Tag Archives: death

Matters of life or death

Awareness of Catholic moral principles can help us navigate difficult questions regarding appropriate medical treatment in long-term care and terminal illness.

CONSIDER THESE RECENT NEWS ITEMS:

Vincent Lambert, a 42-year old Frenchman who had been severely disabled, brain damaged, and minimally conscious for more than a decade after a motorcycle accident, was effectively euthanized by starvation in July after doctors removed his feeding tube following a protracted court battle involving family members and medical professionals.

In Ontario, Canada, 27-year old Idan Azrad suffered a traumatic head injury in August and was declared brain dead. Azrad’s family arrived from Israel and transported him to a long-term care facility back home, as Orthodox Jews believe death occurs only when the heart stops.

In British Columbia, 41-year old Sean Tagert, who required a ventilator full time due to amyotrophic lateral sclerosis (ALS), applied for and received a “medically-assisted death” in August, saying he could neither find nor afford the 24- hour nursing care he needed. “I’m just done, worn-out,” he wrote in a Facebook post announcing his request.

 These high-profile cases raise troubling ethical questions regarding treatment options for individuals with terminal illnesses or grave injuries with little or no hope of recovery. Many of the same questions also surface daily in hospitals, long-term care facilities, and hospice situations everywhere — and sometimes even within our own families. 

We know, of course, that “medically-assisted death” (also called assisted suicide, now legal in several U.S. states and in Canada) and euthanasia are never a moral option. But what medical interventions are we morally obligated to undertake in order to sustain life? Under what circumstances can artificial life support be refused or withdrawn? Who rightfully decides this? And what can we do to prepare for the possibility that we might face such difficult decisions in the future? 

Such questions likely would arise while we are forced to process a tremendous amount of information at a time of great emotional stress amid conflicting personal and professional opinions. Understanding Catholic moral principles can enable us to clear away much confusion so as to make prudent and informed decisions.

 Ordinary vs. extraordinary measures

In evaluating medical treatment options, moral theologians distinguish between “ordinary” measures and “extraordinary” measures — those that are morally obligatory and those that are morally optional. 

“The natural law and the Fifth Commandment require that all ordinary means be used to preserve life, such as food, water, exercise, and medical care,” writes Colin B. Donovan, vice president for theology at EWTN. “Since the Middle Ages, however, Catholic theologians have recognized that human beings are not morally obligated to undergo every possible medical treatment to save their lives” — under certain limited circumstances, “even very ordinary ones.”

Generally speaking, an extraordinary measure is a medical procedure that offers little hope of benefit and is excessively burdensome to the patient. “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘over-zealous’ treatment,” states the Catechism of the Catholic Church. “Here one does not will to cause death: one’s inability to impede it is merely accepted.” (#2278)

We don’t have to sustain life at all costs, because ultimately death is inevitable; we were created not just for this life, but for eternal life. At the same time, we cannot cause or intend death; we can only allow the natural process of death to continue. 

“When a person has an underlying terminal disease, or their heart, or some other organ, cannot work without mechanical assistance, or a therapy being proposed is dangerous, or has little chance of success, then not using that machine or that therapy results in the person dying from the disease or organ failure they already have,” Donovan explained. “The omission allows nature to takes its course. It does not directly kill the person, even though it may contribute to the person dying earlier than if aggressive treatment had been done.” 

Nutrition and hydration

 Sometimes the suggestion is made to allow a patient to die by removing a gastric feeding tube, their only source of food and water.

 In 2004, Pope John Paul II said that “the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act.” In principle, he went on, it should be considered ordinary and proportionate care “and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.”

 The last part of the pope’s statement is key. The purpose of food and water is to provide nutrition and to reduce pain. Although in principle morally obligatory, nutrition and hydration can be discontinued if they no longer fulfill these purposes. 

Donovan describes a situation where withdrawing food and water could be permissible: “In the last hours, even days, of a cancer patient’s life, or if a sick person’s body is no longer able to process food and water, there is no obligation to provide nutrition and hydration. The patient will die of their disease or their organ failure before starvation or dehydration could kill them.”

The distinction remains between intentionally killing the patient through lack of nutrition or allowing the person to die of the disease, he noted.

Palliative Care

In long-term care and in terminal cases, it is important to ease the suffering of the patient through palliative care. Complicating this endeavor is that some pain medications have sedative effects and, in some instances, can speed up the dying process. 

