Whether in Life or in Death

"Whether in Life or in Death, We are the Lord's"
Romans 14: 7

Most Reverend John J. Myers
Archbishop of Newark

I. Introduction

Many of us have experienced the sadness and suffering of standing close by as the life of a loved one fades and comes near the end of the time ordained for this world. My father, my sisters and brothers and I knew this ordeal when we had to make a variety of decisions as my mother's life faded and she underwent a series of medical emergencies. The occasions and the discussions were difficult, even wrenching. Fortunately, the family is close and our relationships have remained good. Finally, in God's time, He took her to himself. We have been deeply comforted by the faith which we shared with her, and which she nurtured in us.

In this spirit, I wish to share some reflections with those in the Archdiocese of Newark who may now or sometime in the future seek comfort in Jesus Christ's victory over sin and over death.

The words from St. Paul's letter to the Romans, in the title, direct us toward the very heart of Christianity. Jesus is sent by the Father to reveal the Mystery of God as a community of persons in a relationship of loving communion. As the revelation of the Father, Jesus, through His humanity, shines light on what it means to be a person created in the image and likeness of God, what it means to be truly human. By His death and resurrection, Jesus redeemed us and made us His own, giving us the means necessary to experience here and now what we will live fully when we have passed from death into eternal life. The Gospel celebrates the truth that "Whether in life or in death, we are the Lord's."

For the Christian people, Jesus remains "the glory of man fully alive." Christ alone completely reveals what it means to express the love from which and for which we were created. Through the Church, God continues to reach out to us in the person of His Son. Through the power of the Holy Spirit, God enables us to understand just what it means to live as men and women created in the divine image. The invitation of Christ is a call for all men and women to encounter the Divine Presence. This encounter affords us the opportunity to bring the most troubling and heart-wrenching questions of human existence to the One who provides us the way to understand and to address the most difficult circumstances of life.

The revelation of God proclaimed by Jesus was expressed most perfectly and definitively through His own willingness to suffer and to die. Jesus is, therefore, precisely the one to whom we should turn when we find ourselves confronted by the reality of death in our own lives or in the lives of those we love. He didn't simply talk about suffering and death; He endured them and He prevailed over them. Jesus teaches us not only what it means that "in life and in death, we are the Lord's." He also enables us to live the truth of the words St. Paul has spoken.

II. What We Must Ask Ourselves

Earlier this year, our nation, indeed the world, watched with stunned fascination the unfolding of death in the life of one American family. The death of Terri Schiavo saw unparalleled media scrutiny. Although we may not know all the facts, we do know that many questions remain, including, for some, confusion about Church teaching in these matters. At the center of our confusion lies a set of important questions:

� What is the nature and meaning of personhood?
� What is our moral responsibility to provide food and water to those who are unable to care for themselves?
� What is the role of competent medical authority in assessing the condition of those who seem incapable of human response?
� What are the obligations of a democratic society to safeguard the lives of those most vulnerable and in need of care?

In order for all of us in the Church to be able to make informed and morally licit decisions when our own health is seriously diminished or death is imminent, we need to review the Church's teachings on these important questions.

Every day in our country, feeding tubes are removed or refused without garnering even local media attention. What set the case of Terri Schiavo apart, what indeed made this situation so unusually tragic, was the struggle between two groups. One group considered Terri as a person who existed with them in loving relationship; the other group considered that her personhood had ended long ago. One group felt that the loving thing to do was to continue caring for Terri; the other group seemed convinced that it was an act of love to move her from life with God here to life with God in heaven.

In the midst of the overwhelming media coverage of Terri Schiavo's dying and of her death, many of us perhaps stopped seeing her as a person but rather as an idea or as a cause, or in a worst-case scenario, as a political tool. In the midst of this confusion, we cannot allow ourselves to forget that beneath all the arguments was a living human being.

