people today about their ideal way to pass away, a lot would respond, “In my sleep, without pain and abruptly, without being aware.” However, there exists a prayer, now largely overlooked, that Catholics used to recite frequently: “Oh Lord, rescue me from an unexpected death!” In matters of death, Catholics previously sought God’s assistance for the precise contrary of what many desire today. Why is this the case? What has changed?

To start, I believe it is fair to assert that many of us Catholics have misplaced a sense of a Catholic perspective on death and dying. This perspective shows that living through one’s dying with intention is among the most significant actions of a person’s life, and it merits prior preparation. As we get ready to transition into eternity to encounter God, there exists the opportunity for deepened prayer and a richer experience of the sacraments, along with avenues for enhancing, healing, and reconciling within our human connections.

In the broader society, there exists not only a diminishing understanding of the significance of dying but also a culture that shuns death, where we conceal the ill and dying from sight while concurrently implementing numerous regulations permitting physician-assisted suicide and euthanasia. We have moved away from experiencing natural death in the presence of family and spiritual rites, opting instead for neglect and termination as an acceptable means to exit this life, or to assist others in doing so.

There are numerous remarkable Catholic apostolates that assist individuals in embracing a genuinely Catholic perspective on death and dying. However, largely speaking, the Church must restore a clear consciousness of a Catholic ethos in this domain, along with a more profound comprehension of the immorality associated with physician-assisted suicide and euthanasia. Indeed, the sole method to genuinely eradicate these sorrowful practices will be through our reasoning, as well as our testimony, which can demonstrate to the world a more admirable path.

What are physician-assisted suicide and euthanasia?

According to Evangelium Vitae (Pope St. John Paul II’s encyclical, “The Gospel of Life”): “Euthanasia in a precise sense refers to an act or neglect that inherently and intentionally leads to death, aimed at eradicating all pain. ‘The parameters of euthanasia, consequently, are located in the intention of the will and the methods employed’” (No. 65, citing the 1980 Vatican Declaration on Euthanasia).

The technique employed in physician-assisted suicide and euthanasia by action involves a fatal overdose of medication. This overdose may be given by a physician or, in certain areas, by alternative healthcare professionals (euthanasia) or consumed by the individual (assisted suicide). In the latter scenario, the individual needs to secure a prescription from a healthcare professional. In terms of physician-assisted suicide and euthanasia by omission, the approach utilized is through starvation and dehydration. The goal in both instances is the intentional termination of the patient’s life.

Two well-known instances highlight the distinction between action and omission. In the scenario of voluntary assisted suicide or euthanasia through action, both the physician and the patient aim to intentionally terminate the patient’s life to alleviate suffering; this was exemplified by Brittany Maynard. Conversely, the Terri Schiavo case represented euthanasia by omission. Although she was incapacitated, she was not in a state of dying; she merely required assistance with her nourishment and hydration. A court order mandated the withdrawal of her nutrition and fluids, leading to her demise from starvation and dehydration.

Altering the legal interpretation of ‘to kill’

Euthanasia is permitted in a limited number of nations, with the Netherlands and Belgium being the most recognized. Some Americans may be surprised to learn that Canada has also authorized euthanasia. In nations where euthanasia is sanctioned, physician-assisted suicide is likewise permitted. Assisted suicide is lawful in nine U.S. states as well as Washington, D.C. Euthanasia remains prohibited across the entire U.S., likely due to the increased risk of medical malpractice suits if a physician administers the fatal dosage compared to the scenario where the patient self-administers it.

The pro-choice and pro-life perspectives concur that physician-assisted suicide and euthanasia constitute death through intentional killing. The contention lies in whether such actions should be lawful. Furthermore, they differ in their views on the ethics surrounding physician-assisted suicide and euthanasia. Indeed, the ethical concerns involved form the foundational aspect of the debate regarding the legal issue.

In terms like “homicide,” “suicide,” and “genocide,” the shared suffix is derived from the Latin verb occidere, which signifies “to terminate life.” Recently, the pro-choice advocates have abandoned the phrases physician assisted suicide and euthanasia, opting instead for medical assistance or aid in dying (MAiD). This choice of euphemism aims to separate the idea of killing from physician assisted suicide and euthanasia.