The U.S. bishops’ Ethical and Religious Directives for Catholic Health Care Services (ERD), which provides moral guidance for medical professionals, states that terminal patients should be kept free of pain so that they can die in comfort and with dignity. However, it cautions that in order to allow the patient to properly prepare for death, the patient “should not be deprived of consciousness without a compelling reason.”

 That primarily means spiritual preparation — the opportunity to receive the sacraments of the Church and to reconcile with loved ones.

The prudent use of pain-management medications remains licit “even if this therapy may indirectly shorten the person’s life so long as the intent it not to hasten death,” the ERD says. 

Brain Death

Theologically, death is the separation of body and soul, but how can we know when that happens?

Death is certain when heartbeat and respiration cease and the patient cannot be revived. More controversial is the declaration of death through neurological criteria. The American Medical Association defines brain death bluntly: “An individual with irreversible cessation of all functions of the entire brain, including the brain stem, is dead.”

According to the National Catholic Bioethics Center, the Catholic Church accepts this definition of death. “The complete and irreversible loss of all brain function may be taken as a reasonable indicator that the rational soul is no longer present,” says a statement by NCBC ethicists.

 That’s not to be confused with “persistent vegetative state” (PVS). “PVS often involves brain damage, but never death of the whole brain,” explains Father Tad Pacholczyk, NCBC’s director of education. “Genuinely brain-dead individuals never ‘wake up.’ Patients in a PVS occasionally do.”

PVS patients “are not dead,” he stressed.

 Accurate determination of brain death can only be made after a thorough battery of tests repeated at intervals and confirmed by other studies such as an EEG. A brain-dead patient who is kept on a ventilator might seem alive but cannot breathe on his or her own, he noted. Even with a ventilator, the patient’s organs will normally begin failing within a few days. 

Advance Directives

Treatment decisions ideally should be made by the patient, if competent, or “by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected,” the Catechism explains.

An individual might establish advance medical directives to govern end-of-life care. These legal documents come in three main types: a living will, a POLST or “Physician Order for Life Sustaining Treatment,” or the appointment of a health care agent or proxy.

In a living will, the individual lists treatment options to be accepted or rejected under particular circumstances. NCBC ethicists, however, discourage their use. “No matter how well-crafted, such a document can never predict all the possible problems that may occur at a later time or anticipate all future treatment options,” they say in a statement. “A living will can be misinterpreted by medical providers who might not understand the patient’s wishes.”

A POLST provides medical orders allowing health care providers to make these end-of life decisions. These documents vary from state to state, and state Catholic conferences thus have varied opinions on them. For example, whereas the California Catholic Conference calls POLST “a valuable tool,” the Minnesota Catholic Conference says the POLST paradigm “cannot be fully reconciled with a Catholic framework for end-of-life decisions.”

The NCBC highly recommends the third type of advance directive, called a “power of attorney for health care” or a “health care proxy,” and suggests Catholics appoint a trusted individual who understands the moral issues to make treatment decisions for them in the event they are unable to do so themselves.

“In choosing an agent or proxy, a person can declare in writing that all treatment and care decisions made on their behalf must be consistent with and not contradict the moral teachings of the Catholic Church,” said the NCBC statement.

GERALD KORSON is a Legatus magazine staff writer

 

CATHOLIC RESOURCES ON LIFECARE

Ethical and Religious Directives for Catholic Health Care Services (USCCB):

Palliative and Hospice Care: Caring Even When We Cannot Cure (Catholic Health Association):

Killing the Pain, Not the Patient: Palliative Care vs. Assisted Suicide (USCCB):

  •  http://www.usccb.org/about/pro-life-activities/respect-life-program/killingthe-pain.cfm Guide to State-by-State Resources: https://www.catholicendoflife.org/resources/

Discerning death of animals and men

We keep animals as pets, but we don’t do the same with humans. We use animals to make clothing and food, but we don’t do the same with humans. For all our similarities to the rest of the animal kingdom, we are aware of a fundamental difference in kind between ourselves and our furry friends. We are not meant to live and die as animals do, and certainly not to be euthanized as they sometimes are. The death of a human is a more complex event that has other important realities associated with it. 

