Fear is a natural reaction to the unknown, to danger, or to pain. Certainly, a diagnosis of a debilitating or terminal illness can easily put a person into a panic. Though fear in these situations is natural, it isn’t helpful. Fear can impede recovery and actually increase pain and fatigue. Fear can move us to make rash or foolish choices or paralyze us into inaction.

If fear is natural, its remedy is not – the cure for fear is above our nature. It is supernatural. Faith fixes fear. And faith is a gift from God. Ask God for the grace to trust Him in whatever lies ahead. You can depend on His loving care to help you move beyond the fear you feel now, and to find strength, hope and comfort in the promises of Jesus Christ.

 

Q. What does the Catholic Church teach about death?+

Death is the separation of the soul from the body. We believe that the body and soul will be reunited on the day of the resurrection of the end of time.

Death is the end of earthly life. As with all living beings on earth, death seems like the normal end of life.

Death is a consequence of sin. Although our nature is (now) mortal, God had destined us not to die. Death entered the world as a consequence of sin.

Death is transformed by Christ. The obedience of Jesus even unto death transformed the curse of death into a blessing. Restoring us to friendship with God.

(Catechism of the Catholic Church, paragraphs 1005-1019)

Q. What should I expect when I am dying?+

About 10% of us, one in ten, will die suddenly and unexpectedly, often through an accident or a sudden medical event like a heart attack or major stroke. The rest of us will live with one condition or another for many weeks, many months or many years, and will eventually die from it. These include conditions like a cancer that cannot be cured; advanced diseases of the heart, lungs, kidneys and brain; and conditions like dementia, or even just old age and frailty.

Different illnesses follow different “trajectories,” from diagnoses to death and describe what happens along the way in terms of ability to function, getting on with daily lives, and engaging in normal activities.

Clinical experience and research show that there are three main typical trajectories. These are “typical” or average trajectories that most people with these conditions may experience, but they can vary from person to person. Not everyone with a specific disease will necessarily follow the same journey or trajectory.

  1. The Cancer Trajectory 

 

There are two cancer trajectories:

Person diagnosed with a disease that it curable. The person is diagnosed with cancer, undergoes treatments, and the cancer is cured or goes into remission. This happens with a lot of cancers these days – much more often than, say, 20 or 30 years ago, especially if they are diagnosed early. Some cancers, such as breast and prostate cancer, are increasingly responding well to new treatments. This allows the disease to slow down or even reverse for a while, resulting in an illness trajectory that looks more like the chronic disease journey.

Person diagnosed with a disease that is not curable. Patients will notice a gradual decline or reduction in what they can do on this trajectory or journey. Over months or years (or sometimes weeks), they will notice that they are not able to do what they used to do before. The get progressively more fatigued, spending more time resting. At one point they may find that their appetite starts decreasing, they start eating and drinking less, and they spend more time sitting or resting. They might be losing weight. 

There may be an unexpected complication, like a lung infection or side effect to a treatment, which makes them feel very sick and perhaps even staying in bed or in hospital. With treatments, they rebound, but not to the same level of activity as before. This journey is gradual, with increasing dependency on others for “activities of daily living.” 

Then, in the last months or weeks, the progression can be more rapid. Within weeks, they may find themselves having to spend most of the time resting. They may experience rapid weight loss. Some symptoms may worsen, such as shortness of breath or pain. They will need more help doing things like bathing. They will eat less and spend more time sleeping. 

  1. Chronic Disease Trajectory of Organ Disease or Failure 

This trajectory is more often seen in patients with serious heart, lung, liver and kidney diseases. In these trajectories, patients experience very gradual declines in their functioning, often over many years or many months. However, they experience occasional serious complications or events, such as a sudden reduction in their heart function (in medical terms, we call it decompensation of the heart) or a lung infection in a patient with chronic lung disease that reduces their functional level quickly and dramatically, sometimes even to the point that they need to be hospitalized. With treatment of the disease or the complication, they rebound and regain strength. 

However, when they rebound, they do not reach the same levels of functioning as before. Then, over time, they start needing more and more help with their daily activities, they start eating less and then, in the last weeks and months, they may have to spend most or all of the time resting or in bed.

  1. Dementia or Frailty trajectory

Lastly, there is the journey that is typical for dementia or frailty. The person declines very gradually, over many years. Occasionally, there may be complications, as in the previous journey, from which people can rebound. With some rarer types of dementia, the decline may be a lot more rapid – within a few years. Sometimes a complication can occur that can speed up the decline and frailty, such as a fall with a hip fracture or new heart disease or stroke.