We all need to keep in mind that Terri Schiavo was and is a person, a sister in our faith. Though much that transpired in the process of her death was disordered, she is with the Lord and she has become, in a sense, a symbol of the confusion in America over the tension between individual autonomy and communal responsibility. Certainly, this experience underscores the need of making one's wishes known in writing and in a form which is recognized in particular jurisdictions.

III. Death is Our Reunion with Christ

We need to remind ourselves that death is not an evil that should be feared. In the words of the ancient preface of the funeral liturgy, "Lord, for your faithful people, life is changed, not ended; and when the body of our earthly dwelling lies in death, we gain an everlasting place in heaven." Death is not only an end to "earthly" existence; it also is the passageway to eternal life. Unnecessarily prolonging death, clinging at all costs to this life, can be an attempt to reject what our faith boldly proclaims, "Death has no more power over Christ!"

It is a virtuous practice to pray for a happy death, and many Christians have implored St. Joseph to obtain for them what each priest and religious prays for every night, "a peaceful death." While we should not hasten our death, we must not fear it either. St. Benedict reminds us to pray for death each day, as if it were to come tomorrow; for we know neither the time nor the hour of its approach. Our hope is not to live our mortal lives without end, but to live for all eternity with God.

The mystery that shrouds death causes fear for many. Faith nonetheless strengthens what is lacking in our human frailty and gives us the courage to embrace what we cannot change. Faith also recognizes the necessity to be fearless in the face of death. "Where I am going you know the way," Jesus tells His apostles. We must live with confidence that Christ is preparing a place for us and will indeed return to unite us with Himself.

While we live as God's children now, we long for the moment when we shall become like Him and see Him face to face. The way we respond to the suffering and death of those whom we love, the way in which we embrace our own mortality, speaks volumes about the way in which we have accepted that Jesus Christ is Lord of the living and the dead. The inability to accept that suffering is redemptive, or the inclination to immediately end the pain of those who are suffering, reveals that we have not yet accepted the Way for us to live the fullness of our humanity. Likewise, the refusal to accept that death comes to all, shown by attempts to maintain biological vitality at all costs, also reveals a failure to place our hopes in Christ. Christians always must embrace life here and now with their hearts and minds set on a world that will never end, a world in which every tear will be wiped away.

IV. Forming End-of-Life Decisions

Our attitude toward death must be an extension of our attitude toward life. Living now for God will determine how we will face the moment when we pass from this world to the next. In order to help the faithful put in place appropriate and clear legal and medical directives, the Church has articulated a set of principles derived from the most fundamental teachings on the dignity of the human person and the inherent dignity of each human life. Just as every individual human life is unique and unrepeatable, from conception until natural death, so too the physical suffering and medical condition of each person is unique and cannot be generalized. The following ethical principles of the Church respect this aspect of our individuality as children of God. They are meant to serve as a helpful guide to end-of-life decisions, allowing us to embrace suffering and death in freedom, and with peace of mind.

Our Obligation for the Proportionate Means of Preserving Life

Life is sacred, for it is a gift from God. As recipients of this precious gift, we are always morally obligated to use ordinary means for maintaining and insuring physical health. "Proportionate means" describes those medical remedies and procedures that in the judgment of the patient and competent medical authority, in light of the Christian understanding of the dignity of human persons, offer a reasonable hope of benefit. Many of us employ this principle without much thought as we consider to what extent we wish to experience the side-effects of over the counter remedies for such common ailments as the flu, a cold, a sore throat, a headache, or muscle pain. At times we forgo a remedy in favor of letting the illness "take its course" because we do not wish to be hindered by the side-effects of the remedy being considered.
This common-sense approach to illness, one with which we are all familiar, is to be applied to those illnesses that are more severe and life threatening. Our reasonable hope in the benefit of a proposed treatment should not reflect an attitude of preserving life "at all costs."

The Presumption in Favor of Providing Nutrition and Hydration

As members of the human family, every man or woman, regardless of age or socio-economic condition, requires a set of fundamental human goods, among which are those required for maintaining life: food, air, and water. Without these primary goods, other basic human needs become inconsequential.