Our pets seem to process the world around them largely in terms of pleasure and pain, oscillating between these two poles as they instinctively gravitate towards pleasurable experiences, and engage in “mechanisms of avoidance” when they come up against pain or discomfort. Animals really can’t do much else in the face of their suffering apart from trying to skirt around it or passively endure it. Because of our strong sense of empathy, we find it more emotionally acceptable to “put the animal to sleep,” rather than watch it go through a long and agonizing death.

It would be a false empathy and a false compassion, however, to promote the killing or assisted suicide of suffering family members. Just like the animals, on an instinctual level, we tend to recoil and do our best to avoid suffering. We can respond, however, in a way that animals cannot, even to the point of deciding to willingly accept, and “offer up,” our sufferings. Every person encounters some suffering, even if it may be purely internal, like the pain that comes from loneliness, isolation, depression, or rejection. Every person must, in one way or another, confront suffering along the trajectory of his or her life, and human maturity is partially measured by how we address and deal with it.

Suffering challenges us to grasp the outlines of our human journey in a less superficial way, and to value human life and protect human dignity in sickness as well as in health. Victoria Kennedy spoke eloquently to this point when describing Senator Ted Kennedy’s final months: 

“When my husband was first diagnosed with cancer, he was told that he had only two to four months to live. … But that prognosis was wrong. Teddy lived 15 more productive months.… Because that first dire prediction of life expectancy was wrong, I have 15 months of cherished memories. … When the end finally did come—natural death with dignity— my husband was home, attended by his doctor, surrounded by family and our priest.” 

As human beings, we reach beyond the limits that suffering imposes by a conscious decision to accept and grow through it, like the athlete or the Navy Seal who pushes through the limits of his exhaustion during training. We also provide a positive example, and teach strength of character and encouragement to the younger generation as they witness our response to, and acceptance of, our own terminal circumstances. Our trials and tribulations also can serve to teach us important lessons regarding reliance on God and remind us of the illusions of self-reliance.

On the other hand, if our fear of suffering drives us to constant circumlocution and relentless avoidance, even to the point of short-circuiting life itself through euthanasia or physician-assisted suicide, we miss those mysterious but privileged moments that invite us to become more resplendently human, right in the midst of the messiness, awkwardness, and agonies that are sometimes part of the dying process. 

REV. TADEUSZ PACHOLCZYK, PH.D. earned his doctorate in neuroscience from Yale and did post-doctoral work at Harvard. He is a priest of the diocese of Fall River, MA, and serves as the director of education at The National Catholic Bioethics Center in Philadelphia. See www.ncbcenter.org

Seeing stealth euthanasia for what it is

Most of us are aware of the horror of abortion, of parents paying a doctor to kill their child, even if it goes by a sugar-coated name such as “choice” or “planned parenthood.” Too few are aware that at the other end of life, children, in an ironic turnabout, can pay a doctor to legally kill their own parents; the sugar-coated names for this are “hospice” or “palliative care.”

I learned this from the case of my own mother, who recently fell victim to “palliative care” and was killed at the hands of doctors and nurses, on the orders of one of her own children. She had imprudently chosen the wrong child to be her “health care proxy,” who then immediately had her physician sign a bland, one-sentence statement that she was legally incompetent. It is true that my mother was somewhat confused, particularly about time, but she recognized and cared about people, ran her own life, and knew what she wanted. Although she should not have made a major financial decision at that point, she certainly knew whether she wanted to live or die.

Unfortunately, a few months later she fell and fractured her pelvis, requiring a move to a nursing home while the bone healed. The nurses attending her were charmed by her kindness and her stories, and said that with physical therapy she should soon be able to walk again. However, her proxy decided instead that it was time for her to die. My mother was removed from medical care, and placed in hospice, or palliative care. As much as I and my mother fought for medical care, there was nothing we could do. No medical aid, including nutritional supplements or physical therapy, were to be provided – just morphine, ostensibly to relieve pain, but as later made clear, actually to hasten death.

