The Roman Catholic Church issued moral and ethical guidelines yesterday for Marylanders facing difficult right-to-die decisions, saying that "burdensome and fragile lengthening of one's life" is not always necessary.
At the same time, "care and protection, including food and water," must never be withheld from terminal patients merely because their condition is what a new Maryland law describes as "end stage," the church authorities said -- "even if advanced medical treatments are judged as extremely burdensome."
The nuanced and sometimes seemingly contradictory moral guidance was contained in a 13-page, single-spaced pastoral letter issued by the cardinal, archbishop and seven bishops who are the spiritual leaders for about 700,000 Catholics living in Maryland.
The document was also addressed to the state's eight Catholic hospitals, which last year served 565,000 patients, many of them not Catholics.
The Pastoral Letter on the Care of the Sick and Dying is intended to supplement the Health Care Decision Act -- the so-called "right-to-die" legislation -- passed by the General Assembly in April.
This law, allowing the refusal of medical care or intravenous feeding not only for people near death but when they are incapacitated by such long-term illnesses as Alzheimer's and AIDS, went into effect Oct. 1.
At a news conference yesterday at downtown Baltimore's Mercy Medical Center, Richard J. Dowling, the Catholic Church's lobbyist in Annapolis, criticized the law for what he called its potential for abuse of the elderly and said the church would offer some as yet unspecified amendments in the next legislative session.
Clergy should be consulted
Archbishop William H. Keeler said Catholic families should seek the opinion of a parish priest or a theologically trained hospital chaplain before making the end-of-life decisions now legally possible. The archdiocese is planning continuing education for clergy and other counselors to equip them for this task, he said.
Among the principles set forth in the pastoral letter and considered immutable under Catholic doctrine, the archbishop said, are:
* The God-given right to human life is a precious gift and must always be protected.
* It is gravely immoral to withhold basic care, comfort or medical ++ treatment for the purpose of hastening death.
* Human suffering can have positive value "as an opportunity to share in the sufferings of Christ, to strengthen others by loving acceptance of the cross, and as a way of preparing for eternal life."
* No patient -- or person acting for one -- should accept or demand a useless treatment, but this does not mean that treatments with limited beneficial effects should be rejected.
* Even if a medical treatment promises a possibly useful result, there is no moral obligation to pursue it if it imposes "serious risks, excessive pain, grave inconvenience, prohibitive costs or some other extreme burden."
* Despite the proper rejection of a particular medical treatment as too burdensome, "we may never morally conclude that our lives are useless or burdensome."
Archbishop Keeler said the pastoral letter will be printed and distributed widely and made available through his office to anyone wishinga copy.
Letters not always followed
Catholics do not always agree with or follow in good conscience the teachings in their bishops' pastoral letters -- such as the widely ignored reaffirmations of the ban on artificial contraception -- but the letters are considered authoritative statements of the position of the worldwide church on the issues discussed.
The Baltimore archbishop was joined at the news conference by Monsignor William E. Lori, principal author of the letter, who is secretary to Cardinal James A. Hickey of Washington. The Maryland counties of Montgomery, Prince George's, Charles, Calvert and St. Mary's are part of the Washington archdiocese.
Other signers of the letter included Bishop Robert E. Mulvee of the Wilmington, Del., diocese -- which includes the Eastern Shore of Maryland -- and six auxiliary bishops of Baltimore and Washington.
"We cannot, of course, provide a ready-made answer for each situation," the letter said.
Role for living wills
Discussing the provisions of the new Maryland law under which people may decide in advance what life-sustaining efforts should be made if they become unconscious or unable to communicate, Archbishop Keeler said, "We see a role for living wills, but there are limitations from an ethical point of view."
He said he and the other authors of the pastoral letter believe "it is definitely preferable to appoint a prudent health care agent who will follow church teaching rather than to draw up a living will."
The pastoral letter instructs that "care should be taken that a living will not become a means of refusing a morally required treatment or of removing prematurely some life-sustaining procedure."
Oral directives to physicians, which the Maryland law permits as an alternative to written instructions, pose a particular danger, Mr. Dowling said. He pointed to the pastoral letter's caution that "no one should make an oral directive without proper forethought, wise counsel and an awareness of the consequences of such important decisions."