The Death of St. Fina
THE issue of pastoral care for those facing terminal or debilitating illness has been rendered much more complex by recent legislation that permits physician-assisted suicide in the State of California. It has always been the case that legalization of practices that were formerly forbidden both reflects changing cultural norms and is invariably accompanied by social pressure to “normalize” the now-legal practice. In the case of physician-assisted suicide this is exemplified by a “Suicide Party” (also called a “Right-to-die-Party”) held in Ojai, California, on July 24, 2016. A woman with a terminal illness invited friends to a party that culminated in her taking a lethal combination of drugs. It is worth noting that the victim’s sister who reported the story in a San Diego Newspaper describes herself as having been raised Catholic, and in the article she interprets Jesus’ Cry of Dereliction (Mk.15:34) as justification for the practice of suicide:
“I grew up Catholic; I went to Catholic school where we were taught Jesus’ final words on the cross, when he could no longer take the suffering: “Father, into thy hands I commend my spirit.” Tell me: How’s that not aid in dying?”
This article and the party it describes hint at the kind of pressure priests and other pastoral care-givers will increasingly face from parishoners, family members, and care-givers who become convinced that physician-assisted suicide is a legitimate, compassionate alternative to emotional and physical suffering that may accompany a terminal illness.
1. PASTORAL CARE of PERSONS
WITH TERMINAL ILLNESSES
PASTORAL CARE of those experiencing terminal illness or chronic pain should include:
PALLIATIVE care is especially important. It is encouraged both in recent papal teaching and in the Catechism of the Catholic Church: “Palliative care is a special form of disinterested charity. As such it should be encouraged.” (§2279) The availability and quality of palliative care is significantly endangered by cultural pressure to “mainstream” physician-assisted suicide. Lamentably, some health-care agencies that offer palliative care have decided to include physician-assisted suicide among the “alternatives” they offer. Therefore, those who provide pastoral care should familiarize themselves with agencies and persons in their regions that provide palliative care without encouraging suicide.
2. PASTORAL CARE of PERSONS CONSIDERING
PERSON with terminal illness who request assisted-suicide fear pain and loss of autonomy. They often feel abandoned, or are afraid that they have become, or will become, a burden to their families and care-givers. They are particularly vulnerable to depression. Pastoral care of such persons should include assessment of family networks and support systems, since those unfamiliar with caring for the dying can easily become physically or emotionally exhausted, and may thus inadvertently contribute to the patient’s fear of being a burden.
A particularly difficult pastoral issue arises when a patient who has decided to obtain, or who has already obtained, a lethal dose of medication requests the sacrament of penance and reconciliation and/or the anointing of the sick. Pastoral care of such persons should emphasize the alternative of palliative care, including assistance in recovering a sense of meaning and self-worth as a step towards reconsidering their decision to commit suicide. The moral situation of such persons is complex, as is the question whether it could be possible for them to validly receive sacramental absolution:
My own opinion is that most individuals intending to commit physician-assisted suicide will not be properly disposed to receive absolution in the sacrament of penance and reconciliation, and will thus also not have the disposition necessary to receive the absolution conferred in the sacrament of the anointing of the sick. There could be exceptions to this, but they would depend on states of the individual’s conscience that would be impossible for the confessor to determine with certainty, and which could be finally known only to God. From the pastoral perspective this would not be a situation in which the confessor would be required to explicitly “withhold absolution” for the penitent’s moral good; but rather one in which the confessor recognizes that the formula of absolution would have no effect, and that reciting the formula would actually be a pretense and simulation of absolution.
The appropriate pastoral response would be to explain to the penitent the nature of the sacraments and to do everything possible to help them move towards the goal of repenting of their intention to end their life. In addition to moral encouragement, such pastoral response should include prayer with and blessing of the penitent, but not the provision of a “sham” formula of absolution or a probably-invalid anointing. Thus, if called to care for someone who is known in advance to be planning to commit physician-assisted suicide, the priest should clearly explain beforehand his pastoral plan to the person and/or their family, including the priest’s intention to do everything possible to discourage them from committing suicide.