The doctor ordered large doses of morphine at six-hour intervals, whether my mother was in pain or not. Morphine is known to depress appetite; it is used, illegally, by runway models to lose weight. When she weighed little more than 70 pounds and was losing about a pound a day, I asked that she be given a nutritional supplement, such as “Ensure.” I was told it was forbidden, under doctor’s orders. When I asked that the morphine be given only when in pain, I was told it had to be given by the clock. When I confronted the director of nursing, saying “You are allowed to give morphine to relieve pain, but not to hasten death” her reply was, point blank, “Not true – it depends on the quality of  life.” When I asked what the terminal condition was that justified her being put in hospice, the answer was “she is 96 years old and has a broken pelvis.” A broken bone is not a terminal condition. What they were saying is it was time for her to die.

Although her weight dropped to about 60 pounds, she ended up dying not of starvation, but of thirst. When she became too weak to lift a glass to her lips, the nurses were forbidden to syringe any water into her mouth – under doctor’s orders, at the behest of the proxy. My mother’s will to live kept her alive far longer than the “authorities” wished, but she eventually died after an excruciating last few weeks.

The irony is that as a young Jewish woman in Germany in the 1930s, she was slated to be exterminated at Auschwitz, but miraculously escaped from the train en route. Ironically, 75 years later she died a 60-pound skeleton, looking for all the world like an Auschwitz victim, killed not by that Holocaust but by our own Holocaust, that of our “culture of Death.”

 

ROY SCHOEMAN  is a Jewish entrant into the Catholic Church, best known for his writing and speaking on the Jewish roots of the Church, particularly in his bestseller, Salvation Is from the Jews. He has taught theology at Ave Maria University and Holy Apostles Seminary, and currently hosts a weekly radio show on Radio Maria.

We each build our own bridge

It has been said that death is the most important thing in life. How we die – the state of our soul at that critical instant, and the moral choices that affect it – is the only thing we can ultimately control. Everything else in life – worldly successes and failures, reputation, vocation, family, health, business, friendships – is not fully in our grasp to engineer exactly as we want.

Christine Valentine-Owsik

The beginning of each year dazzles with new possibilities. New ventures are sought, relationships pursued, improvements planned, so much beckons on the horizon.

It can be a shame to confuse distraction with destination.

When St. Thomas More was approached shortly before his beheading by those encouraging him to acquiesce to King Henry VIII’s demands for a sanctioned divorce and pretend to set aside his deference to Catholic teaching, Thomas simply said: “The way we die is in our own hands.”

Our purpose is to be ready for that heroic moment. The second our soul departs our body, we are met by God on how we handled what He taught and provided us, then are awarded our eternal destiny. And even though He is the final arbiter, we had a lifetime to affect the decision.

It begs the question on how we spend our time and resources, and what comprises top priority. Life can be short or long, well lived or not, valued or cheapened, taken seriously or flippantly.

On a recent morning after Mass, I watched two trench-coated men enter the church to arrange for a funeral. They set up two easels for holding picture-boards of the deceased, whom I saw was a striking young man in his 20s, about the age of my sons … handsome, athletic, with a pretty girlfriend, plenty of social life, everything seemingly going for him. I slid closer to study the photos – he attended a prominent college, had a nice car, and there seemed to be many good times and parties. Life was good.

Then the funeral director placed a small burnished urn on a table between two tall sprays of lilies. Wow, and there he is. I wondered what happened to him, and asked the usher. “He was in a horrible car accident a few nights ago, several were killed instantly.”

His attractive parents walked to the front of church, stunned and tearful. His mom looked at the urn and deftly reordered the flowers, then put both hands over her face and shook. The stark reality of death – like being burned in a fire – peels away layers of protective artifice to reveal our raw longing to know what happens after this life.

“Death is nothing to be feared when we keep ourselves always prepared,” a priest once told me. I’d never thought of it like that, but began to. “Live every day, every hour, like it may be your last,” he advised.

St. Alphonsus Liguori, one of the great doctors of the church, said “time is as valuable as God Himself.” Our soul is our most valuable asset – it’s our bridge to eternity. How we invest in it and preserve its worth is our most important ongoing decision.

CHRISTINE VALENTINE-OWSIK is Legatus magazine’s Editor.

Is a soul conscious after death?

A distinguished group of Catholic bioethicists had gathered in a conference room of a Washington, D.C., hotel to discuss the topic of brain death. When my turn came for a presentation, I was in for a shock.

Edward J. Furton

Within 10 minutes, the room grew uneasy. There were quizzical looks and the shuffling of papers. One of the attendees became angry and began to shout. His words were at first unintelligible — they included complex Latin quotations — but it became clear that he was objecting to my statement that the intellective soul survives the death of the body.

