Introduction

The Good Samaritan who leaves his path to help the sick man (cf. Lk 10 : 30-37) is the image of Jesus Christ who meets the man in need of salvation and takes care of his wounds and his pain. with "the oil of consolation and the wine of hope". ^[1] He is the physician of souls and bodies and "the faithful witness" ( Rev 3, 14) of the saving presence of God in the world. But how can this message be made concrete today? How to translate it into a capacity to accompany the sick person in the terminal stages of life in order to assist them by always respecting and promoting their inalienable human dignity, their call to holiness and, therefore, the supreme value of their very existence?

The extraordinary and progressive development of biomedical technologies has exponentially increased the clinical capabilities of medicine in diagnostics, therapy and patient care. The Church looks with hope to scientific and technological research, and sees in them a favorable opportunity of service to the integral good of life and the dignity of every human being. ^[2] However, these advances in medical technology, although valuable, are not in themselves decisive for qualifying the proper meaning and value of human life. Indeed, any advancement in the skills of health workers requires a growing and wise capacity for moral discernment ^[3]to avoid a disproportionate and dehumanizing use of technologies, especially in the critical or terminal phases of human life.

Furthermore, the organizational management and the high articulation and complexity of contemporary health systems can reduce the relationship of trust between doctor and patient to a purely technical and contractual relationship, a risk that looms above all in countries where laws are being approved that legitimize forms of assisted suicide and voluntary euthanasia of the most vulnerable patients. They deny the ethical and juridical boundaries of the sick subject's self-determination, obscuring in a worrying way the value of human life in illness, the meaning of suffering and the meaning of the time before death. Pain and death, in fact, cannot be the ultimate criteria that measure human dignity, which is proper to every person, for the sole fact that he is a "human being".

Faced with these challenges, capable of putting into play our way of thinking about medicine, the meaning of care for the sick person and social responsibility towards the most vulnerable, this document intends to enlighten pastors and the faithful in their concerns and their doubts about the medical, spiritual and pastoral assistance due to the sick in the critical and terminal phases of life. All are called to give witness alongside the sick and become a "healing community" so that Jesus' desire that all may be one flesh, starting with the weakest and most vulnerable, is concretely realized. ^[4] In fact, the need for moral clarification and practical guidance on how to assist these people is perceived everywhere, since "a unity of doctrine and practice is necessary"^[5] with respect to such a delicate issue, which concerns the weakest patients in the most delicate and decisive stages of a person's life.

Various Episcopal Conferences in the world have published pastoral documents and letters, with which they have tried to respond to the challenges posed by assisted suicide and voluntary euthanasia - legitimized by some national laws - with particular reference to those who work or are hospitalized inside hospitals, including catholic ones. But the spiritual assistance and the doubts that arise, in certain circumstances and particular contexts, about the celebration of the Sacraments for those who intend to put an end to their life, today require a clearer and more precise intervention on the part of the Church, in order to:

- reaffirm the message of the Gospel and its expressions as doctrinal foundations proposed by the Magisterium, recalling the mission of those who are in contact with the sick in the critical and terminal phases (family members or legal guardians, hospital chaplains, extraordinary ministers of the Eucharist and pastoral workers, hospital volunteers and health personnel), as well as the sick themselves;

- provide precise and concrete pastoral guidelines, so that at the local level these complex situations can be faced and managed in order to favor the patient's personal encounter with the merciful love of God.

I. Taking care of others

It is difficult to recognize the profound value of human life when, despite every assistance effort, it continues to appear to us in its weakness and fragility. Suffering, far from being removed from the existential horizon of the person, continues to generate an inexhaustible question about the meaning of life. ^[6] The solution to this dramatic question can never be offered only in the light of human thought, since suffering contains the greatness of a specific mystery that only God's Revelation can reveal . ^[7] In particular, each health worker is entrusted with the mission of a faithful guardian of human life until its natural fulfillment, ^[8]through a path of assistance that is capable of re-generating in each patient the profound meaning of his existence, when it is marked by suffering and illness. For this reason, it seems necessary to start from a careful consideration of the proper meaning of care, to understand the meaning of the specific mission entrusted by God to every person, health and pastoral worker, as well as to the sick person himself and to his family.

