THE ETHICS of END-OF-LIFE HEALTH CARE, PART I: ORDINARY MEANS of PRESERVING LIFE

Human life is a precious gift from god. In its very first chapter, the Bible tells us, “God created mankind in his image; in the image of God he created them” (Genesis 1:27). Human beings are made in God’s image, which accounts for the surpassing dignity and value of human life. We see that dignity most especially in the spiritual souls with which human beings are endowed, giving them the capacity to know and to love. The Catechism of the Catholic Church puts it this way: “Being in the image of God the human individual possesses the dignity of a person, who is not just something, but someone. He is capable of self-knowledge, of self-possession and of freely giving himself and entering into communion with other persons” (CCC 357). Because human beings are endowed with such dignity, human life is to be respected and protected. This is the basis for the fifth commandment: “You shall not kill” (Exodus 20:13). Human life is inviolable. As the Catechism says, “Human life is sacred because from its beginning it involves the creative action of God and it remains for ever in a special relationship with the Creator, who is its sole end. God alone is the Lord of life from its beginning until its end: no one can under any circumstance claim for himself the right directly to destroy an innocent human being” (CCC 2258).

The dignity and inviolability of human life implies, not only that we should refrain from destroying life, but also that we should take positive measures to protect, preserve and promote life. We have a duty to care for our bodily lives and bodily health, as well as the lives and health of the persons for whom we are responsible. This care will involve all reasonable means of preserving life. Obvious examples of such means would include eating, drinking, feeding our children, breathing oxygen, and obtaining shelter, clothing, and warmth. Reasonable means of preserving life also include forms of medical care that are needed, available, and entail minimal risk. Cleaning and binding up wounds, taking antibiotics to cure infections, and having your appendix removed when it is in danger of rupturing would all be clear examples.

The church uses the term “ordinary means” to describe such reasonable ways of preserving life and health. The duty we have to care for our lives and our bodily health requires that such ordinary means of preserving life not be omitted. Should someone deliberately omit the use of ordinary means of preserving his own life or the life of someone in his care, he would be guilty of a grave sin. If the person to whom such care is denied were himself, he would be guilty of suicide. If it were someone else, he would be guilty of murder. If he is cooperating with a willing victim, the murder could also be called assisted suicide or euthanasia. The wrongfulness of these omissions, at least in some cases, is obvious. Deliberately starving a child or letting oneself bleed to death are clear examples. In other cases, especially when the victim is already undergoing a great deal of suffering, the refusal to provide ordinary care is still gravely wrong, though the wrongfulness is less obvious. The Catechism states that, whatever the motive or means, “An act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God” (CCC 2277).

To act rightly, therefore, it is necessary to make use of the ordinary means of preserving life both for ourselves and for those in our care. Not every means of preserving life, however, qualifies as an ordinary means. Moreover, not every means of preserving life that is ordinary in one set of circumstances would qualify as an ordinary in a different set of circumstances. For example, feeding a sick person who cannot feed herself would, in most circumstances, be an ordinary means of preserving life. But feeding a sick person who is unable to digest would be extraordinary and therefore not necessary.

Human life is a great gift from god, who made us in His image. Created in God’s image and endowed with spiritual souls, human beings have a dignity that surpasses other creatures and implies the inviolability of human life and a duty to protect and preserve the human lives for which we are responsible. Failure to employ reasonable, ordinary means to preserve those lives involves us in serious wrongdoing. Conversely, we grow in virtue and holiness by appropriately protecting and preserving the gift of human life.

Natural life and bodily health are great gifts of God, but supernatural life and the health of our immortal souls are even greater gifts. By distinguishing between ordinary and extraordinary means of preserving life, we free ourselves from the burden of clinging to natural life at all costs. We can both preserve the natural life that is God’s gift to us and accept natural death, which in Christ has become the way to eternal life.

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