When Christ revealed to his followers that they were to love their neighbor as themselves for the love of God, He was asked: “Who is my neighbor?” His reply is of great significance for the resolution of the issues before us. He answered with the parable of the Good Samaritan (Luke 10:215-37). The Good Samaritan not only interrupted his journey in order to dress the wounds of the traveler who had been attacked, robbed and abandoned at the roadside, he also carried the poor victim to an inn where he instructed the innkeeper to care for the man, paid the inn’s fee and then promised to reimburse the innkeeper for any additional costs that might be incurred. According to the parable, he did not place a limit on his generosity nor limit the time required for the wounded man to recover. As a result of centuries of reflection on the significance of this parable, caring for the sick, the wounded and the helpless out of a love for God has been a fundamental concern of the Catholic Church since its beginning and has generated the vast enterprise that is the Catholic health system.
In 1957 Pope Pius XII addressed an international group of anesthesiologists (The Prolongation of Life Address to an International Congress of Anesthesiologists, November 24, 1957. The Pope Speaks 4 (4) 394). In that meeting, Pius XII advised the group that there could be conditions where the patient or guardian could refuse treatment prescribed by the attending physician. Such conditions might include treatment offering little advantage and causing great pain. There might be situations where the cost of the treatment would place an excessively onerous financial burden on the patient and/or the family.
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If the cost of the treatment was financially crippling to the patient or to the family, such treatment could be refused by the patient and/or the family. Contrary to much recent misinterpretation, Pope Pius XII in that address did not authorize the doctors or the hospital administrators – much less hospital ethics committees – to make such decisions for the patients.
In that same address, Pope Pius XII asked rhetorically whether a patient in a deeply unconscious state was still alive and, if so, was he to be treated as a live person. Earlier in the same speech, he stated that the formal and only definition of death according to the Catholic Church is the complete separation of the soul from the body. In response to the question he posed, the Pope stated: “In general, it will be necessary to presume that life remains because there is involved a fundamental right received from the Creator, and it is necessary to prove with certainty that it (life) has been lost.” (Ibid.) Consequently, the patient must continue to be treated until natural death has occurred without acting in omission or commission to hasten his death.
More recently, Pope John Paul II spoke to a gathering of health-care providers, moral theologians and philosophers. (Life-Sustaining Treatments and Vegetative State: Scientific and Ethical Dilemmas. March 17-20, 2004). In his address, Pope John Paul II asserted that the denial of food and fluids to any patient, except in conditions where food and fluids could not be absorbed, was contrary to the teaching of the Catholic Church.
Furthermore, he identified such actions as a form of passive euthanasia – denying the necessities of life so as to result in the death of the patient.
It was truly prophetic that the first encyclical issued by Pope Benedict XVI dealt with the subject of Divine Love. In that encyclical, he contrasts the love that is Eros and the love that is Agape. Agape is the love of God that is directed toward the attainment of the happiness that follows upon the attainment of the infinite Good, God. Eros, a love now separated from the Divinity, is identified with the pleasure experienced in the possession of the goods of the temporal order. Benedict’s awareness of the overwhelming pre-occupation with sex and material possessions that characterizes the modern world and transforms all its institutions precipitated the issuance of this most important document. He reminds us:
Love of God and love of neighbor are thus inseparable, they form a single commandment. No longer is it a question, then, of a ‘commandment’ imposed from without and calling for the impossible, but a freely bestowed love from within, a love, which by its very nature must be shared by others. Love grows through love. Love is ‘divine’ because it comes from God and unites us to God.
(Deus Caritas Est. God is Love. Pauline Books and Media. Boston, MA, 2006 n. 18.)
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In our world, Eros and Agape confront each other. Agape strives to draw Eros within its loving grasp even while Eros seeks constantly to extend it domination of the culture. Christian institutions brought into being out of this Agape love experience great pressure to conform to the standards of a world largely alienated from God and ruled by the demands of Eros. These pressures must be resisted. Every patient in every hospital is a unique incarnation of God’s creative love and, in their oftentimes tortured and pain-wracked countenances, as Mother Theresa reminded us, we can see the face of Christ if we simply look.
In our world, there is a great inclination to judge value and the good from an exclusively monetary perspective; frequently employing cost-benefit analysis. When we do so, we succumb to the Erotic principle – as Pope Benedict so beautifully articulated. The Good Samaritan saw a helpless person in dire need and recognized that his role at that moment was to save the victim’s life with all the means available to hi and without any consideration of the cost. Only later would he have to reckon with his own accountant. Christ saw a man, the Samaritan, moved by Agape, a man moved to help a stranger in desperate need, a man acting out of his love for the unknown neighbor – and above all, by his love for God. The message of the Good Samaritan remains true for our time – and is far more urgent to be acknowledged.
If hospitals cease to be moved by Agape in their efforts to care for their fellow human beings in need, then inevitably patients come to be evaluated solely on the basis of cost/benefit analysis moved by Eros. The denial of needed treatment for reasons of cost or as a result of arbitrary quality of life value judgments cannot be guiding principles for Catholic hospitals or for Catholic caregivers. When needed care is denied to patients and such denial results in harm or death to that patient, this cannot be an act committed out of love for God. The denial of food and fluids, for example, so as to bring about the death of a patient for whatever conceivable reason cannot be an act of Christian charity.
In summary then, I wish to stress the following points:
1. The generous altruism of the Good Samaritan must remain the ideal of health care.
2. The right of refusal of treatment belongs to the patient or guardian.
3 The patient must receive life sustaining treatment until natural death occurs without acts of commission or omission to hasten that death.
4. Denying a patient the necessities of life, such as nutrition and hydration, is passive euthanasia.
5. The care of patients must not be governed primarily by secular cost/benefit analysis or subjective quality of life value judgments.
ABYSSUS ABYSSUM INVOCAT / DEEP CALLS TO DEEP 