Rachel Evans
The Catholic Church does not have a definitive teaching on whether Do Not Resuscitate (DNR) orders are ethically permissible. Many people struggle with the ethical discernment surrounding the decision to have a DNR put in place for themselves or a loved one. A DNR is a specific medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing or heart stops. While the decision to implement a DNR should be made on a case-by-case basis, considering the patient's medical situation and whether the benefits of CPR outweigh the burdens, it is important to note that healthcare providers are morally obligated to refuse compliance with a DNR if there is a reasonable hope of benefit from CPR or if it does not impose an excessive burden on the patient.
| Characteristics | Values |
|---|---|
| Nature of DNR | A Do Not Resuscitate Order (DNR) is a specific medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing or heart stops. |
| Catholic Church's stance | The Catholic Church does not have definitive teachings on the ethical permissibility of DNRs. |
| Moral considerations | DNR decisions should consider the benefits of CPR against the burdens it may impose on the patient, their family, or the community. Ordinary measures like hydration and nutrition should not be denied. |
| Individual autonomy | The free and informed judgment of a competent adult patient regarding life-sustaining procedures, including DNRs, should be respected unless it contradicts Catholic moral teachings. |
| Case-by-case basis | DNR implementation should consider each patient's unique medical situation, and healthcare providers should exercise ethical decision-making to prevent misuse or discrimination. |
| Advance care planning | DNRs are a type of advance directive, allowing individuals to indicate their treatment preferences in advance if they become incapable of directing their care. |
| Emotional considerations | Emotions run high in end-of-life situations, and seeking counsel from a third party familiar with Catholic moral principles can be beneficial. |
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What You'll Learn
The Catholic Church's stance on DNRs
The Catholic Church does not have any definitive teaching on whether Do Not Resuscitate Orders (DNRs) are ethically permissible. However, the United States Conference of Catholic Bishops’ “Ethical and Religious Directives for Catholic Health Care Services” (ERD) provides some general guidance that can be applied in determining when a DNR is ethically permissible.
The Catholic Church's position on DNRs is that they can be ethically permissible in certain circumstances. The Church's teaching emphasizes the sanctity of life and the moral obligation to preserve it using ordinary or proportionate means. According to the ERD, "a person has a moral obligation to use ordinary or proportionate means of preserving his or her life." Proportionate means are those that offer a reasonable hope of benefit and do not impose excessive burdens or expenses on the patient, their family, or the community. On the other hand, a person may forgo extraordinary or disproportionate means of preserving life if they are burdensome, dangerous, or offer little expected outcome.
The implementation of a DNR should be made on a case-by-case basis, taking into account the patient's particular medical situation. The main consideration is whether the benefits of cardiopulmonary resuscitation (CPR) outweigh the burdens. The free and informed judgment of a competent adult patient concerning the use or withdrawal of life-sustaining procedures should be respected and complied with, unless it contradicts Catholic moral teachings.
In some cases, DNRs have been misused or implemented in a discriminatory manner. For example, in the UK in 2021, it was reported that COVID-19 patients with learning disabilities were being given DNRs. Bishop Moth, of the Catholic Bishops' Conference of England and Wales, condemned this practice as "wholly unacceptable and immoral."
The decision to implement a DNR should not be made lightly or in haste, and emotions can run high in these situations. The default position is to resuscitate, and only in certain cases can the decision not to resuscitate be ethically justified. The National Catholic Bioethics Center (NCBC) offers free personal consultations to provide insights and counsel based on Catholic moral principles for those facing difficult end-of-life care choices, including the appropriateness of a DNR.
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Ethical considerations for Catholics
The Catholic Church does not have a definitive teaching on whether Do Not Resuscitate (DNR) orders are ethically permissible. However, there are several ethical considerations that Catholics may want to take into account when contemplating a DNR for themselves or a loved one.
A DNR is a specific medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing or heart stops. It is a legally recognised advance directive, which gives a person or their healthcare proxy the authority to prevent or withdraw CPR. The decision to implement a DNR should be made on a case-by-case basis, taking into account the patient's particular medical situation and whether the benefits of CPR outweigh the burdens.
The Vatican Declaration on Euthanasia and the United States Conference of Catholic Bishops affirm that a person or their proxy healthcare decision-maker can rightly refuse treatments that do not offer a reasonable hope of benefit, entail an excessive burden, or impose excessive expense on the family or community. This is further supported by the Congregation for the Doctrine of the Faith's Vatican Declaration on Euthanasia, which states that a "correct judgement" about treatments can be made by studying the type of treatment, its complexity, risk, cost, and expected results, in comparison to the state of the patient and their physical and moral resources.
Catholics are not obligated to accept "extraordinary" measures to extend life, but ordinary measures such as hydration and nutrition should not be denied. The National Catholic Bioethics Center advises that even as patients are dying of serious illnesses, they should continue to be cared for, supported, and comforted using ordinary means such as heart and blood pressure medications, diuretics, and insulin.
In conclusion, while the Catholic Church has no official teaching on DNRs, Catholics contemplating this decision should consider the specific medical circumstances, the potential benefits and burdens of CPR, and the availability of ordinary means of care and support. Each situation is unique, and emotions can run high, so it is important to seek counsel from those knowledgeable in Catholic moral principles to ensure that any decisions made are ethically permissible within the Catholic faith.
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When DNRs are misused
A Do Not Resuscitate Order (DNR) is a specific medical order instructing healthcare providers not to perform cardiopulmonary resuscitation (CPR) on a patient if their breathing or heart stops. The Catholic Church does not have definitive teachings on the ethical permissibility of DNRs, but Catholic bioethicists agree that a DNR can be moral or immoral depending on the circumstances.
