CHARTER FOR HEALTH CARE WORKERS 83
83 The progress and spread of transplant medicine and surgery nowadays makes possible treatment and cure for many illnesses which, up to a short time ago, could only lead to death or, at best, a painful and limited existence.[175] This "service to life,"[176] which the donation and transplant of organs represents, shows its moral value and legitimizes medical practice. There are, however, some conditions which must be observed, particularly those regarding donors and the organs donated and implanted. Every organ or human tissue transplant requires an explant which in some way impairs the corporeal integrity of the donor.
175. Cf. John Paul II, <To the participants at the First International Congress on the Transplant of Organs>, June 20, 1991, in <Insegnamenti> XIV/1 (1991) 1710.
176. Ibid, "Organ transplants are not morally acceptable if the donor or those who legitimately speak for him have not given their informed consent. Organ transplants conform with the moral law and can be meritorious if the physical and psychological dangers and risks incurred by the donor are proportionate to the good sought for the recipient. It is morally inadmissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons" (CEC 2296).
84 <Autoplastic transplants>, in which there is the explant and implant on the same person, are legitimate in virtue of the principle of totality by which it is possible to dispose of a part for the integral good of the organism.
85 <Homoplastic transplants>, in which the transplant is taken from a person of the same species as the recipient, are legitimized by the principle of solidarity which joins human beings, and by charity which prompts one to give to suffering brothers and sisters.[177] "With the advent of organ transplants, begun with blood transfusions, human persons have found a way to give part of themselves, of their blood and of their bodies, so that others may continue to live. Thanks to science and to professional training and the dedication of doctors and health care workers...new and wonderful challenges are emerging. We are challenged to love our neighbor in new ways; in evangelical terms—to love 'even unto the end' (Jn 13,1), even if within certain limits which cannot be transgressed, limits placed by human nature itself."[178]
In homoplastic transplants, organs may be taken either from a living donor or from a corpse.
177. Cf. Pius XII, <To the delegates of the Italian Association of Cornea Donors and the Italian Union for the Blind>, May 14, 1956, in AAS 48 (1956) 464-465; John Paul II, <To the participants at the First International Congress on the Transplant of Organs>, June 20 1991, in <Insegnamenti> XIV/1 (1991) 1711.
178. John Paul II, <To the participants at the First International Congress on the Transplant of Organs>, June 20, 1991, in <Insegnamenti> XIV/1 (1991) 1711.
86 In the first case the removal is legitimate provided it is a question of organs of which the explant would not constitute a serious and irreparable impairment for the donor. "One can donate only what he can deprive himself of without serious danger to his life or personal identity, and for a just and proportionate reason."[179]
179. Ibid., n. 4.
87 In the second case we are no longer concerned with a living person but a corpse. This must always be respected as a human corpse, but it no longer has the dignity of a subject and the end value of a living person. "A corpse is no longer, in the proper sense of the term, a subject of rights, because it is deprived of personality, which alone can be the subject of rights." Hence, "to put it to useful purposes, morally blameless and even noble" is a decision "not be condemned but to be positively justified."[180]
There must be certainty, however, that it is a corpse, to ensure that the removal of organs does not cause or even hasten death. The removal of organs from a corpse is legitimate when the certain death of the donor has been ascertained. Hence the duty of "taking steps to ensure that a corpse is not considered and treated as such before death has been duly verified."[181]
In order that a person be considered a corpse, it is enough that cerebral death of the donor be ascertained, which consists in the "irreversible cessation of all cerebral activity." When total cerebral death is verified with certainty, that is, after the required tests, it is licit to remove organs and also to surrogate organic functions artificially in order to keep the organs alive with a view to a transplant.[182]
180. Cf. Pius XII, <To the delegates of the Italian Association of Cornea Donors and the Italian Union for the Blind>. May 14, 1956 in AAS 48 (1956) pp. 462-464.