The discussion continued for weeks afterwards via email. To my surprise, I discovered that the majority of these distinguished thinkers did not know that the soul continues in conscious existence after separation from the body. One influential figure told me that at death, the soul went into a deep unconscious state and lacked all awareness. Another said that the soul ceased to exist at all until it was reunited with the resurrected body. Yet the Church teaches that at death there is a “particular judgment” that either unites the soul with the life of Christ in heaven (often through purgatory) or condemns it to eternal damnation (Catechism of the Catholic Church, #1021). This event precedes the “last judgment” and the resurrection of the dead (CCC #1038).

Death is the separation of the soul from the body, but the soul does not lose consciousness — or cease to exist — when it undergoes that separation. The soul is fully aware of the particular judgment. This is not to deny in any way that the soul is the substantial form of the body. The two form a composite union, but the soul has its own principle of existence, given to it by God. As a spiritual entity, the soul doesn’t need the body to exist or to engage in thought. The soul has an “intellective memory” that survives death and can also have new thoughts through God’s direct infusion of ideas into the mind.

These are interesting philosophical inquiries, but they also have some measure of empirical support from a remarkable phenomenon within the field of medicine. Some patients who are dead by standard medical criteria report after resuscitation that they were aware of efforts to revive their bodies and are able to describe specific events that occurred then. Thus a patient might say, “I saw a nurse wearing a red cap enter the room, give the physician a syringe, and then leave.” But during that time the patient had no heartbeat, no brain function, and no signs of life, but lay on the operating table dead.

Revived patients who experience these events often describe a feeling of looking down on the room from above, but the question of location is really not important. What matters from an evidentiary point of view is the accuracy of their accounts. If the soul ceased to exist at death, or fell into a state of complete unconsciousness, it would not be able to know anything. But in these cases, the patient is able to describe details about events connected to the resuscitation that could not possibly have been known unless he or she were somehow still aware.

One of the most comprehensive surveys of this phenomenon is titled “AWARE” (Parnia et al., Resuscitation 85.12, Dec. 2014, 1799-1805). The study shows that 40% of patients who survived cardiac arrest were aware during the time that they were clinically dead. If death is the separation of the soul from the body, as the Church teaches, then these cases should not surprise us. The person has indeed died because the soul has separated from the body, but a successful resuscitation causes the soul to return life to the body. The particular judgment does not take place because death had not been finalized.

Of course, we live in an age of materialism. Those who hold that there is no life after death tell us that these experiences are the result of chemical imbalances in the brain or some other purely material cause. Yet that view cannot explain the factual nature of the accounts. Hallucinations caused by chemical imbalances don’t produce accurate reports.

Given that Church teachings on the nature of the soul are not matters of faith but are evident to reason, such studies provide an important type of empirical evidence. I have met physicians who have experienced this phenomenon, but they are uneasy speaking about it. They fear ridicule from their colleagues. At least they aren’t likely to be shouted at in Latin!

EDWARD J. FURTON, PH.D., is a staff ethicist and the director of publications for the National Catholic Bioethics Center.

Why do Catholics offer Masses for the dead?

Christians know that death is not the end of life but the real beginning. Freed from the imperfections of earthly existence, the dead are more alive than we are. They are with us, and we still live with them in love.

Mike Aquilina

St. John tells us about the heavenly Jerusalem in Revelation. It’s more beautiful, more glorious, than we can imagine. “But nothing unclean shall enter it,” he adds (Rev 21:27). So the Catholic Church tells us that there is a purification after death. St. Paul hints at it when he writes to the Corinthians about building on the foundation of Christ:

“For no other foundation can anyone lay than that which is laid, which is Jesus Christ. Now if anyone builds on the foundation with gold, silver, precious stones, wood, hay, straw — each man’s work will become manifest; for the Day will disclose it, because it will be revealed with fire, and the fire will test what sort of work each one has done. If the work which any man has built on the foundation survives, he will receive a reward. If any man’s work is burned up, he will suffer loss, though he himself will be saved, but only as through fire” (1 Cor 3:11-15).

In metalworking, fire burns off the impurities, leaving only pure metal. Paul sees the same sort of thing happening on the Day of the Lord. Whoever has built on the foundation of Jesus Christ will be saved, but first “fire” will purify us. This purification is what we call purgatory. There all our impurities are cleaned away and we are made ready to enter heaven. We offer Masses for the dead as a way of speeding that purification for them.