The experience of medical care starts from that human condition, marked by finitude and limit, which is vulnerability. In relation to the person, it is inscribed in the fragility of our being, both "body", materially and temporally finite, and "soul", desire for infinity and destination to eternity. Our being "finite" creatures, and also destined for eternity, reveals both our dependence on material goods and the mutual help of men, and our original and profound bond with God. This vulnerability is the foundation of the ethics of taking care , especially in the field of medicine, understood as solicitude, concern, sharing and responsibility towards the women and men entrusted to us because they are in need of physical and spiritual assistance.

In particular, the relationship of care reveals a principle of justice, in its double dimension of promoting human life ( suum cuique tribuere ) and of not causing harm to the person ( alterum non laedere ): the same principle that Jesus transforms into the positive golden rule. "Whatever you want men to do to you, you also do to them" ( Mt 7:12 ). it is the rule that finds an echo in traditional medical ethics in the aphorism primum non nocere.

The care of life is therefore the first responsibility that the doctor experiences in the encounter with the patient. It is not reducible to the ability to heal the sick, being its broadest anthropological and moral horizon: even when healing is impossible or improbable, medical-nursing assistance (care of the essential physiological functions of the body), psychological and spiritual , is an unavoidable duty, since the opposite would constitute an inhuman abandonment of the patient. Medicine, in fact, which uses many sciences, also possesses an important dimension of "therapeutic art" which implies a close relationship between the patient, health workers, family members and members of the various communities to which the patient belongs: therapeutic art , clinical acts andcare are inextricably linked in medical practice, especially in the critical and terminal stages of life.

The Good Samaritan, in fact, "not only becomes a neighbor, but takes charge of that man whom he sees half dead on the side of the road". ^[9] He invests in him, not only the money he has, but also what he does not have and which he hopes to earn in Jericho, promising that he will pay when he returns. Thus Christ invites us to place trust in his invisible grace and pushes us to generosity based on supernatural charity, identifying himself with every sick person: "Whenever you have done these things to only one of these least of my brothers, you have done it to me" ( Mt 25, 40). Jesus' affirmation is a moral truth of universal significance: "it is a question of " taking care "of the whole life and of the life of all ", ^[10] to reveal the original and unconditional love of God, the source of the meaning of all life.

To this end, especially in hospitals and care facilities inspired by Christian values, it is more than ever necessary to make an effort, including a spiritual one, to make room for a relationship built starting from the recognition of fragility and vulnerability.of the sick person. Weakness, in fact, reminds us of our dependence on God and invites us to respond with due respect for our neighbor. Hence the moral responsibility, linked to the awareness of each person who takes care of the sick (doctor, nurse, family member, volunteer, pastor) of being faced with a fundamental and inalienable good - the human person - which requires not being able to overcoming the limit in which respect for oneself and for the other is given, that is, the acceptance, protection and promotion of human life up to the natural occurrence of death. In this sense, it is a question of having a contemplative gaze , ^[11]who knows how to grasp in his own existence and that of others a unique and unrepeatable prodigy, received and welcomed as a gift. It is the gaze of those who do not pretend to take possession of the reality of life, but know how to welcome it as it is, with its efforts and sufferings, trying to recognize in the disease a meaning by which they allow themselves to be challenged and "guided", with trust of those who abandon themselves to the Lord of life who manifests himself in him.

Of course, medicine must accept the limit of death as part of the human condition. There comes a time when there is nothing to do but recognize the impossibility of intervening with specific therapies on a disease, which soon presents itself as fatal. It is a dramatic fact, which must be communicated to the sick with great humanity and also with confident openness to the supernatural perspective, aware of the anguish that death generates, especially in a culture that hides it. In fact, one cannot think of physical life as something to be preserved at all costs - what is impossible - but as something to be lived by reaching the free acceptance of the meaning of bodily existence: "only in reference to the human person in his "Unified totality",^[12]