181. Ibid, pp. 466-467.
182. Cf. Pontifical Academy of Sciences, <Declaration on the Artificial Prolongation of Life and Determining the Precise Moment of Death>, Oct. 21, 1985, n. 1, 3.
88 Ethically, not all organs can be donated. The brain and the gonads may not be transplanted because they ensure the personal and procreative identity respectively. These are organs which embody the characteristic uniqueness of the person, which medicine is bound to protect.
89 There are also heterogeneous transplants, that is, with organs of a different species than that of the recipient. "It cannot be said that every transplant of tissues (biologically possible) between two individuals of different species is morally reprehensible, but it is even less true that every heterogeneous transplant biologically possible is not forbidden and cannot raise objections. A distinction must be made between cases, depending on which tissue or organ is intended for transplant. The transplant of animal sexual glands to humans must be rejected as immoral; but the transplant of the cornea of a non-human organism to a human organism would not create any problem if it were biologically possible and advisable."[183]
Among heterogeneous transplants are also included the implanting of artificial organs, the lawfulness of which is conditioned by the beneficial effect for the person and respect for his dignity.
183. Pius XII, <To the delegates of the Italian Association of Cornea Donors and the Italian Union for the Blind,> May 14, 1956, in AAS 48 (1956) pp. 462-464.
90 The medical intervention in transplants "is inseparable from a human act of donation."[184] In life or in death the person from whom the removal is made should be aware that he is a <donor>, that is, one who <freely consents> to the removal.
Transplants presuppose a free and conscious previous decision on the part of the donor or of someone who legitimately represents him, normally the closest relatives. "It is a decision to offer, without recompense, part of someone's body for the health and well-being of another person. In this sense, the medical act of transplanting makes possible the act of donation of the donor, that sincere gift of himself which expresses our essential call to love and communion."[185]
The possibility, thanks to biomedical progress, of "projecting beyond death their vocation to love" should persuade persons "to offer during life a part of their body, an offer which will become effective only after death." This is "a great act of love, that love which gives life to others."[186]
184. John Paul II, <To the participants at the First International Congress on the Transplant of Organs>, June 20, 1991, in <Insegnamenti> XIV/I (1991) 1711, n. 3.
185. Ibid; cf. Pius XII, <To the delegates of the Italian Association for Cornea Donors and the Italian Union for the Blind>, May 14 1956, in AAS 48 (1956) p. 465. Cf. Pius XII, <Discourses to Doctors> p. 467: "In advertising (for cornea donors) an intelligent reserve should be maintained to avoid serious interior and exterior conflicts. Also, is it necessary, as often happens, to refuse any compensation as a matter of principle? The question has arisen. Without doubt there can be grave abuses if recompense is demanded; but it would be an exaggeration to say that any acceptance or requirement of recompense is immoral. The case is analogous to that of blood transfusion; it is to the donor's credit if he refuses recompense, but it is not necessarily a fault to accept it."
186. Cf. John Paul II, <To the participants at the First international Congress on the Transplant of Organs>, June 20, 1991, in <Insegnamenti> XIV/1 (1991) 1712.
91 As part of this oblative "economy" of love, the medical act itself of transplanting, of even just blood transfusion, "is not just another intervention." It "cannot be separated from the donor's act of giving, from life-giving love."[187]
Here the health care worker "becomes a mediator of something which is particularly meaningful, the gift of self by a person—even after death—so that another might live."[188]
187. Cf. ibid, 7, p. 1713, n. 5.
188. Ibid., p. 1713, n. 5: "The difficulty of the intervention, the need to act promptly, and the need for maximum concentration on the task, should not lead to the doctor's losing sight of the mystery of love contained in what he is doing."
92 Dependency, in medical-health terms, is an addiction to a substance or product—such as drugs, alcohol, narcotics, tobacco—for which the individual feels an uncontrollable need, and the privation of which can cause him psycho-physical disorders.
The phenomenon of dependency is <escalating> in our societies, which is disturbing and, under certain aspects, dramatic. This is related, on the one hand, to the crisis of values and meaning which contemporary society and culture[189] is experiencing and, on the other hand, to the stress and frustrations brought about by the quest for efficiency, by activism and by the high competitiveness and anonymity of social interaction.