To insure that the human dignity of every person is respected, there must always be a presumption in favor of food and hydration, even for those patients who require assistance for the delivery of those goods. When specific medical conditions indicate that a medical treatment may place excessive burdens on the patient without a sufficient benefit, the decision not to undertake such a treatment can be morally licit. When such a decision is made, continued care must be extended, including offering food and water to the extent to which the patient is able to receive them.

The presumption for food and hydration must also be carefully weighed, however, in consideration of both perceived benefit and excessive burden. This is especially true when a feeding tube has already been inserted. Depending upon the assessment in light of proper ethical principles and in consultation with proper medical professionals regarding the condition of the patient and the capability of human response, it may be morally licit not to undertake artificial nutrition and hydration, providing that the intention is not to bring about the death of the patient and that basic care is continued. For instance, if the food and hydration in fact harms the patient, then capping or removing the feeding tube would be a prudential judgment to relieve unnecessary pain and suffering. The patient himself or herself or the designated surrogate are the proper persons to make any required decisions.

Forgoing Extraordinary or Disproportionate Means of Preserving Life

Often when it is time to make a decision to forgo extraordinary means of preserving life, families and loved ones are overwhelmed by the situation at hand. They may be pressed for decisions on whether or not to harvest organs, whether or not to remove life support or assisted respiration, or whether or not to accept a diagnosis of "brain death." In such moments, when there is little time to work through the facts and the emotions of the situation, it is important to realize that the Church's teaching is not "life at all costs." A discussion of reasonable hope and excessive burden is not a denial of love and care for the person who is suffering.

Whether or not a proposed medical procedure is "extraordinary" or "disproportionate" can only be determined with reference to a specific medical condition of one given individual. Not all cancer patients, not all non-responsive individuals, not all persons facing imminent death can be assessed under a predetermined protocol. An informed judgment can only be made by the patient or legal surrogate in close concert with medical professionals in the light of Church teaching.

The intensity of emotion can inhibit our ability to assess either the hope of benefit of the proposed treatment or any potential burden that treatment might inflict on the patient and on those responsible for providing the care - the family, doctors, nurses, and aides who are tied in love and charity to the patient. It is essential to establish a loving human relationship between the medical caregivers and the patient in order to insure that the dignity of that person is appropriately respected. Always, provisions should be made that the person receive the sacraments of the Church, including the Apostolic Blessing reserved for those near death. The family and friends should have the benefit of the ministry of the Church, and representatives of the Church should encourage them with prayer and by sharing our faith in Jesus and the salvation He offers.

The Importance of Making a Free and Informed Judgment

In order to assure a patient or a chosen legal surrogate that the decisions made regarding the end of life are licit and expressive of faith in Jesus Christ, the Church encourages all the faithful to seek guidance from medical professionals and from pastoral caregivers.

An informed decision should include competent medical authority. We must welcome and embrace all that has been learned by those who practice the medical arts as a vocation of human relationship. The development of this relationship will help remind all parties involved that the decisions to be made are always moral, as well as scientific.

No one should feel alone or incapable of deciding what best respects the individual dignity of the person suffering. When fully informed by the teaching of the Church, each Christian's prudential judgment regarding end-of-life issues is an exercise of that same freedom we experience in our sacramental union with Christ. It is the same freedom we feel having celebrated the sacrament of Penance, the same freedom we feel receiving the Eucharist, and the same freedom we feel in the loving company of those whom Christ has gathered around him in friendship.

On the Nature and Meaning of Human Personhood

Those whose lives are dedicated to the medical arts can also help us understand the Church's teaching on the nature and meaning of being a person. The advances in our knowledge of the workings of the mind and body as a compact unity affirm that which the Church has always held: being a person is a gift of having been created in the image and likeness of God. While all created reality serves God's purpose, only human beings are able through their physiology and spirituality to participate with God in the work of creation. Likewise, the medical arts are a supreme example of our ability to work with nature as we journey toward our completeness in physical health and through a "long stretch of days." Medicine, when rightly practiced, seeks to insure that all men and women can experience their humanity with vitality and fullness.