The Lila Mansfield Sapinsley Compassionate Care Act, which is presently awaiting approval to permit physician-assisted suicide in Rhode Island, terminology it labels as MAiD, declares in its concluding section, “Actions conducted under this chapter shall not be interpreted for any reason as suicide, assisted suicide, mercy killing, or homicide according to the law.” The phrase “according to the law” holds significance in this context. Through this, a differentiation is established between the actual and the legal interpretations of “to kill.”

The true definition of “to kill” refers to intentionally causing the death of a living being. This concept is evident in physician-assisted suicide and euthanasia; indeed, that is the primary aim of these practices. Given that taking the life of the innocent is unethical, there exist numerous established laws addressing this issue. Some instances of killing have been permitted, but they have always necessitated a rationale. Historically, instances included self-defense, just warfare, and capital punishment, though the latter has recently been labeled “inadmissible” in light of an updated directive in the Catechism by Pope Francis. Even when self-defense and just war are deemed acceptable, they remain unfortunate realities, and we seek to avert them, ideally never needing to resort to such measures. Therefore, while it is regrettable, killing individuals deemed harmful or dangerous can sometimes be considered justified. However, there is no rationale for terminating the life of someone who is ill and vulnerable; such an act is fundamentally unethical and illegal. The pro-choice advocates must recognize that there is no valid justification for physician-assisted suicide and euthanasia, which is why they aim to eliminate the term “killing” from the discussion, so that individuals do not contemplate seeking justification and confront the grim reality of these actions.

Since MAiD permits unjustified killing, the Rhode Island Act (and I believe this holds true in all other states) emphasizes numerous sections affirming that for non-physician assisted suicide instances involving the killing of innocents, existing laws concerning homicide, suicide, and life insurance remain applicable. However, in cases of assisted suicide, prosecution will not occur. For instance, physicians will not face any civil or criminal liability provided they record in the patient’s file that all specified guidelines have been fulfilled; life insurance policies must provide payouts, unlike those occurring in non-physician assisted suicide cases; and “duty to aid” laws, which obligate bystanders to assist individuals facing severe physical danger, will still be enforceable in all circumstances except physician assisted suicide but not in instances of assisted killing.

Beneath the precarious incline

Legislation aimed at legalizing physician-assisted suicide and euthanasia is filled with multiple limitations because this is the only method to advance a bill in areas where these actions are prohibited and still viewed as morally wrong by many. The original proposal will be as constrained as necessary to secure public approval. Common restrictions that must be satisfied before death includes age requirements, mandatory waiting periods, second medical assessments, psychological screenings, and confirmation of a six-month life expectancy, among others. However, by permitting even a single individual to legally access physician-assisted suicide or euthanasia, the pro-choice advocates achieve a significant triumph, as they gain a foothold to further broaden these options as extensively as they wish.

The explanation for this is that the enactment of such legislation brings about a complete reversal — specifically, shifting from a context where physicians refrain from utilizing their expertise and training to partake in ending patients’ lives to one where they do engage in ending patients’ lives. Following this transformation, debates over stipulations become a relatively insignificant concern. The limitations merely create a figurative barrier around the specific ill individuals we have chosen to end lives, concealing the fundamental immorality of physician-assisted suicide and euthanasia in ways that seem rational. However, post-legalization, the barrier can be easily widened and ultimately demolished altogether, as the limitations begin to appear unjust to those who fail to fulfill one or more of them, resulting in their gradual removal. This phenomenon is known as the slippery slope, and it consistently occurs.

For instance, in Belgium and the Netherlands, euthanasia is currently permitted for mental health conditions. In 2020, a widely circulated account highlighted an elderly woman from Canada who, lacking a terminal illness or significant pain, was lawfully euthanized because of her loneliness during the lockdowns. A comprehensive official analysis of MAiD data shows that among the 9,950 individuals euthanized in Canada in 2021, 17.3% cited “isolation and loneliness” as a factor in their choice. The requirements for MAiD in Canada have been simplified to “intolerable physical or psychological suffering that results from their medical condition or their decline that cannot be alleviated in ways the individual deems acceptable,” meaning that MAiD is essentially accessible in Canada for nearly any justification. In Ireland, there is a clear demand for physician-assisted suicide to be available to all — that is, to eliminate all limitations.