Doubtless, the evils caused by dependency and their cure are not a matter for medicine alone. But it does have a preventive and therapeutic role.
189. "At the root of alcohol and drug abuse—taking into account the painful complexity of causes and situations—there is usually an existential vacuum, due to an absence of values and a lack of self-esteem, of trust in others and in life in general" (John Paul II, <To the participants at the International Conference on Drugs and Alcohol>, Nov. 23, 1991, in <Insegnamenti> XIV/2 (1991) 1249, n. 2.
93 <Drugs> and <drug-dependency> are almost always the result of an avoidable evasion of responsibility, an aprioristic contestation of the social structure which is rejected without positive proposals for its reasonable reform, an expression of masochism motivated by the absence of values.
One who takes drugs does not understand or has lost the meaning and the value of life, thus putting it at risk until it is lost: many deaths from <overdose> are voluntary suicides. The drug-user acquires a nihilistic mental state, superficially preferring the <void> of death to the <all> of life.
94 From the moral viewpoint "using drugs is always illicit, because it implies an unjustified and irrational refusal to think, will and act as free persons."[190]
To say that drugs are illicit is not to condemn the drug-user. That person experiences his condition as "a heavy slavery" from which he needs to be freed.[191] The way to recovery cannot be that of ethical culpability or repressive law, but it must be by way of rehabilitation which, without condoning the possible fault of the person on drugs, promotes liberation from his condition and reintegration.
190. Ibid., n. 4.
191. Cf. John Paul II, <To the participants at the VII World Congress of Therapeutic Communities>, Sept. 7, 1984, in <Insegnamenti> VII/2, p. 347, n. 3.
95 The detoxification of the person addicted to drugs is more than medical treatment. Moreover, medicines are of little or no use. Detoxification is an integrally human process meant to "give a complete and definitive meaning to life,"[192] and thus to restore to the one addicted that "self confidence and salutary self-esteem" which help him to recover the joy of living.[193]
In the rehabilitation of a person addicted to drugs it is important "that there be an attempt to get to know the individual and to understand his inner world; to bring him to the discovery or rediscovery of his dignity as a person, to help him to reawaken and develop, as an active subject, those personal resources, which the use of drugs has suppressed, through a confident reactivation of the mechanisms of the will, directed to secure and noble ideals."[194]
192. Ibid, p. 350, n. 7.
193. Cf. John Paul II, <Message to the International Congress in Vienna>, June 4, 1987, in <Insegnamenti> VII/2, p. 347, n. 3.
194. John Paul II, <To the participants at the VII World Congress of Therapeutic Communities>, Sept. 7, 1984, in <Insegnamenti> VII/2, p. 347, n. 3.
96 Using drugs is anti-life. "One cannot speak of 'the freedom to take drugs' nor of 'the right to drugs,' because a human being does not have the right to harm himself and he cannot and must not ever abdicate his personal dignity which is given to him by God,"[195] and even less does he have the right to make others pay for his choice.
195. John Paul II, <To the participants at the International Conference on Drugs and Alcohol>, Nov. 23, 1991, n. 4. "The use of drugs inflicts very grave damage on human life and health. Their use, except on strictly therapeutic grounds, is a grave offense. Clandestine production of and trafficking in drugs are scandalous practices. They constitute direct cooperation in evil, since they encourage people to practices gravely contrary to the moral law" (CEC 2291).
97 Unlike taking drugs, alcohol is not in itself illicit: "its moderate use as a drink is not contrary to moral law."[196] Within reasonable limits wine is a nourishment.
"It is only the abuse that is reprehensible":[197] alcoholism, which causes dependency, clouds the conscience and, in the chronic stage, produces serious harm to the body and the mind.