While all living creatures reveal the mystery of God in a way unique to each, only human beings reveal the mystery of God in a way not determined or limited by physiology alone. Only human beings can act in such a way that their life in the body conforms to their hearts, their minds, and their wills. This is why a human being is rightly called a person, for human beings are more than the aggregate of physiological integrity. They have a spiritual life as well, and are capable of thought and decision, even though in the embryo or fetus these abilities are present potentially.

When assessing the mental state or physical condition of a developed human being, competent medical authorities seek to determine the extent to which everything physically required for an individual to express him - herself, beyond merely bodily response, is functioning appropriately. Our medical professionals try to ascertain whether or not, in some appreciable measure, the individual is capable of communicating, "I am present." While this diagnostic communication is taking place, we should all encourage our doctors to be open and honest with us as patients, family, and friends. Participating in a genuine relationship with our doctors requires that we trust their professional judgment, especially when the situation is deemed life-threatening.

When facing end-of-life situations, we should never forget that personhood and human life are inextricably bound together. The Catholic Church teaches that the dignity of personhood is an innate dimension of being human. Personhood and human life can never be separated, for they are a unity willed by God. The Church looks to the advances made in the medical arts to understand better those situations in which the unity willed by God is no longer viable.

Each human person, therefore, is always more than the sum total of biological integrity. While it is true that human beings can be physically and mentally disabled by imperfections of the mind or body, it is never true that the physical or mental diminishment of a human being means that an individual is no longer a person. Personhood must never be thought of solely as a judgment imposed by others. Being a person is the ultimate gift of having been created by God in such a way that one can choose to share God's life. To make such choices, we must first have a degree of mental and physical health that enables us to do so.

On the Question of Euthanasia

Many, many Catholics have shared the experience of tending to their loved ones in their last days and know the complexity of the emotions and questions which can arise. Their love for the Creator and His will offers sure guidance and comfort in protecting life appropriately, even when the situation is beyond our understanding.

We must be careful as a nation that the laws we enact to promote and protect our prudential judgments over end-of-life issues do not intentionally or unintentionally allow for the direct termination of a human life. What a person experiences in embracing suffering and death informs and instructs others about the responsibility we have to one another in love. Human life will only be cherished and sacred to the extent that the commitment we make to respect, care for, and love one another is unwavering.

V. The Sacrament of Presence

For the Catholic faithful, the gift of each life is essentially a "sacrament" of presence. This teaching emanates from the fact of God becoming man in the person of Jesus. The abiding sign of the Church's belief in the dignity of the human person is the belief in the real presence of Christ in the Blessed Sacrament. By Jesus' words and the power of the Holy Spirit, the Eucharist is the means by which Jesus' real presence remains with us until the end of time. Through the power of the Holy Spirit, the goods of creation are used to permeate the whole of human history with the Presence of divinity. What appears as simple bread and wine communicates a Presence that transcends our human senses.
In the same way, human life is able to communicate a Presence that transcends what we sensibly perceive. Through the power of the Holy Spirit, individual human lives are incorporated into the life of Christ in such a way that they become the means by which his Presence is encountered and experienced in the world. Just as we cannot reduce the elements of the Eucharist only to that which we are capable of sensing, we must likewise never reduce a human life to what is merely biological.
Every human life bears the dignity of the Creator. No human life is ever considered to be the mere sum of biological and physiological processes. These natural processes ordered toward and directed by the brain, allow a person the sense of being present. Because of advances in medical technology, the precise time of death can be difficult to ascertain. Both ethical and medical criteria should be applied, often in dialogue with those with special training. Again, the patient or proper surrogate should make any decisions, fully informed of the teaching of the Church.