The pro-life movement must exercise caution against crafting its argument solely around the risks of the slippery slope, as this allows the pro-choice faction to redirect the discussion towards imposing “restrictions to prevent abuses.” However, posing the issue in this manner is a distraction, which, if acknowledged, causes pro-life advocates to unknowingly play directly into the narrative of the pro-choice camp. The key issue lies in the mixing of two interpretations of “abuse”: 1) abuse refers solely to the killing through physician-assisted suicide and euthanasia of any individual who does not satisfy one or more of the legal requirements, and 2) abuse encompasses the killing through physician-assisted suicide or euthanasia of any individual. By engaging in the debate purely on the premise of the slippery slope risks, the assumption is quietly accepted that abuse occurs only when assisted suicide and/or euthanasia is inflicted on individuals beyond the restrictions. Thus, the pro-life advocate inadvertently concedes the erroneous notion that terminating the lives of individuals within the boundaries is permissible.

We need to advocate for the worth and value of each individual and the immorality of forsaking anyone. We must not let our astonishment at the dangerous trend in Canada lead us to overlook the very first individual who was legally euthanized through physician-assisted suicide in Oregon. As I mentioned in my online article, “What’s love got to do with it: The ethical contradictions of Peter Singer”“To take the life of or forsake a single individual is, in some ways, equally terrible as taking the lives of or forsaking thousands. Because individuals are uniquely invaluable, the act of killing one symbolizes an endless wrongdoing, thus the act of taking many lives is not a ‘greater’ wrongdoing in numerical terms, meaning that when you hit a particular figure, like 100,000, only then does the sense of immorality begin.”

Catholic ethics

Regarding the ethics of death and dying from a Catholic viewpoint, there are two significant pitfalls to avoid: overly aggressive treatment and physician-assisted suicide as well as euthanasia. Let us now examine overly aggressive treatment. Since death is unavoidable, there comes a moment when the illness or physical condition is terminating the life of the patient, and at that juncture, it is morally acceptable to refrain from or discontinue extraordinary or disproportionate treatment (cf. Catechism of the Catholic Church, No. 2278). This does not equate to killing the patient, as it is the illness that causes the patient’s death; hence, this should be appropriately viewed as a humble acceptance of death’s arrival. However, even in these circumstances, all ordinary care remains a moral obligation (cf. CCC, No. 2279). Ordinary care refers to care that, if terminated, would either bring about the death of a patient who is not terminal or, in the case of a dying patient, would lead to a deliberate hastening of their death for reasons unrelated to the illness. Simple illustrations of this include intentionally stopping bed care to avert bedsores or refusing to administer an insulin injection for comfort. The case of Terri Schiavo, noted previously, serves as an example where nutrition and hydration through a feeding tube constituted ordinary care, as she was not dying, and her body was processing food and water normally. In certain circumstances, the withdrawal of assisted nutrition and hydration may be warranted.

Numerous individuals are curious if there exists a comprehensive list of what constitutes ordinary care. Conceptually, such a list does not exist as it varies based on the specific circumstances of each patient. Some believe this reality introduces a dimension of moral relativism into the doctrine, but it does not. This is due to the fact that in every distinct instance, it can be ascertained which interventions are extraordinary and which are deemed ordinary. Once this distinction is made clear, the patient or healthcare proxy can choose to discontinue the extraordinary treatment; however, they cannot cease ordinary care.

In numerous instances, it may require thoughtful, challenging judgment and conversation with physicians and spiritual advisors to ascertain if a treatment is extraordinary or ordinary. Provided that the goal is not to cause death, but consistently to provide care, the family ought to pray, reflect, and subsequently take action, placing their trust in God for the ultimate decision. There are several useful Catholic resources available to assist in discernment during these circumstances.

The Catholic perspective involves a modest embrace of the end-of-life process, which starkly contrasts with the principles of assisted suicide and euthanasia statutes that focus on legitimizing the termination of patients through an overdose.

Liberty, independence, and agreement

In his renowned oath, Hippocrates pledged, “I will never provide a lethal substance to anyone who requests it, nor will I offer any advice to this effect.” The aspect regarding the advice has consistently captivated my interest. A forerunner to Evangelium Vitae In 500 B.C., Hippocrates understood the disturbing implication of proposing to those in distress that they might think about ending their lives. Through the authorization of assisted suicide and euthanasia, not only medical professionals but also healthy individuals in society, albeit unintentionally, imply to the ill that they should terminate their existence. Embedded within this implicit suggestion is a coercive aspect that conflicts with authentic freedom. The (legal) “authorization” for assisted suicide instills in vulnerable individuals the perception that they are a liability. Before long, the “right to die” starts to resemble a “duty to die.” Pressure from healthcare providers would already be concerning, as Hippocrates clearly recognized, but when you include everyone else in society, it becomes intolerable.