196. John Paul II, <To the participants at the International Conference on Drugs and Alcohol>, Nov. 23, 1991, n. 4.
197. Ibid, n. 4.
98 The alcoholic is a sick person who needs medical assistance together with help on the level of solidarity and psychotherapy. A program of integrally human rehabilitation must be put in place for him,[198]
198. "The present economic conditions in society, as well as the high level of poverty and unemployment, can be contributary factors that increase in your people a sense of unrest, insecurity, frustration and social alienation, leading them on to the illusory world of alcohol as an escape from the problems of life": John Paul II, <To the participants at a congress on alcoholism>, in <Insegnamenti> VIII/1, p. 1741.
99 With regard to tobacco also, the ethical unlawfulness is not in its use but in its abuse. At the present time it is established that excessive smoking damages the health and causes dependency. This leads to a progressive lowering of the threshold of abuse.
Smoking poses the problem of dissuasion and prevention, which should be done especially through health education and information, even by way of advertisements.
100 Psycho-pharmaceuticals are a special category of medicines used to counter agitation, delirium and hallucinations and to overcome anxiety and depression.[199]
199. There are three categories of psycho-pharmaceuticals. The first is that of <neuroleptics>, the anti-psychotics which have made possible the closing of psychiatric hospitals, since they overcome agitation, deliria and hallucinations, and so make it useless to confine and isolate patients; in any case, these measures were non-curative. The second category is comprised of <sedatives> or tranquilizers and the third <antidepressives>.
101 To prevent, contain and overcome the risk of dependency and addiction, psycho-pharmaceuticals should be subject to medical control. "Recourse to tranquilizing substances on medical advice in order to alleviate—in well-defined cases—physical and psychological suffering should be governed by very prudent criteria in order to offset dangerous forms of addiction and dependency."[200]
It is the task of health authorities, doctors and those responsible for research centers to apply themselves in order to reduce these risks to a minimum through apt measures of prevention and information."[201]
200. John Paul II, <To the participants at the International Conference on Drugs and Alcohol>, Nov. 23, 1991, n. 4.
201. Ibid.
102 Administered for therapeutic purposes and with due respect for the person, psycho-pharmaceuticals are ethically legitimate. The general conditions for lawfulness in remedial intervention applies to these also.
In particular, the informed consent of the patient is required and his right to refuse the therapy must be respected, taking into account the ability of the mental patient to make decisions. Also to be respected is the principle of therapeutic proportionality in the choice and administration of these medicines, on the basis of an accurate etiology of the symptoms and the motives for the subject's requesting this medicine.[202]
202. Cf. Pius XII, <To the International Congress of Neuro-psychopharmacology>, Sept. 9, 1958, in <Discourses and Broadcasts> Vol. XX, pp. 327-333.
103 Non-therapeutic use and abuse of psycho-pharmaceuticals is morally illicit if the purpose is to improve normal performance or to procure an artificial and euphoric serenity. This use of psycho-pharmaceuticals is the same as that of any narcotic substance so the ethical verdict already given in the case of drugs is valid also here.
104 There is already ample evidence that all bodily illness has a psychological component, either as a co-efficient or as an after-effect. This is what <psychosomatic medicine> is concerned with, where the therapeutic value depends on the doctor-patient relationship.[203]
Health care workers should seek to relate to the patient in such a way that their humanitarian attitude reinforces their professionalism and their competence is more effective through their ability to understand the patient.
A human and loving approach to the patient, required by an integrally human view of illness and strengthened by faith,[204] is the key to this therapeutic effectiveness of the doctor-patient relationship.
203. This is confirmed by the frequency and the conviction with which patients tell the doctor: "Now that I have spoken to you I feel better." And in fact just as "there is therapeutic input which physical healing can bring to the spirit of the patient; inversely, there is a therapeutic input which can be brought to physical suffering through psychologico-spiritual comforting." Paul VI, <To the III World Congress of the International College of Psychosomatic Medicine>, Sept. 18 1975, in AAS 67 (1975) 544.