3. PASTORAL CARE of PERSONS WHO HAVE
COMMITTED PHYSICIAN-ASSISTED SUICIDE
and of THEIR FAMILIES
THE moral rationale for permitting Catholic funerals for those who have committed suicide has traditionally been based on the assumption that the victim lacked the use of reason and was thus not fully aware of the significance of their actions. However, California law specifies that physician-assisted suicide may only be offered to those capable of giving fully-informed consent, and who are free of any mental illness or external coercion that could affect their decision. Thus, in effect, California law demands that physician-assisted suicide be made available only to those whom the Church would traditionally have deemed ineligible for Catholic burial. Nevertheless, it could be argued that the moral disposition of the suicide victim at the time of death could be very different from what it had been at the time they were medically assessed and provided with a lethal dose of medication. Attempted suicide has always been regarded at the very least as a sign of irrationality, and often as an indication of severe mental illness. The Church is not obliged to accept the State of California’s determination that persons eligible for physician-assisted suicide are morally free, fully-informed agents.
Nevertheless, in the social climate of a massive effort to “mainstream” physician-assisted suicide, the effect on the local Catholic community and the potential for scandal inherent in providing Catholic funerals for such persons cannot be ignored. Such ceremonies will certainly be interpreted by many as an indication of the Church’s grudging acquiescence to a shifting cultural mindset that considers suicide a legitimate option for anyone who is afraid of the future or simply tired of life.
However, I am not convinced that forbidding funerals and Requiem Masses for those who have committed physician-assisted suicide would serve a good purpose at this time. From a broader, social perspective it could be argued that, at least in California, overt opposition from the Catholic Church sometimes paradoxically increases public support of the issue the Church opposes. This was certainly the case in California when legislation was passed to fund embryonic stem-cell research. And denying funerals would also deny an opportunity for pastoral ministry and catechesis for affected family members and friends.
My own opinion is that requests for funerals of persons who have committed physician-assisted suicide should be carefully assessed by the local pastor, who is in the best position to determine the disposition of the victim at the time of death. If it is determined that the victim was not subjectively culpable, a funeral may be provided, but with the clear and explicit intention of offering appropriate catechesis concerning suicide during the course of the ceremony. Although a funeral is necessarily oriented towards the important value of consoling the friends and relatives of the deceased, in the current very-confusing secular moral climate it is essential that nothing be said or done that would imply a lessening of the inherent moral evil of suicide. Thus the family should be warned ahead of time that the funeral liturgy will also be used as an opportunity for instruction of the Catholic faithful concerning Church teaching on physician-assisted suicide.
 Pope John Paul II, Evangelium Vitae (1995) §65; Address by Pope John Paul II On the Occasion of the International Conference of the Pontifical Council for Pastoral Health Care. Friday, November 12, 2004, §4-5; Address of Benedict XVI to Ambassadors of Belgium to the Holy See. Thursday, 26 October 2006.
 Thomas Aquinas, Summa.Theologica II-II, Q. 64, Art. 5.
 The psychological trauma experienced by those who participate in the death of a loved one is tragically illustrated in the case of Joe Cruzan, the father of Nancy Cruzan, who obtained permission from the U.S. Supreme Court in a widely-publicized decision in 1990 to withdraw nutrition and hydration from his disabled daughter Nancy. She had been in a persistent vegetative state since suffering brain damage in an automobile accident in 1983. After years of agonizing over the decision and the experience of collaborating in his daughter’s death, Lester “Joe” Cruzan committed suicide on August 17, 1996.
 The bishops describe physician-assisted suicide as “medical aid in dying.” They cite Evangelii Gaudium and the Catechism in support of their directives and argue that “The Sacrament of Penance is for the forgiveness of past sins, not the ones that have yet to be committed.” The Atlantic Episcopal Assembly (of Canada), “A Pastoral Reflection on Medical Assistance in Dying” (Nov. 27, 2016), p. 3: https://www.dropbox.com/s/qeauugxsaqetyh3/AEA%20%20Pastoral%20letter%20medical%20assisted%20dying.pdf?dl=1
 Alphonsus Liguori, Theologia Moralis, Tractate 4, On the Fourth and Sixth Precepts of the Decalog; Ch. 1§ 375, “Whether one who has committed suicide may be buried in consecrated ground”.
 California End of Life Option Act, §443.5, a.1-4.
This Webpage was created for a workshop held at Saint Andrew's Abbey, Valyermo, California in 2002