In a heartfelt commentary opposing euthanasia, French author Michel Houellebecq recently stated, “I can easily envision myself requesting to end my life with the hope that others respond: ‘Oh no, no. Please remain with us a bit longer.’” The societal notion that legalizing assisted suicide implies preempts that valuable sentiment and substitutes it with feelings of neglect and the suggestion that one ought to be dead. As coercion contradicts the essence of freedom, the phrase “pro-choice” is inaccurately labeled, as the alleged right to die restricts rather than liberates. Conversely, in jurisdictions where physician-assisted suicide and euthanasia are prohibited, vulnerable individuals find reassurance in the commitment of others to support them until they pass away naturally, allowing them to die with authentic dignity, the dignity of a child of God.

The pro-choice perspective argues that by outlawing assisted suicide and euthanasia, one infringes upon freedom by undermining the concept of personal autonomy. Addressing this concern relies on understanding that these practices, fundamentally, represent forms of abandonment, which is the opposite of the love we ought to extend to every individual. Consent is not akin to magical fairy dust that can be applied to any behavior, rendering it morally acceptable. Certain actions are intrinsically degrading, and agreeing to partake in those actions does not eliminate their degrading nature.

‘Ars moriendi’

Confronting pain and mortality can be daunting; John Paul II articulated this deeply and thoughtfully in Salvifici Doloris (“On the Christian Meaning of Human Suffering”). With the rise of contemporary medicine, along with our culture’s aversion to death, it is fair to assert that the anxiety of passing away in solitude while dependent on machines is a valid concern. To tackle this issue, we must reassess our societal values.

For instance, we invest considerable time, finances, and personal passion engaging in different professional sports seasons (I am not delivering a broad criticism of professional sports here). If we could merely shift a small portion of that time, money, and enthusiasm towards recognizing the complete humanity of the ill and providing them support, they would not experience such fear and isolation, interpersonal connections would deepen, and we would all become slightly more human.

An exquisite and long-neglected Catholic custom is the ars moriendi, signifying “the practice of dying.” It encompassed techniques for readying oneself for a sacred death, focusing on placing the ill individual at the heart of concern, encircled by loved ones, caregivers, and the clergyman. This is artfully illustrated in numerous medieval artworks. We ought to create a community that envelops the fragile with compassionate support until they pass away a natural death — an ars moriendi for the 21st century.

The Gospel of Life

Revisiting the initial theme of this essay — specifically, the significance of revitalizing the diminished Catholic perspective on death and dying — I will conclude with a poignant excerpt from Pope St. John Paul II’s “The Gospel of Life”:

“To achieve this, we must, above all else, cultivate a contemplative perspective within ourselves and encourage it in others. Such a perspective emerges from trust in the God of life, who has fashioned each individual as a ‘marvel.’ It embodies the viewpoint of those who perceive life in its profound significance, understanding its complete gratuity, its beauty, and its invitation to both freedom and responsibility. It reflects the attitude of individuals who do not believe they can own reality but rather embrace it as a gift, uncovering in all things the image of the Creator and recognizing in each person his living likeness. This perspective does not succumb to despair when faced with individuals who are ill, suffering, marginalized, or near death. Conversely, in all these situations, it feels a compulsion to seek meaning, and particularly in these moments, it remains receptive to recognizing in the countenance of every individual a summons for encounter, dialogue, and solidarity.”

Death was not part of God’s original plan

Due to the Fall, we now must undergo suffering, pain, sickness and death. However, death, and the sickness that precedes it, was not part of God’s original plan for human beings. For unlike angels, we are composed of body and soul — this is our very way of being. In a sense we don’t just “have” a body or inhabit one, but rather, we are our body, and this is deeply good (cf. Gn 1:1-31). This very nature of ours as embodied persons is the foundation for the Catholic belief in the resurrection from the dead, by which is meant the resurrection of our bodies that undergo corruption after death, but will be restored, glorified and reunited with our separated souls at the Resurrection, and we will then live so as our true full selves for all eternity.

Peter J. Colosi, PhD is associate professor of philosophy at Salve Regina University in Newport, Rhode Island, and the author of “A Catholic Anthropology and Medical Ethics” in Catholic Witness in Health Care (CUA Press).