204. Cf. John Paul II, Motu Proprio <Dolentium hominum>, Feb. 11, 1988, in <Insegnamenti> VIII/1, p. 474.
105 Psychological disorders and illnesses can be dealt with and treated through <psychotherapy>. This includes a variety of methods by which someone can help another to be cured or at least to improve.
Psychotherapy is essentially a <growing process>, that is, a path of liberation from childhood problems, or from the past, in any case, which enables the individual to assume his identity, role and responsibilities.
106 Psychotherapy is morally acceptable as a medical treatment.[205] But it must respect the person of the patient, who allows access into his inner world.
This respect prohibits the psychotherapist from violating the privacy of the other without his consent and obliges him to work within these limits. "Just as it is unlawful to appropriate the goods of another or invade his corporal integrity without his permission, so it is not permissible to enter the inner world of another person against his wishes, whatever be the techniques and methods employed."[206]
The same respect prohibits the influencing or forcing of the patient's will. "The psychologist whose only desire is the good of the patient, will be all the more careful to respect the limits to his action set down by the moral code in that—in a manner of speaking—he holds in his hands the psychological faculties of a person, his ability to act freely, to achieve the noblest ideals which his personal destiny and his social calling imply."[207]
205. "Considered in its totality, modern psychology deserves approval from the moral and religious viewpoint." (Pius XII, <To the members of the XIII International Congress on Applied Psychology,> April 10, 1958, in AAS 50 (1958) p. 274.
206. Ibid, p. 276.
207. Ibid, p. 281.
107 From the moral standpoint, logotherapy and <counseling> are privileged forms of psychotherapy. But they are all acceptable, provided that they are practiced by psychotherapists who are guided by a profound ethical sense.
108 <Pastoral care> of the sick consists in spiritual and religious assistance. This is a fundamental right of the patient and a duty of the Church (cf. Mt 10,8 Lc 9,2 Lc 10,9). Not to assure it, not to support it, to make it discretionary or to impede it is a violation of this right and infidelity to this duty.
This is the essential and specific, though not exclusive, task of the health care pastoral worker. Because of the necessary interaction between the physical, psychological and spiritual dimension of the person, and the duty of giving witness to their own faith, all health care workers are bound to create the conditions by which religious assistance is assured to anyone who asks for it, either expressly or implicitly.[208] "In Jesus, the 'Word of life,' God's eternal life is thus proclaimed and given. Thanks to this proclamation and gift, our physical and spiritual life, also in its earthly phase, acquires its full value and meaning, for God's eternal life is in fact the end to which our living in this world is directed and called."[209]
208. "Experience teaches that man, needing either preventative or therapeutic assistance, reveals needs that go beyond actual organic pathology. It is not only suitable treatment that he wants from the doctor-treatment which, in any case, sooner or later will fatally show itself to be insufficient—but the human support of a brother, who can share with him a life view, in which also the mystery of suffering and death will make sense. And whence can be had, if not in faith, this tranquilizing response to the supreme questions of existence?" (John Paul II, <To the World Congress of Catholic Doctors>, Oct. 3, 1982, in <Insegnamenti> V/3, p. 675, n. 6).
209. John Paul II, Encyclical <Evangelium vitae>, March 25, 1995, EV 30.
109 Religious assistance implies that there be, within the health care structure, the possibility and the means to carry this out.
The health care worker should be totally available to support and accede to the patient's request for religious assistance.
Where such assistance, for general or particular reasons, cannot be given by the pastoral worker, it should be given directly—within possible and allowable limits—by the health care worker, respecting the freedom and the religious affiliation of the patient and aware that, in doing so, he does not detract from the rights of health care assistance properly so called.
110 Religious assistance to the sick is part of the wider vision of medical-pastoral assistance, that is, of the presence and activity of the Church which is meant to bring the word and the grace of the Lord to those who suffer and to those who care for them.