Offering sacrifices for someone else is certainly no new idea. It was common practice in Old Testament times. “Job’s sons used to go and hold a feast in the house of each on his day; and they would send and invite their three sisters to eat and drink with them. And when the days of the feast had run their course, Job would send and sanctify them, and he would rise early in the morning and offer burnt offerings according to the number of them all; for Job said, ‘It may be that my sons have sinned, and cursed God in their hearts.’ Thus Job did continually. (Job 1:4-5)

Job, who was “blameless and upright,” offered sacrifices for his sons just in case. Offering sacrifice for another is something a good person was expected to do.

If indeed the dead are still with us, and even more alive than we are, then it would be shameful neglect not to pray and make offerings for them as much as for the living. The second book of Maccabees tells us how Judas Maccabeus offered prayers and sacrifices for his dead soldiers when he discovered that they had sinned.

We Catholics pray and offer Masses both for the dead and for the living — and for exactly the same reasons.

MIKE AQUILINA is the author or editor of more than 40 books on Catholic history, doctrine and devotion. This column is reprinted with permission from his book Understanding the Mass: 100 Questions, 100 Answers (Servant Books, 2011).

Catechism 101

From the beginning the Church has honored the memory of the dead and offered prayers in suffrage for them — above all the Eucharistic sacrifice — so that, thus purified, they may attain the beatific vision of God. The Church also commends almsgiving, indulgences and works of penance undertaken on behalf of the dead.

Let us help and commemorate them. If Job’s sons were purified by their father’s sacrifice, why would we doubt that our offerings for the dead bring them some consolation? Let us not hesitate to help those who have died and to offer our prayers for them.

Catechism of the Catholic Church, #1032

Living with the end in mind

I attended a number of funerals this past Lent — and we as a country experienced the tremendous loss of a truly heroic Catholic and Supreme Court justice: Antonin Scalia.

Tom Monaghan

When I attend funerals or contemplate the loss of someone like Justice Scalia, I cannot help but wrestle with my own mortality. Of course we all know intellectually that we are going to die and that it’s a question of when, not if. But do we really live like we are going to die? By which I mean: Does it affect our day-to-day decisions?

The traditional Ash Wednesday prayer when we are marked with the sign of the cross is, “Remember that you are dust, and to dust you shall return” (Gen. 3:19). The Church obviously wants us to keep this in mind. Many of the great saints also exhorted us to be mindful of our final end. Saint Bonaventure wrote, “To lead a good life, a man should always imagine himself at the hour of death.” We often see pictures of saints with a skull on their desk. While at first glance this might seem morbid, this was to remind themselves that this world is not their ultimate end.

In 21st century America, the whole reality of death is almost hidden. With all the advances in medicine, we can be made to feel like we will live forever. Of course no one would ever say this outright, but we might be tempted to live with this underlying principle. Youth, health, strength, beauty are all good things, but our culture idolizes them almost to the point of denying that we will die one day.

When we think or talk about running our businesses and making goals, whether we do so consciously or not, many of us use “Habit 2: Begin with the End in Mind,” made famous by Stephen Covey in The 7 Habits of Highly Effective People. This is exactly what the Church teaches us when we’re encouraged to contemplate our final end.

We are in the Year of Mercy, as declared by our Holy Father. However, unless we understand that we need mercy, seeking or receiving mercy is not going to mean a whole lot to us or to those around us. However, when we really do a thorough examination of conscience and get in touch with our sinfulness and our need for God’s mercy, that’s when we can truly seek and receive it.

TOM MONAGHAN is Legatus’ founder and chairman.

What are the Four Last Things?

PETER KREEFT breaks down the Catholic understanding of God’s judgment . . .

Peter Kreeft

Peter Kreeft

The Church’s teaching about life after death is summarized in the Four Last Things — death, judgment, heaven, and hell. However, even humanity outside the Church instinctively knows something about these four things.

Life’s one certainty is death. Everyone knows this, though not everyone knows what comes next. Nearly all religions, cultures and individuals in history have believed in some form of life after death. Man’s innate sense of justice tells him that there must be an ultimate reckoning, that in the final analysis no one can cheat the moral law and get away with it or suffer undeserved injustices throughout life and not be justly compensated. Since this ultimate justice does not seem to be accomplished in this life, there must be “the rest of the story.”