Recognizing the impossibility of healing in the near prospect of death does not, however, mean the end of medical and nursing action. Exercising responsibility to the sick person, it means ensuring their care until the end, " heal if possible, always take care ( to cure if possible, always to care )." ^[13]This intention to always cure the patient offers the criterion for evaluating the different actions to be taken in the situation of an "incurable" disease: incurable, in fact, is never synonymous with "incurable". The contemplative gaze invites the broadening of the concept of care. The objective of assistance must aim at the integrity of the person, guaranteeing physical, psychological, social, family and religious support with the appropriate and necessary means. The living faith maintained in the souls of the bystanders can contribute to the sick person's true theological life, even if this is not immediately visible. The pastoral care of everyone, family members, doctors, nurses and chaplains, can help the sick person to persist in sanctifying grace and die in charity, in the Love of God. Faced with the inevitability of illness, in fact,

If the figure of the Good Samaritan sheds new light on the practice of caring, the living experience of the suffering Christ, of his agony on the Cross and of his Resurrection, these are the places where the closeness of God made man to multiple forms is manifested. anguish and pain, which can affect the sick and their families, during the long days of illness and at the end of life.

Not only is the person of Christ announced by the words of the prophet Isaiah as a man who is familiar with pain and suffering (cf. Is 53), but if we reread the pages of Christ's passion we find there the experience of misunderstanding, of mockery, abandonment, physical pain and anguish. These are experiences that today affect many sick people, often considered a burden on society; sometimes not understood in their questions, they often experience forms of emotional abandonment, loss of ties.

Every sick person needs not only to be listened to, but to understand that their interlocutor "knows" what it means to feel alone, abandoned, anguished in the face of the prospect of death, the pain of the flesh, the suffering that arises when the gaze of society it measures its value in terms of quality of life and makes it feel a burden for the projects of others. For this reason, turning our gaze to Christ means knowing that we can appeal to those who have felt in their flesh the pain of whipping and nails, the derision of the flagellators, the abandonment and betrayal of their closest friends.

Faced with the challenge of illness and in the presence of emotional and spiritual discomforts in those who experience pain, the need to know how to say a word of comfort emerges in an inexorable way, drawn from the hopeful compassion of Jesus on the Cross. . A credible hope, that professed by Christ on the Cross, capable of facing the moment of trial, the challenge of death. In the Cross of Christ - sung by the liturgy on Good Friday: Ave crux, spes unica - all the evils and sufferings of the world are concentrated and summarized. All physical evil , of which the cross, as an infamous and infamous instrument of death, is the emblem; all the psychological evil, expressed in the death of Jesus in the darkest loneliness, abandonment and betrayal; all moral evil , manifested in the death sentence of the Innocent; all spiritual evil , highlighted in the desolation that makes one perceive the silence of God.

Christ is the one who felt around him the painful dismay of the Mother and of the disciples, who "are" under the Cross: in this "being" of theirs , apparently full of impotence and resignation, there is all the closeness of affection which allows God made man to live even those hours that seem meaningless.

Then there is the Cross: in fact an instrument of torture and execution reserved only for the last, which seems so similar, in its symbolic charge, to those diseases that nail to a bed, which foreshadow only death and seem to take away meaning from the time and its passing. And yet, those who “ are"Around the sick person they are not only witnesses, but they are a living sign of those affections, of those bonds, of that intimate availability to love, which allow the sufferer to find on himself a human gaze capable of giving meaning to the time of illness . Because, in the experience of feeling loved, all of life finds its justification. Christ was always supported, in the path of his passion, by the confident trust in the love of the Father, which became evident, in the hours of the Cross, also through the love of the Mother. Because the love of God is always revealed, in human history, thanks to the love of those who do not abandon us, of those who "are" , despite everything, by our side.

If we reflect on the end of life of people, we cannot forget that in them there is often concern for those who leave: for children, spouses, parents, friends. A human component that we can never neglect and to which support and help must be offered.

It is the same concern of Christ, who before dying thinks of the Mother who will remain alone, in a pain that he will have to bring into history. In the dry chronicle of John's Gospel, Christ is to the Mother who turns, to reassure her, to entrust her to the beloved disciple so that he may take care of her: "Mother, here is your son" (cf. Jn 19 : 26-27). The time of the end of life is a time of relationships, a time in which loneliness and abandonment must be overcome (cf. Mt 27:46 and Mk 15:34), in view of a confident surrender of one's life to God ( cf. Lk 23:46).