For the Christian people, baptism empowers the original dignity of personhood to become an active and innovative sign of God's love as a present reality. That is why the Church speaks of the "quality" of a human life as something greater than one's emotions or reflexive responses. The quality of each human life lies in the fact of its presence as a living, existing reality that remains an incarnate sign of the God who created all things.

Therefore, special and loving care must be extended to each human being, especially those no longer experiencing life as the compact unity that God intended. For them and for those who have died, we have a singular responsibility to insure that our treatment of them is worthy of the dignity they possess as having been created in God's image and likeness. Whether in life or in death, every one of us matters.
Veneration for and care for the body does not end with death. Since the body is integral to the human person, Christian believers have, from the earliest days, accorded the body special respect. It is preferable that the body be buried with due solemnity and with prayers for the deceased. Together, after all, we look forward to its resurrection and to our more complete sharing in the Life of Christ.

VI. Conclusion: Keeping Vigil with the Dying

To stand with others and keep vigil while they suffer and die is the greatest gift of love a human being can experience. It also provides the greatest opportunity to learn. Those who suffer and those preparing to die have much to teach the healthy and the living about the mystery of our humanity and the dignity that is ours through our relationship with God. Every human life is valuable. Those who keep vigil with the dying are familiar with the overwhelming beauty of this truth.

We witnessed this recently through the unfolding death of John Paul II. While the world watched the controversy surrounding the last days of Terri Schiavo, this great man offered his life as a testimony to what the Church believes and holds sacred. His choices about how he would die embodied the way he chose to live: of and for the God who had called him to the priesthood and eventually to stand as Peter. In life and in death, John Paul II made it clear that he lived for God. Through his own slow demise, he became an icon of human dignity and a sacrament of the inherent worth of each individual person.
Christ demonstrated this for us on the Cross. He allowed the experience of His physical condition to become an opportunity for others to learn what only those who are dying are capable of teaching. Like the crowd of people who stood and kept vigil, we are challenged to find our place near "the Cross" of other people's suffering and death.

The grace of keeping vigil touched the lives of the men who were present only out of duty and obligation. It was the job of the soldiers to stand and keep vigil. What Jesus revealed through His suffering and death changed the lives of many of those men; they experienced something beyond what they were used to or what they expected. It was because of the way that Jesus embraced the dignity of His personhood through the reality of His tortured and diminishing humanity that one of the men was forced to say, "Truly this was the Son of God." At the moment of the Cross, humanity and divinity were perfectly one in a glorious way.

Others were moved to be present for varying reasons, some out of genuine human compassion. They were affected in ways they could not have anticipated. Their willingness to keep vigil opened their eyes to the revelation of Divinity that was only possible through the diminished physical body and limited human responsiveness of Jesus. That afternoon they walked away with a deeper insight into the dignity of their own fragile and vulnerable humanity because they recognized in the suffering and death of Jesus the real presence of God.

Those who had felt such a presence throughout Jesus' public ministry were also there that day. Foremost among them was John, the beloved friend who had left everything to come and see the one who just might be the messiah. No one can imagine what John felt as he kept vigil with Jesus dying on the Cross. We can say with utmost certainty that the moment of the Cross defined everything John thought about Jesus and every experience they shared. For Pope John Paul II, one of the greatest gifts he received from Christ was that many kept vigil with him while he died.

Next to John at the foot of the Cross was Mary, the Mother of Jesus. She experienced the grace of keeping vigil with the dying in a way unlike any other. What she learned through the suffering and death of her only Son was a gift entrusted to the Church at its inception. It remains a gift preserved by the Church to this day. Mary's insights about suffering and death, her solidarity with those whose lives are physically and mentally diminishing, are a great consolation to all of us who will one day pass from this life to the next. What Mary is able to teach us can help us in the decisions we make about how we will approach the end of our lives. Let us ask her to assist us now and at the moment of our deaths in order that we may see with greater clarity how to live both our life and our death as she did: for the Lord.

Given at my Chancery this 8th day of September, 2005, The Nativity of the Blessed Virgin