1. The natural course of diverse diseases; the aggressiveness of modern life, especially that of motor traffic, on people´s health; and the ageing process, all bring human beings closer to the final period of their biological lives. In modern societies, we can also speak of some loss or devaluation of the meaning of life when life is not pleasant for the person concerned.
During this final period, physicians are called upon to practise a very delicate aspect of their professional activity: not curative medicine but caring medicine (also known as “palliative” medicine).
Today, this new aspect of medical activity has its leges artis just as well established as those of preventive and curative medicine.
The first precept is that, for as long as there is reasonable hope of bringing about a cure or an amelioration of the morbid state, achieving a quality of life that is acceptable to the patient, the attending physician must abide by the rules of curative medicine, both the scientific and the ethical. Special attention must be given, from an ethical perspective, to informed consent and the principles of beneficence and non-maleficence; and, from a scientific perspective, to a rigorous scientific evaluation of the situation.
When there is no reasonable hope of a cure, and any presumable improvement depends on treatments that impose heavy physical sacrifices on the patient, the rules of caring medicine must prevail.
The fundamental purpose of this form of medical care is to offer the patient who is at a stage of incurability the greatest physical, mental and emotional comfort and well-being.
The treatments that are to be carried out aim at the alleviation of painful symptoms and at the eradication of those acute conditions that may be cured by immediate medical or surgical interventions (e.g. pneumonia, acute appendicitis).
Medical decisions in the field of caring medicine have a scientific basis; but above all they are rooted in a significant ethical framework. It is not merely the technician who decides what to do with a body whose biological life is running out: it is the medical doctor as a human person, steeped in a long tradition of respect for the patient codified since Hypocrates; the medical doctor as a member of a certain type of society and as the bearer of a certain culture constructed through History; it is that person who has to face the situation of caring for a fellow human who will die within a relatively short period.
Consequently, the ministration of health care during the final period of someone´s life is an eminently ethical act.
2. The present Report will analyse this ethical nature of the medical decisions involved, so as to provide the basis for an Opinion. It will be guided by the doctrine already set forth in this Council´s previous Report-Opinion on Medically-Assisted Reproduction, whose main points are quoted next:
“It is the aim of this Council to promote an ethical reflection which, on the one hand, may be shared by every citizen in our multicultural society but which, on the other hand, will not be limited to an ethically pragmatic approach, to a deontology not grounded on critical analysis, nor to the passive acceptance of practises or positions commonly defended in our own country or abroad.
“Accordingly, the Council defends that the ethical fundamentation must be centred on a concept of human nature which neither reduces it to its purely biological aspect nor extends it unduly to a point where it cannot be distinguished from non-human nature. Several aspects are essential to the nature of the human being - it is rational, temporal, historical, an end in itself, and free. These make it a being in permanent evolution, as it seeks its self-fulfilment, capable of seeking external help, including medical interventions, that does not essentially contradict its own nature (as defined above).
“In that sense, we deem to be ethical all behaviour that seeks, promotes or respects personal self-fulfilment through constructive interaction with others, in the context of just institutions.
“This ethical need for personal and social self-fulfilment (which reveals itself in each person´s awareness of his/her rights and responsibilities in the construction of his/her own life and others lives) requires freedom to be fully exercised. And that freedom makes it imperative that no person be used as an instrument or as a means to any end. Every human person must be considered as an end in itself (..)
“The recognition of this non-instrumental value of each person is an important achievement of our civilisation, and it has been asserted in diverse forms - in the abolition of all kinds of slavery (including that of children); in the universal declaration of human rights and fundamental freedoms; in the recognition of the right to conscientious objection and religious freedom; and so on.
“Ethical freedom does not mean arbitrary choice, permissiveness or moral relativism. What it does mean is the possibility of fulfilling all the potentials of the human person. In this sense, ethical freedom means not only the absence of external constraints but also the liberation from internal pressures, ranging from those originating in scientific, economic or political interests to those based on cultural prejudices or forms of religious positivism that have not been fully integrated (intellectually or emotionally). It also requires internal liberation from petty intellectual possessiveness, vices or self-destructive egoism, and from economic or hedonistic absolutism.”