From this perspective, looking at the Crucifix means seeing a choral scene, in which Christ is at the center because he summarizes in his own flesh, and truly transfigures, the darkest hours of human experience, those in which the possibility of despair silently appears. . The light of faith makes us grasp, in that plastic and sparse description that the Gospels provide us, the Trinitarian Presence, because Christ trusts in the Father thanks to the Holy Spirit, who supports the Mother and the disciples, who "stand " and, in this their "Being" near the Cross, they participate, with their human dedication to the Sufferer, in the mystery of the Redemption.

Thus, although marked by a painful passing away, death can become an occasion for a greater hope, precisely thanks to faith, which makes us participants in the redemptive work of Christ. In fact, pain is existentially bearable only where there is hope. The hope that Christ transmits to the suffering and the sick is that of his presence, of his real closeness. Hope is not just a wait for the better future, it is a look at the present, which makes it full of meaning. In the Christian faith, the event of the Resurrection not only reveals eternal life, but makes it clear that in history the ultimate word is never death, pain, betrayal, evil. Christ rises in the history and in the mystery of the Resurrection there is the confirmation of the love of the Father who never abandons.

Rereading, then, the living experience of the suffering Christ also means handing over to the men of today a hope capable of giving meaning to the time of sickness and death. This hope is love that resists the temptation of despair.

However important and valuable as they may be, palliative care is not enough if there is no one who "stands" next to the patient and testifies to his / her unique and unrepeatable value. For the believer, looking at the Crucifix means trusting in the understanding and Love of God: and it is important, in a historical era in which autonomy is exalted and the splendor of the individual is celebrated, to remember that if it is true that everyone he experiences his own suffering, his own pain and his own death, these experiences are always charged with the gaze and presence of others. Around the Cross there are also the officials of the Roman state, there are the curious, there are the distracted, there are the indifferent and resentful; they are under the Cross, but they do not "stay" with the Crucifix.

In intensive care units, in nursing homes for the chronically ill, one can be present as officials or as people who "stay" with the patient.

The experience of the Cross thus makes it possible to offer the sufferer a credible interlocutor to whom to speak, to think, to whom to hand over anguish and fear: to those who take care of the sick, the scene of the Cross provides an additional element for understand that even when it seems that there is nothing more to be done, there is still a lot to do, because “being” is one of the signs of love, and of the hope that it carries within itself. The announcement of life after death is not an illusion or a consolation, but a certainty that is at the center of love, which is not consumed with death.

Man, in whatever physical or mental condition he finds himself, maintains his original dignity of being created in the image of God. He can live and grow in divine splendor because he is called to be in the "image and glory of God" ( 1 Cor 11 , 7; 2 Cor 3, 18). His dignity is in this vocation. God became man to save us, promising us salvation and assigning us to communion with him: here lies the ultimate foundation of human dignity. ^[14]

It is proper to the Church to accompany the weakest with mercy on their path of pain, to maintain the theological life in them and direct them to God's salvation. ^[15] It is the Church of the Good Samaritan, ^[16] which "considers service to the sick as an integral part of its mission ". ^[17] Understanding this salvific mediation of the Church in a perspective of communion and solidarity among men is an essential help to overcome every reductionist and individualistic tendency. ^[18]

In particular, the Good Samaritan program is "a heart that sees". He “teaches that it is necessary to convert the gaze of the heart, because often the viewer does not see. Because? Because there is no compassion. ^[…] Without compassion, the beholder does not become involved in what he observes and passes beyond; instead, those with a compassionate heart are touched and involved, stop and take care of them ». ^[19] This heart sees where love is needed and acts accordingly. ^[20] The eyes perceive in weakness a call from God to act, recognizing in human life the first common good of society. ^[21] Human life is a very high good and society is called to recognize it. Life is a gift ^[22]sacred and inviolable and every man, created by God, has a transcendent vocation and a unique relationship with the One who gives life, because "God invisible in his great love" ^[23] offers every man a plan of salvation so that he can affirm : «Life is always good. This is an intuition or even a datum of experience, of which man is called to grasp the profound reason ". ^[24] For this reason the Church is always happy to collaborate with all men of good will, with believers of other confessions or religions or non-believers, who respect the dignity of human life, even in its extreme stages of suffering and death, and reject any act contrary to it. ^[25]God the Creator, in fact, offers man life and his dignity as a precious gift to be preserved and increased and to be ultimately accountable to him.