In the ministry of those—priests, religious and laity—who individually or as communities are engaged in the pastoral care of the sick, the mercy of God lives on, who in Christ has bound to human suffering, and the task of evangelization, sanctification and charity entrusted to the Church by the Lord is carried out in a singular and privileged manner.[210]
This means that pastoral care of the sick has a special place in catechesis, in the liturgy and in charity. Respectively, it is a matter of <evangelizing> illness, helping a person to uncover the redemptive meaning of suffering borne in communion with Christ; of <celebrating> the sacraments as efficacious signs of the recreative and vitalizing grace of God; of <witnessing> by means of the "diakonia" (service) and the "koinonia" (communion) to the therapeutic power of charity.
210. "A unique light shines from the paschal mystery on the specific task which pastoral health care is called to fulfill in the great commitment of evangelization" (John Paul II, <To the plenary assembly of the Pontifical Council for Pastoral Assistance to Health Care Workers>, Feb. 11, 1992, in Oss. Rom. Feb. 12, 1992, n. 7). Cf. CEC 1503.
111 In pastoral care of the sick, the love—full of truth and of grace of God comes near to them in a special sacrament meant for them: the <Anointing of the Sick>.[211]
Administered to any Christian who is in a life-threatening condition, this sacrament is a remedy for body and spirit, relief and strength for the patient in his corporeal-spiritual integrity casting light on the mystery of suffering and death and bringing a hope which opens the human present to the future of God. "The whole person receives help from it for his salvation; he feels strengthened in his trust in God and he receives reinforcement against the temptations of the devil and the fear of death."[212]
Since it has the efficacy of grace for the sick person, the Anointing of the Sick "is not the sacrament of those only who are at the point of death." Hence "the suitable time to receive it is when one of the faithful, either from illness or old-age, begins to be in danger of death."[213]
As with all the sacraments, the Anointing of the Sick should also be preceded by a suitable catechesis so that the recipient, the sick person, is a conscious and responsible subject of the grace of the sacrament, and not an unconscious object of the rite of imminent death.[214]
211. In the anxious and painful state in which he finds himself, the seriously ill person needs a special grace from God to keep him from losing heart. There is the danger that temptation might make his faith waver. For this very reason, Christ wished to give his sick faithful the strength and the very real support of the sacrament of Anointing" (Cong. Div. Worship, <Sacrament of Anointing and Pastoral Care of the Sick>, Nov. 17, 1972. Ed. Typica, Vat. Polyglot Press, 1972, p. 81, n. 5). Cf. CEC 1511.
212. Ibid, n. 6.
213. Cf. Ecum. Coun. Vatican II, Constit. on the Sacred Liturgy <Sacrosanctum concilium>, SC 73. Cf. CEC 1514.
214. "By the grace of this sacrament the sick person receives the strength and the gift of uniting himself more closely to Christ's Passion; in a certain way he is <consecrated> to bear fruit by configuration to the Savior's redemptive Passion" (CEC 1521). The sick who receive this sacrament, "by freely uniting themselves to the passion and death of Christ," "contribute to the good of the people of God" (LG 11). "By celebrating this sacrament, the Church, in the communion of saints, intercedes for the benefit of the sick person, and he, for his part, through the grace of this sacrament, contributes to the sanctification of the Church and to the good of all people for whom the Church suffers and offers herself through Christ to God the Father" (CEC 1522).
112 The proper minister of the Anointing of the Sick is the priest only, and he should see that it is conferred "on those of the faithful whose state of health is seriously threatened by old-age or illness." To evaluate the seriousness of the illness it is sufficient "to have a prudent or probable judgment."
Celebrating communal Anointing might help to overcome negative prejudices against the Anointing of the Sick, and help to value the meaning of this sacrament and the sense of ecclesial solidarity.
Anointing can be repeated if the sick person, having recovered from the illness for which the sacrament was received, should again become ill, or if in the course of the same illness his Condition should worsen.
It can be given before surgery if the reason for surgery is "a dangerous illness."
Anointing may be conferred on the elderly "because of the notable diminishing of their strength, even if they do not have any serious illness."
If the conditions are present, it can also be conferred on children, "provided they have sufficient use of reason."