This instinctive conviction that there must be a higher, more-than-human justice is nearly universal. Thus the second of the Four Last Things, judgment, is also widely known. As Scripture says, “Whoever would draw near to God must believe that he exists and that he rewards those who seek him” (Heb 11:6). The final judgment is an encounter with Christ.

Most men also know that justice distinguishes the good from the evil and, therefore, that after death there must be separate destinies for us — rewards for good and punishments for evil. Thus mankind also usually believes in some form of heaven and hell.

There are only two eternal destinies: heaven or hell, union or disunion with God. Each one of us will be either with God or without him forever. If hell is not real, the Church and the Bible are also liars. Our basis for believing in the reality of hell is exactly the same authority as our basis for believing in the reality of heaven: Christ, his Church, and her scriptures.

If hell is not real, then Jesus Christ is either a fool or a liar for he warned us repeatedly and with utmost seriousness about it. There is no reincarnation, no “second chance” after time is over. There is no annihilation, no end of the soul’s existence. There is no change of species from human being to angel or to anything else.

The particular judgment occurs immediately after each individual’s death. The general judgment takes place at the end of all time and history.

So the scenario of final events is: (a) first, death; (b) then, immediately, the particular judgment; (c) then, either hell, or purgatory as preparation for heaven, or heaven; (d) and, at the end of time, the general judgment; (e) and the “new heavens and new earth” for those who are saved.

PETER KREEFT, a professor of philosophy at Boston College, is the best-selling author of over 75 books. This column is reprinted with permission from his book “Catholic Christianity: A Complete Catechism of Catholic Beliefs Based on the Catechism of the Catholic Church” (Ignatius Press, 2001).


Catechism 101

Death puts an end to human life as the time open to either accepting or rejecting the divine grace manifested in Christ. The New Testament speaks of judgment primarily in its aspect of the final encounter with Christ in his second coming, but also repeatedly affirms that each will be rewarded immediately after death in accordance with his works and faith.

Each man receives his eternal retribution in his immortal soul at the very moment of his death, in a particular judgment that refers his life to Christ: either entrance into the blessedness of heaven — through a purification or immediately — or immediate and everlasting damnation. At the evening of life, we shall be judged on our love.

Catechism of the Catholic Church, #1021-1022

What happens after we die?

Scholar Peter Kreeft writes that death teaches us the infinite value of human life . . .

Peter Kreeft

Peter Kreeft

Nothing brings home to us the importance and value of human life more sharply than death. We seldom appreciate life until we realize how fragile it is, when friends and family are taken from us by death.

Death clarifies our perspective, sharpens our sight, and brings our whole life to a point, like the single summit of a many-sided mountain. Death teaches us all the truth of Jesus’ words: “Martha, Martha, you are anxious and troubled about many things; one thing is needful” (Lk 10:41). That “one thing” is God. Only God is necessary in his own being, and only our relationship with him is absolutely necessary for our being.

I don’t know any specific facts about you. I don’t know your present life, whether you’re believer or unbeliever, saint or sinner, young or old. I don’t know your past. I don’t know your future, what the rest of your life in this world will be like or whether you’ll spend eternity in heaven or in hell. Only one concrete fact do I know with certainty about you: You will die.

The Church knows that about you too, but the Church also knows the meaning of death. The Church comes to you as a newspaper reporter with a startling piece of good news about death — and life after death — from the Man who claimed to be God and proved it by rising from death. The skeptic asks, “What do you know about life after death anyway? Have you ever been there?” And the Catholic answer is: “No, but I know Someone who has, and I believe him.” We Catholics know Him — that is the essential thing we know and the essential reason to be a Catholic — and therefore we know the meaning of death, through his witnesses, his apostles and their successors, the Church.

Death is both very bad and very good (if we are in Christ). It’s very bad because what is lost is very precious: life, the body, the whole world to the individual who dies. Christ wept at his friend Lazarus’ grave, and so should we if we love life as He did. But death is also very good if we die in Christ, because what is gained is infinitely more than what is lost. For if we live in Christ, death means only more of Christ and more of life. This body dies, like a precious little seed, but a greater body rises, like a greater and glorious plant (see Jn 12:24 and 1 Cor 15:35-53).

