24 September 2020, The Tablet

The spiritual and existential challenge of caring for the dying

by David Albert Jones

The spiritual and existential challenge of caring for the dying

Protesters hold a banner and placards as they demonstrate against a euthanasia law in Brussels in this file photo.
CNS photo/Laurent Dubrule, Reuters

“In this culture of waste and death, euthanasia and assisted suicide emerge as erroneous solutions to the challenge of the care of terminal patients.” This sentence dramatically juxtaposes the main themes of Samaritanus Bonus, the latest letter from the Vatican’s Congregation for the Doctrine of the Faith. The letter is shaped very strongly by the pastoral and theological vision of Pope Francis. It is an important document and well worth reading.  

The letter has two aims. In the first place, it expresses and encourages the Christian vocation to minister to the sick and the dying.  Throughout the centuries, following the teaching and example of Jesus, the Church has created structures of hospitality and welcome for the sick. In the second place, the letter warns against the dangers of false compassion and harmful end-of-life practices. Euthanasia, whether by lethal intervention or by the withdrawal of basic care, fails to respect the “sacred, unique, unrepeatable, and inviolable” character of every human life.  

The first line of the letter makes clear that the Good Samaritan is not only a parable told by Jesus to give us a moral example. The Good Samaritan signifies Jesus himself, the saviour who encounters the human being (Adam) in need of salvation and cares for his wounds with “the oil of consolation and the wine of hope”. The quotation is from the Italian edition of the Roman Missal (Common Preface VIII) and had previously been invoked by Pope John Paul II in a Message for the World Day of the Sick.  It reflects a reading of the parable found in Augustine and other early Christian writers. To emulate the Good Samaritan is to share in the mission of Christ himself.   

The letter is divided into five parts. Parts I to IV provide an extended theological reflection on the Good Samaritan as the model of Christian care for the sick. Part V is entitled “The Teaching of the Magisterium” and is subdivided into twelve sections. These address practical issues such as the obligation not to overtreat, the obligation to provide basic care such as nutrition and hydration, the care of children diagnosed with life-limiting conditions, often and wrongly referred to as “incompatible with life”, and the pastoral accompaniment of patients who have requested euthanasia.  

Some readers may skip Parts I to IV and go directly to the part that deals with contentious issues. However, this would be a mistake.  Parts I to IV are not merely a preamble to the teaching section. They put forward a theological vision which is the foundation for what follows. The challenge of care for the dying is not only intellectual but is spiritual and existential. It is hard to accompany someone whose dignity is obscured by suffering or despair and who is facing decline and death. It is essential to recognise the value of continuing to care even when there is no cure.  

Part V is mixed. Several sections repeat teaching has been communicated before and sometimes more clearly elsewhere. The sections on the moral obligation to exclude aggressive medical treatment and on the requirement of nutrition and hydration could be confusing if not read in conjunction with other documents. In contrast, the section on the role of the family in accompanying the dying is new and valuable as is the section on the “perinatal hospice”, though while the Italian version refers to Hospice Perinatali, the English translation mistakenly refers to the “prenatal” hospice. It would also have helped had the document referred to the Address of Pope Francis to the Conference “Yes to Life” (25 May 2019) which expands on some of these points.  

The section on accompanying those who have requested euthanasia, and what to do if they request the last sacraments, is somewhat brief but it is the first time the issue has been raised in a document of the universal Church. This is an important pastoral question and, regrettably, already affects many thousands of Catholics in the Low Countries, Canada and the United States. Although some may be tempted to read this section as mandating a denial of absolution to those who have requested euthanasia, the focus is principally on the pastoral accompaniment needed to bring about repentance and conversion of heart, which reopen the door to the sacraments.  

This document has relatively little to say about natural law and is addressed to believers, or at least to those who are attracted to the person of Jesus Christ as disclosed by the parable of the Good Samaritan. There is merit in an overtly Christian approach as the attraction of the apparently simple solution of euthanasia is felt even among the faithful, and to counteract this requires not only argument but an alternative vision of the good. With assisted suicide bills being introduced in many countries, including the Republic of Ireland, and with lobbyists preparing the ground both in England and Wales and in Scotland, these reflections are of the greatest importance for all Christians.

David Albert Jones is Director of the Anscombe Bioethics Centre in Oxford and Professor of Bioethics at St Mary’s University, Twickenham.




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