In the case of sick people who are unconscious or deprived of the use of reason, it is to be Conferred "if there is reason to believe that in possession of their faculties they themselves, as believers, would have, at least implicitly, requested holy Anointing."
"The sacrament cannot be conferred on a patient who is already dead."[215]
"When there is a doubt whether the sick person has attained the use of reason, or whether the person is gravely ill or whether the person is dead, this sacrament is to be conferred."[216]
215. Cf. Cong. Div. Worship, <The Sacrament of Anointing and Pastoral Care of the Sick>, nn. 8-19.
216. <Code of Canon Law>, CIC 1005; cf. CIC 1004-1007.
113 The Eucharist, also, as <Viaticum>, has a special significance and efficacy for the patient. "Viaticum of the body and blood of Christ strengthens the believer and furnishes him with the pledge of resurrection, as the Lord has said: The one who eats my flesh and drinks my blood has eternal life, and I will raise him up on the last day" (Jn 6,54).[217]
For the sick person, the Eucharist is this viaticum of life and hope. "Communion in the form of Viaticum is, in fact, a special sign of participation in the mystery celebrated in the sacrifice of the Mass, the mystery of the death of the Lord and of his passing to the Father."[218]
Therefore it is the duty of a Christian to request and receive Viaticum, and the Church has a pastoral responsibility to administer it.[219]
The minister of Viaticum is a priest. But he may be substituted by a deacon or an extraordinary minister of the Eucharist.[220]
217. Cong. Div. Worship, <The Sacrament of Anointing and Pastoral Care of the Sick>, n. 26. Cf. CEC 1524.
218. Ibid., n. 26.
219. "All the baptized who can receive Holy Communion are obliged to receive Viaticum. In fact all the faithful, who for any reason are in danger of death, are bound by precept to receive Holy Communion, and pastors should take care that the administration of this sacrament be not deferred, so that the faithful can benefit from it while they are still in full possession of their faculties" (Ibid, n. 27).
220. Cf. ibid, n. 29.
114 For the health care worker, serving life means assisting it right up to its natural completion.
Life is in God's hands: He is the Lord, He alone decides the final moment. Every faithful servant guards this fulfillment of God's will in the life of every person entrusted to his care. He does not consider himself the arbiter of death, just as and because he does not consider himself the arbiter of anyone's life.
115 When the state of one's health deteriorates to an irreversible and fatal condition, a person enters into a terminal state of earthly existence. For him life is particularly and progressively precarious and painful. To illness and physical suffering is added the psychological and spiritual drama of detachment which death signifies and implies.
As such, the terminally ill patient is one who needs human and Christian accompaniment, and it is here that doctors and nurses are called on to make their expert and unrenounceable contribution. What is in question is special medical assistance for the dying person, so that also in dying he must know and will as a living human being. "Never more than in the proximity of death and in death itself is life to be celebrated and extolled. This must be fully respected, protected and assisted even in one who is experiencing its natural end.... The attitude to the terminally ill is often the acid test of a sense of justice and charity, of the nobility of mind, of the responsibility and professional ability of health care workers, beginning with doctors."[221]
221. John Paul II, <To the participants at the International Congress of the "Omnia Hominis" Association>, Aug. 25, 1990, in <Insegnamenti> XIII/2, p. 328. "Such a situation can threaten the already fragile equilibrium of an individual's personal and family life, with the result that, on the one hand, the sick person, despite the help of increasingly effective medical and social assistance risks feeling overwhelmed by his or her own frailty; and on the other hand, those close to the sick person can be moved by an understandable even if misplaced compassion" (John Paul II, Encyclical <Evangelium vitae>, March 25, 1995, n. 15).
116 Dying is part of life as its ultimate phase. It should be cared for, then, as belonging to it. Hence it calls for the therapeutic responsibility of the health care worker just as much and no less than every other moment in human life.