Another circumstance where DNRs can be misused is when they are applied as a blanket rule without considering each patient's unique medical situation. DNR decisions should be made on a case-by-case basis, weighing the benefits of CPR against the burdens in the context of the patient's specific medical condition. Healthcare providers are morally obligated to refuse compliance with a DNR if there is a reasonable hope of benefit from CPR or if it would not impose an excessive burden on the patient.
Additionally, DNRs should not be used as a means to hasten death or as a substitute for appropriate end-of-life care. While a DNR ensures patients receive the kind of care they want at the end of their life, it does not mean "do not treat." Other treatments, such as antibiotic therapy, transfusions, dialysis, or ventilation, that may prolong life can still be provided. Palliative care to manage pain and keep the patient comfortable should also always be offered.
In the Catholic perspective, the free and informed judgment of a competent adult patient regarding the use or withdrawal of life-sustaining procedures should generally be respected. However, this must be considered within the framework of Catholic moral teaching. DNR decisions are significant and should not be made lightly or hastily, especially given the current cultural context, where many individuals believe that certain lives are "not worth living." Seeking counsel from those well-versed in Catholic moral principles can provide valuable guidance in these complex end-of-life care choices.
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DNRs and euthanasia
A Do Not Resuscitate Order (DNR) is a specific medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) on a patient if their breathing or heart stops. The decision to put a DNR in place can be ethically challenging for individuals and their loved ones, and many people seek guidance from Catholic bioethicists on this matter.
From the perspective of the Catholic Church, human life is sacred and a gift from God, and it is our duty to preserve it. The Church has consistently opposed euthanasia and "over-zealous" treatment, emphasizing that life must be protected from conception to natural death. Pope Pius XII affirmed that it is not obligatory to employ all therapeutic means, and in certain cases, it is lawful to abstain from them. This principle of proportionality of treatment was also emphasized by Pope John XXIII.
The Vatican has clarified that discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to expected outcomes is legitimate. This is not euthanasia, as the intention is not to cause death but to accept that it cannot be impeded. Catholic bioethicists agree that a DNR can be moral in certain circumstances, but it should be made without haste and with caution.
While DNRs can be permissible, active euthanasia is not. Euthanasia is considered a rejection of God's sovereignty and a denial of the natural instinct to live. Suicide, or intentionally causing one's own death, is viewed as equally wrong as murder and is a grave offense against the dignity of the human person and respect for God.
In summary, Catholics facing end-of-life decisions should seek guidance from Catholic bioethicists. While DNRs can be morally acceptable in certain circumstances, euthanasia is not permitted as it intentionally causes death. The Catholic Church emphasizes the sanctity of life and the rejection of both euthanasia and excessive medical intervention, instead advocating for palliative care that relieves pain while respecting the dignity of the individual.
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Advance directives and DNRs
A Do Not Resuscitate Order (DNR) is a specific medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing or heart stops beating. The decision to implement a DNR can be ethically complex, especially from a Catholic perspective. While the Catholic Church has no definitive teaching on the ethical permissibility of DNRs, several Catholic organisations and individuals have offered guidance and perspectives on this issue.
The National Catholic Bioethics Center (NCBC) frequently receives consultation requests regarding the ethical appropriateness of DNRs. They emphasise the need for caution and careful discernment in making such momentous decisions. Emotions often run high in these situations, and it can be helpful to have a third party familiar with Catholic moral principles provide counsel and insights.
Some Catholic bioethicists argue that DNRs can be moral or immoral depending on the specific circumstances. They emphasise the importance of ethical decision-making by healthcare providers to prevent misuse or discriminatory implementation of DNRs. For example, in the UK in 2021, it was deemed unacceptable and immoral to issue DNRs to COVID-19 patients with learning disabilities solely based on their communication challenges.
Catholics seeking guidance on DNR ethics are often referred to the "Ethical and Religious Directives for Catholic Health Care Services" (ERD) provided by the United States Conference of Catholic Bishops. The ERD states that individuals have a moral obligation to use ordinary or proportionate means to preserve their lives. Proportionate means offer a reasonable hope of benefit without imposing excessive burden or expense on the individual, their family, or the community. This guidance can help determine when a DNR may be ethically permissible.
Advance directives, including DNRs, are legal documents that allow individuals to indicate their medical treatment preferences in advance if they become incapable of directing their own care. While DNRs specifically address resuscitation efforts, advance directives can cover a broader range of medical scenarios. Anyone over the age of 18 can prepare advance directives, and it is essential to communicate your wishes clearly to family, friends, and relevant medical and legal professionals.
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Frequently asked questions
DNR stands for Do Not Resuscitate. It is a medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing or heart stops.
The Catholic Church does not have definitive teachings on the ethical permissibility of DNRs. The decision to implement a DNR should be made on a case-by-case basis, considering the patient's medical situation and whether the benefits of CPR outweigh the burdens.
Yes, faithful Catholic bioethicists agree that there are circumstances where a DNR can be moral. When death is imminent and disease states are advanced, a DNR may not raise moral problems if spiritual matters have been addressed. Catholics are not obligated to accept "extraordinary" measures to extend life, but ordinary measures like hydration and nutrition should be provided.
As a Catholic, any decision regarding a DNR should be based on Catholic moral principles and beliefs. You can access free personal consultations from organizations like the National Catholic Bioethics Center to help guide your specific situation. Ultimately, the decision should be made when you are competent and in a condition to do so.