The Church affirms the positive meaning of human life as a value already perceptible by right reason, which the light of faith confirms and values ​​in its inalienable dignity. ^[26] This is not a subjective or arbitrary criterion; it is rather a test based on natural inviolable dignity - because life is the first good condition because of the use of any property - and transcendent vocation of every human being, called to share in the trinitarian love of the living God: ^{[ 27]} "The very special love that the Creator has for every human being" confers on him an infinite dignity "". ^[28]The inviolable value of life is a basic truth of the natural moral law and an essential foundation of the legal order. Just as it is not possible to accept that another man is our slave, even if he asks us to, likewise one cannot directly choose to attack the life of a human being, even if he requests it. Therefore, suppressing a patient who asks for euthanasia does not at all mean recognizing his autonomy and valuing it, but on the contrary it means disregarding the value of his freedom, strongly conditioned by illness and pain, and the value of his life, denying him any further possibility. of human relationship, of the meaning of existence and growth in the theological life. Furthermore, the moment of death is decided in God's place. For this reason, "abortion,^{[…] They} spoil human civilization, they dishonor those who behave in this way even more than those who suffer them and greatly damage the honor of the Creator ». ^[29]

Some factors nowadays limit the ability to grasp the profound and intrinsic value of every human life: the first is the reference to an equivocal use of the concept of "worthy death" in relation to that of "quality of life". A utilitarian anthropological perspective emerges here, which is "mainly linked to economic possibilities," well-being ", beauty and enjoyment of physical life, forgetting other deeper dimensions - relational, spiritual and religious - of existence". ^[30]By virtue of this principle, life is considered worthy only if it has an acceptable level of quality, according to the judgment of the subject himself or of third parties, in relation to the presence-absence of certain psychic or physical functions, or often also identified with presence of a psychological discomfort. According to this approach, when the quality of life appears poor, it does not deserve to be continued. Thus, however, it is no longer recognized that human life has a value in itself.

A second obstacle that obscures the perception of the sacredness of human life is a mistaken understanding of "compassion" ^[31] . Faced with a suffering qualified as "unbearable", the end of the patient's life is justified in the name of "compassion". To avoid suffering it is better to die: it is the so-called "compassionate" euthanasia. It would be compassionate to help the patient die through euthanasia or assisted suicide. In reality, human compassion does not consist in causing death, but in welcoming the sick person, in supporting him in difficulties, in offering him affection, attention and the means to alleviate suffering.

The third factor that makes it difficult to recognize the value of one's own life and that of others within intersubjective relationships is a growing individualism, which leads to seeing others as a limitation and threat to one's freedom. At the root of this attitude is “a neo-Pelagianism whereby the radically autonomous individual claims to save himself, without recognizing that he depends, in the depths of his being, on God and on others ^[…] . A certain neo-Gnosticism, for its part, presents a merely interior salvation, enclosed in subjectivism " ^[32] , which hopes for the liberation of the person from the limits of his body, especially when frail and sick.

Individualism, in particular, is at the root of what is considered the most latent disease of our time: loneliness ^[33] , thematized in some normative contexts even as the "right to solitude", starting from the autonomy of the person and from the "principle of permission-consent": a permission-consent which, given certain conditions of malaise or illness, can extend to the choice or not to continue living. It is the same "right" that underlies euthanasia and assisted suicide. The basic idea is that those who are in a condition of dependence and cannot be assimilated to perfect autonomy and reciprocity are in fact cared for by virtue of a favor. The concept of good is thus reduced to being the result of a social agreement: everyone receives the care and assistance that autonomy or social and economic profit make possible or convenient. The result is an impoverishment of interpersonal relationships, which become fragile, devoid of supernatural charity, of that human solidarity and social support so necessary to face the most difficult moments and decisions of existence.

This way of thinking about human relationships and the meaning of good cannot fail to undermine the very meaning of life, making it easily manipulated, also through laws that legalize euthanasia practices, causing the death of the sick. These actions cause severe insensitivity to caring for the sick person and distort relationships. In such circumstances, unfounded dilemmas sometimes arise about the morality of actions which, in reality, are merely acts of simple care of the person, such as hydrating and feeding an unconscious patient with no prospect of recovery.