PETER KREEFT, a professor of philosophy at Boston College, is the best-selling author of over 75 books. This column is reprinted with permission from the book Catholic Christianity: A Complete Catechism of Catholic Beliefs Based on the Catechism of the Catholic Church (Ignatius Press, 2001).


Catechism 101

It is in regard to death that man’s condition is most shrouded in doubt. In a sense, bodily death is natural, but for faith it is in fact “the wages of sin.” 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.

Death is the end of earthly life. Our lives are measured by time, in the course of which we change, grow old and, as with all living beings on earth, death seems like the normal end of life. That aspect of death lends urgency to our lives: Remembering our mortality helps us realize that we have only a limited time in which to bring our lives to fulfillment.

Catechism of the Catholic Church, # 1006, 1007

Making tough end-of-life decisions

John Haas writes that Catholics should be equipped to address end-of-life questions . . .

Dr. John Haas

The National Catholic Bioethics Center provides over 1,400 consultations in a given year. Without a doubt, the issue most often raised with our ethicists has to do with making difficult, sometimes heart-wrenching, decisions at the end of life.

Catholics, however, should be the best equipped to address these challenges calmly. After all, we know that our final destiny lies not here but in the life beyond the grave. Also, how many times a day do we bring up our own death when we pray the Hail Mary? And then there’s the wonderful Catholic devotion of praying to St. Joseph for a holy death.

Nonetheless, when we face the challenge of making decisions for our loved ones, it can be very difficult. We don’t want them to suffer on the one hand, and we don’t want to lose them on the other. We’re also sometimes conflicted because we don’t know exactly what the Church would have us do.

Because of our love for life, many Catholics think the Church insists that we use every means available to keep someone alive as long as possible. This is not the case. The U.S. bishops have issued a guide known as The Ethical and Religious Directives for Catholic Health Care Services. This useful document, however, cannot tell Catholics exactly what must be done in every situation. Decisions must be taken in each individual case — and there are countless details that can enter into each situation.

For this reason, the Church generally discourages the use of a “living will” or “advance medical directive” which presume to state what one wants at the end of life (for example, “I do not want tubes”). However, one cannot know ahead of time whether the “tube” will alleviate suffering or assist in significantly extending one’s life. This is why we at the Center encourage people to designate a “health care proxy,” someone to make decisions on their behalf when they’re no longer able to do so.

One time I received a “living will” from a parish priest who asked me to read through it to see if it was ethically sound. He had written 27 pages, single-spaced, about what medical interventions ought to be taken if this or that happened. I wrote him back and said, “Father, I have one criticism of your living will: It’s not long enough!” It was not long enough because we simply cannot anticipate all the problems that could arise. That’s why it’s better to designate a trusted friend or family member who can make such decisions when you can’t.

But what about some specific advice our tradition can give us? Directive 56 of the Directives reads: “A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.” This is a very helpful guideline for Catholics, and it’s obvious that the facts of the case can vary with each individual.

It’s important to note that the judgment with respect to what would constitute an excessive burden or an excessive expense rests with the patient. It might be that the patient simply doesn’t believe that an experimental cancer treatment which has terrible side-effects and which might extend his or her life for two months offers a “reasonable hope of benefit.”

Or the patient might prefer that family resources be used to send his last child to college rather than be used on an experimental treatment. This ought to be a judgment made by the patient, not by an insurance company or a governmental agency!

And one step we should certainly take near the end of our earthly pilgrimage is to call a priest to bring the comfort and joy of the sacraments of Reconciliation and Anointing.

The bishops’ Directives remind us that we must ultimately be prepared for eternity. “The dignity of human life flows from creation in the image of God, from redemption by Jesus Christ, and from our common destiny to share a life with God beyond all corruption.” The only thing that could risk the loss of that shared destiny is sin.

The bishops’ Directives are available at the USCCB website or through The National Catholic Bioethics Center. The Center also provides the simple and easy to understand Catholic Guide to End of Life Decisions, which includes a form for an “advance medical directive” or the designation of a “health care proxy” which conforms to Catholic moral teaching.

John M. Haas, PH.D., is president of the National Catholic Bioethics Center and founding president of the International Institute for Culture. He is a member of the Pontifical Academy for Life.