The dying person should not be dismissed as incurable and abandoned to his own resources and those of the family, but should be re-entrusted to the care of doctors and nurses. These, interacting and integrating with the assistance given by chaplains, social workers, relatives and friends, allow the dying person to accept and live out his death.[222] To help one to die means <to help him to live> intensely the final experience of his life. Where possible and when the one concerned wishes, he should be given the opportunity of spending his last days at home with suitable medical assistance.
222. Cf. Cong. Doct. Faith, <Declaration on Euthanasia>, May 5 1980. in AAS 72 (1980) p. 551.
117 A terminally ill person should be given whatever medical assistance helps to alleviate the pain accompanying death. This would include the so-called palliative or symptomatic treatment.
The most important assistance is "loving presence" at the bedside of the dying person.[223] There is a proper medical-health presence which, though not deceiving him, makes him feel alive, a person among persons, because he is receiving, like every being in need, attention and care. This caring attention gives confidence and hope to the patient and makes him reconciled to death.[224] This is the unique contribution which doctors and nurses, by their being human and Christian—more than by their expertise—can and should make to the dying person, so that rejection becomes acceptance and anguish gives way to hope.
In this way human dying is withdrawn from the phenomenon of "being overly medicalized," in which the terminal phase of life "takes place in crowded and activity-dominated environments, controlled by medical health personnel whose principal concern is the biophysical aspect of the illness." All of this "is being seen increasingly as disrespectful to the complex human state of the suffering person."[225]
223. Cf. John Paul II, <To the participants at the International Congress on Assistance to the Dying>, in Oss. Rom. March 18, 1992 n. 5.
224. "It is only a human presence, discreet and caring, which allows the patient to express himself and to find a human and spiritual comfort, that will have a tranquilizing effect" (Pont. Coun. "Cor Unum," <Some Ethical Questions Relating to the Gravely Ill and the Dying>, July 27, 1981, in <Enchiridion Vaticanum> 7, <Documenti ufficiali della Santa Sede> 1980-1981. EDB, Bologna 1985, p. 1151, n. 4.3).
225. Cf. John Paul II, <To the participants at the International Congress on Assistance to the Dying>, in Oss. Rom. March 18, 1992, n. 5.
118 "Before the mystery of death we are powerless; human certainties waver. But it is precisely in the face of such a checkmate that Christian faith...becomes a fount of serenity and peace.... What seems meaningless takes on meaning and worth."[226]
When this "checkmate" takes place in the life of a person, in this decisive hour of his existence, <the witness of the health care worker's faith and hope in Christ> has a determining role. It displays new horizons of meaning, that is, of resurrection and life, to the one who sees the prospects of earthly existence being closed to him.
"Over and above all human consolations, no one can be blind to the enormous help given to the dying and to their families by faith in God and the hope of eternal life."[227] To make faith and hope present is for doctors and nurses the highest form of humanizing death. It is more than alleviating a suffering. It means applying one's skills in order to "make going to God easy for the patient."[228]
226. Ibid, n. 1. "'It is in regard to death that man's condition is most shrouded in doubt' (GS 18). In a sense bodily death is natural, but for faith it is in fact 'the wages of sin' (Rm 6,23). For those who die in Christ's grace it is a participation in the death of the Lord, so that they can also share his Resurrection" (CEC 1006 cf. also CEC 1009).
227. John Paul II, <To two work groups set up by the Pontifical Academy of Sciences>, Oct. 21, 1985, in <Insegnamenti>, VIII/2, p. 1083, n. 6; cf. <To the participants at the International Congress on Assistance to the Dying>, in Oss. Rom. March 18, 1992, n. 5.
228. John Paul II, <To two work groups set up by the Pontifical Academy of Sciences>, Oct. 21, 1985, in <Insegnamenti> VIII/2, p. 1083, n. 6. Cf. CCC 1010. "Death itself is anything but an event without hope. It is the door which opens wide on eternity and, for those who live in Christ, an experience of participation in the mystery of his death and resurrection" (John Paul II, Encyclical <Evangelium vitae>, March 25, 1995, n. 97).
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