In this sense, Pope Francis spoke of a "throwaway culture". ^[34] The victims of this culture are precisely the most fragile human beings, who risk being "discarded" by a cog that wants to be efficient at all costs. This is a strongly anti-solidarity cultural phenomenon, which John Paul II described as a "culture of death" and which creates authentic "structures of sin". ^[35]It can induce actions that are wrong in themselves for the sole reason of "feeling good" in doing them, generating confusion between good and evil, whereas every personal life has a unique and unrepeatable value, always promising and open to transcendence. In this culture of rejection and death, euthanasia and assisted suicide appear as an erroneous solution to solve the problems related to the dying patient.

V. The teaching of the Magisterium

1.     The prohibition of euthanasia and assisted suicide

The Church, in the mission of transmitting to the faithful the grace of the Redeemer and the holy law of God, already perceptible in the dictates of the natural moral law, feels the duty to intervene in this forum to once again exclude any ambiguity regarding the teaching of the Magisterium. on euthanasia and assisted suicide, even in those contexts where national laws have legitimized such practices.

In particular, the spread of medical protocols applicable to end-of-life situations, such as the Do Not Resuscitate Order or the Physician Orders for Life Sustaining Treatment- with all their variants depending on the national legal systems and contexts, initially conceived as tools to avoid persistent therapy in the terminal stages of life - today raises serious problems in relation to the duty to protect the lives of patients in the most critical phases of the disease . While, on the one hand, doctors feel increasingly bound by the self-determination expressed by patients in these statements, which now comes to deprive them of the freedom and duty to act to protect life even where they could do so, on the other, in some healthcare contexts, concerns the abuse now widely denounced in the use of these protocols in a euthanasia perspective, when neither patients nor families are consulted in the final decision.

For these reasons, the Church believes that it must reaffirm as a definitive teaching that euthanasia is a crime against human life because, with this act, man chooses to directly cause the death of another innocent human being. The definition of euthanasia does not proceed from the weighting of the goods or values ​​at stake, but from a sufficiently specified moral object , that is, from the choice of "an action or omission which of its nature or intention causes death, in order to eliminate any pain ". ^[36] "Euthanasia is therefore situated at the level of the intentions and methods used". ^[37]The moral evaluation of it, and of the consequences that derive from it, does not therefore depend on a balance of principles which, according to the circumstances and the patient's suffering, could, according to some, justify the suppression of the sick person. Value of life, autonomy, decision-making capacity and quality of life are not on the same level.

Euthanasia, therefore, is an inherently evil act, under any occasion or circumstance. The Church in the past has already definitively affirmed “ that euthanasia is a grave violation of the Law of God, as the deliberate and morally unacceptable killing of a human person. This doctrine is founded on natural law and on the written Word of God, it is transmitted by the Church's Tradition and taught by the ordinary and universal Magisterium. Depending on the circumstances, such a practice involves the malice proper to suicide or murder ”. ^[38] Any formal or immediate material cooperationsuch an act is a grave sin against human life: “No authority can legitimately impose it or permit it. It is, in fact, a violation of divine law, an offense against the dignity of the human person, a crime against life, an attack against humanity ”. ^[39] Therefore, euthanasia is a homicidal act that no end can legitimize and that does not tolerate any form of complicity or collaboration, active or passive. Those who pass laws on euthanasia and assisted suicide are therefore complicit in the grave sin that others will carry out. They are also guilty of scandal because such laws contribute to deform the conscience, even of the faithful. ^[40]

Life has the same dignity and the same value for each one: respect for the life of the other is the same as one owes to one's existence. A person who freely chooses to take his own life breaks his relationship with God and with others and denies himself as a moral subject. Assisted suicide it increases its gravity, as it makes another share in his own despair, inducing him not to direct his will towards the mystery of God, through the theological virtue of hope, and consequently not to recognize the true value of life and to break the covenant which constitutes the human family. Helping the suicide is an undue collaboration in an illicit act, which contradicts the theological relationship with God and the moral relationship that unites men so that they share the gift of life and participate in the meaning of their own existence.

Even if the request for euthanasia arises from anguish and despair, ^[41] and "although in such cases personal responsibility may be diminished or even not exist, yet the error of judgment of conscience - even if in good faith - does not change the nature of the murder, which in itself always remains inadmissible ». ^[42] The same applies to assisted suicide. Such practices are never an authentic help to the sick, but an aid to die.