References:

Jynn J. Perspectives on care at the close of life. JAMA 2001;285 (7):925–932

Murray S, et al. Illness trajectories and palliative care. BMJ 2005;330(7498):1007–1011

Q. Can I request euthanasia or assisted suicide as a treatment option?+

No. The purpose of treatment in health care is to maintain, restore, or promote health and well-being. Euthanasia and assisted suicide do none of these things. Rather, the sole purpose is to intentionally cause death. “Intentionally causing one’s own death (suicide), or directly assisting another in such an action (assisted suicide), is morally wrong” and cannot be chosen as a treatment option (Catholic Health Alliance of Canada, Health Ethics Guide, 2012).

Q. What is palliative care?+

Palliative care is care to relieve the symptoms and stress of living with a serious illness. This is especially true of those who suffer through the complications of age, disability and/or disease. The goal of true palliative care is to relieve physical, psychological, social, and spiritual suffering. It helps patients and their loved ones go through the end of life in a truly dignified way. Click HERE to learn more about palliative care.

Q. Is euthanasia or assisted suicide part of palliative care?+

No. The World Health Organization (WHO) says that palliative care “intends to neither accelerate nor postpone death.” However, although “medical assistance in dying” is not currently part of palliative care in Canada, recent legislation passed in Quebec obliges all palliative care facilities in the province to offer doctor-supplied end of life. There is a push to pass similar legislation in other provinces and at the federal level.

Q. Is withdrawing treatment the same as euthanasia or assisted suicide?+

No. When a person reaches a point where continued intervention is deemed futile or disproportionate (the expected burdens of the treatment are greater than the expected benefits), withdrawing treatment simply allows nature to take its course. However, medically assisted nutrition and hydration must be given until the person can no longer benefit from this care. Withholding or withdrawing nutrition and hydration must never be done to hasten death (Catholic Health Alliance of Canada, Health Ethics Guide, 2012).

Q. If I request euthanasia or assisted suicide, can I receive the Sacraments?+

As long as there is potential for a change of heart, you may receive the Sacrament of Anointing. However, if you refuse to turn away from the intention to die by euthanasia or assisted suicide, then the priest must deny the sacrament. As minister of the sacraments, the priest is at once both judge and healer. He is ultimately concerned with the salvation of your soul. The same is true for the Sacrament of Penance. As the penitent, you must be contrite and willing to leave behind your sins. If you intend to die by euthanasia or assisted suicide, then you are choosing to participate in a gravely sinful act. Without contrition, the priest will be unable to offer absolution (forgiveness of sins).

 

Q. If I choose to die by euthanasia or assisted suicide, can I receive a Catholic funeral?+

The first thing to keep in mind is that all Catholic funerals are offered for sinners. However, the Church does require that the funeral be a sign of faith, and respectful of the conscience and decisions made by the person who has died. When a person chooses to die by euthanasia or assisted suicide, the Church must ask:
  • Did the person willingly choose euthanasia or assisted suicide, knowing it was contrary to the faith?
  • Was the person high-profile – or notorious – and his or her choice well known?
  • Did the family support or even celebrate the choice?
  • Would the celebration of a Catholic funeral cause scandal, encouraging others to engage in this evil?
  • The priest will explore these questions and more with your family before a funeral mass can be offered.

If the official funeral rites are denied, the priest may offer alternatives such as a Liturgy of the Word at the funeral home, simple prayers at the graveside, or a memorial mass at a later date.

 

Q. What is palliative (terminal) sedation?+

Terminal sedation is the medical term used for intentionally giving sedatives during a terminal illness to cause unconsciousness, even permanent unconsciousness. When opioid medication became available in the 1940s, Pope Pius XII used the principle of double effect to explain that Roman Catholics may use this type of medication in serious cases to reduce pain, even if it does have the side effect of shortening life. His teaching reassures us that, since we are not intending death, and are intending relief of pain and suffering, then it is morally permissive to make use of sedatives in this way.
 
Some health care providers have started to use terminal sedation to mean giving patients at the end of life higher levels of sedation than would simply relieve pain, with the intention of bringing about death. We would call that, more straightforwardly, euthanasia. There is clearly a world of difference between causing death and relieving pain. Some have suggested palliative sedation as a better term for the latter, but in fact it is the intention of the person administering the drugs that determines what is really happening. From Bioethics Matters (2023) by Dr. Moira McQueen, pp. 91-91.