It is therefore a question of an always wrong choice: "medical personnel and other health workers - faithful to the task of" always being at the service of life and assisting it to the end "- cannot lend themselves to any euthanasia practice even at the request of the 'interested, much less his relatives. In fact, there is no right to arbitrarily dispose of one's life, so that no health worker can be the executive guardian of a non-existent right ”. ^[43]

This is why euthanasia and assisted suicide are a defeat of those who theorize them, those who decide them and those who practice them. ^[44]

Therefore, the laws that legalize euthanasia or those that justify suicide and help it are gravely unjust, for the false right to choose a death that is improperly defined only because it is chosen. ^[45]These laws affect the foundation of the legal order: the right to life, which supports every other right, including the exercise of human freedom. The existence of these laws deeply wounds human relationships, justice and threatens mutual trust between men. The legal systems that have legitimized assisted suicide and euthanasia also show an evident degeneration of this social phenomenon. Pope Francis recalls that “the current socio-cultural context is progressively eroding awareness of what makes human life precious. Indeed, it is increasingly evaluated on the basis of its efficiency and usefulness, to the point of considering “discarded lives” or “unworthy lives” those that do not meet this criterion. In this situation of loss of authentic values, the mandatory duties of solidarity and human and Christian fraternity also fail. In reality, a company deserves the qualification of "civil" if it develops antibodies against the throwaway culture; if it recognizes the intangible value of human life; if solidarity is effectively practiced and safeguarded as the foundation of coexistence ".^[46] In some countries around the world, tens of thousands of people have already died by euthanasia, many of them complaining of psychological suffering or depression. And there are frequent abuses denounced by the doctors themselves for the suppression of the lives of people who never would have desired the application of euthanasia for themselves. The question of death, in fact, in many cases is a symptom of the disease itself, aggravated by isolation and despair. The Church sees in these difficulties an opportunity for spiritual purification, which deepens hope, so that it becomes truly theological, focused on God, and only on God.

Rather, instead of indulging in false condescension, the Christian must offer the sick person the indispensable help to get out of his despair. The commandment "Thou shalt not kill" ( Ex 20:13 ; Dt 5, 17), in fact, is a yes to life, of which God is the guarantor: "it becomes the appeal to a solicitous love that protects and promotes the life of one's neighbor ". ^[47] The Christian therefore knows that earthly life is not the supreme value. Ultimate bliss is in heaven. Thus the Christian will not expect physical life to continue when death is evidently near. The Christian will help the dying person to free himself from despair and put his hope in God.

From a clinical point of view, the factors that most determine the demand for euthanasia and assisted suicide are unmanaged pain and the lack of hope, both human and theological, also induced by human, psychological and spiritual assistance which is often inadequate on the part of those who take care of the sick. ^[48]

This is what experience confirms: “the pleas of the very seriously ill, who sometimes invoke death, must not be understood as an expression of a true desire for euthanasia; in fact they are almost always anxious requests for help and affection. In addition to medical care, what the sick person needs is love, human and supernatural warmth, with which all those close to him, parents and children, doctors and nurses can and must surround him ». ^[49] The sick person who feels surrounded by the loving human and Christian presence, overcomes all forms of depression and does not fall into the anguish of those who, on the other hand, feel alone and abandoned to their destiny of suffering and death.

Man, in fact, experiences pain not only as a biological fact that must be managed to make it bearable, but as the mystery of human vulnerability in relation to the end of physical life, an event difficult to accept, given that the unity of soul and body is essential for man.

Therefore, only by re-signifying the very event of death - through the opening in it of a horizon of eternal life, which announces the transcendent destination of each person - can the "end of life" be faced in a way consonant with human dignity. and adequate to that labor and suffering which inevitably produces the imminent sense of the end. Indeed, "suffering is something even wider than disease, more complex and at the same time even more deeply rooted in humanity itself". ^[50] And this suffering, with the help of grace, can be animated from within with divine charity, just as in the case of the suffering of Christ on the Cross.

For this reason, the ability of those who care for a person suffering from chronic disease or in the terminal phase of life, must be to "know how to stay" (to stay ), to watch over those who suffer from the anguish of dying, "console" to be-with in solitude, to be com-presence that opens to hope. ^[51] Through faith and charity expressed in the intimacy of the soul, in fact, the person who assists is capable of suffering the pain of the other and of opening up to a personal relationship with the weak which broadens the horizons of life far beyond the event of death, thus becoming a presence full of hope.

"Weep with those who are in tears" ( Rm 12, 15), since those who have compassion are happy to the point of weeping with others (cf. Mt 5, 4). In this relationship, which becomes the possibility of love, suffering is filled with meaning in the sharing of a human condition and in solidarity in the journey towards God, which expresses that radical alliance between men ^[52] which makes them glimpse a light even beyond death. It makes us see the medical act from within a therapeutic alliancebetween the doctor and the patient, linked by the recognition of the transcendent value of life and the mystical sense of suffering. This alliance is the light to understand good medical action, overcoming the individualistic and utilitarian vision prevailing today.

2.     The moral obligation to exclude therapeutic persistence

The Magisterium of the Church recalls that, when the end of earthly existence approaches, the dignity of the human person is specified as the right to die in the greatest possible serenity and with the human and Christian dignity that is due to him. ^[53] Protecting the dignity of dying means excluding both the anticipation of death and the delaying it with the so-called “therapeutic persistence”. ^[54]In fact, today's medicine has means capable of artificially delaying death, without the patient receiving a real benefit in some cases. In the imminence of an inevitable death, therefore, it is legitimate in science and conscience to make the decision to renounce treatments that would only procure a precarious and painful prolongation of life, without however interrupting the normal care due to the patient in such cases. ^[55]This means that it is not permissible to suspend effective treatments to support essential physiological functions, as long as the body is able to benefit from them (supports hydration, nutrition, thermoregulation; as well as adequate and proportionate help for breathing, and others. , insofar as they are required to support bodily homeostasis and reduce organ and systemic suffering). The suspension of any unreasonable obstinacy in the administration of the treatments must not be therapeutic withdrawal. This clarification is now indispensable in the light of the numerous judicial cases that in recent years have led to the curative withdrawal - and the anticipated death - of patients in critical but not terminal conditions, to whom it has been decided to suspend life support care, by now they do not have prospects for improving the quality of life.

In the specific case of therapeutic persistence, it must be reiterated that the renunciation of extraordinary and / or disproportionate means «is not equivalent to suicide or euthanasia; rather, it expresses acceptance of the human condition in the face of death " ^[56] or the deliberate choice of avoiding the implementation of a medical device that is disproportionate to the results one could hope for. The renunciation of such treatments, which would only lead to a precarious and painful prolongation of life, can also mean respect for the will of the dying person, expressed in the so-called advance declarations of treatment, excluding any euthanasia or suicidal act . ^[57]

Proportionality, in fact, refers to the totality of the patient's good. The false moral discernment of the choice between values (for example, life versus quality of life) can never be applied ; this could lead us to exclude from consideration the safeguarding of personal integrity and the good-life and the true moral object of the act performed. ^[58] In fact, every medical act must always have as its object and intentions the accompaniment of life and never the pursuit of death. ^[59]The doctor, in any case, is never a mere executor of the will of the patient or of his legal representative, retaining the right and the duty to escape at will discordant from the moral good seen by his own conscience. ^[60]

3.     Basic care: the duty of nutrition and hydration

The fundamental and unavoidable principle of the accompaniment of the sick in critical and / or terminal conditions is the continuity of assistance to his essential physiological functions. In particular, a basic cure due to every man is to administer the foods and liquids necessary for maintaining the homeostasis of the body, to the extent that and until this administration proves to achieve its proper purpose, which consists in providing hydration and nourishment of the patient. ^[61]

When supplying nutrients and physiological liquids is not of any benefit to the patient, because his body is no longer able to absorb or metabolize them, their administration must be suspended. In this way, death is not unlawfully anticipated by deprivation of the hydrating and nutritional supports essential to vital functions, but respecting the natural course of critical or terminal illness. Otherwise, the deprivation of these supports becomes an unjust action and can be a source of great suffering for those who suffer from it. Nutrition and hydration do not constitute medical therapy in the proper sense, as they do not contrast the causes of a pathological process taking place in the patient's body, but represent a cure due to the patient's person, a primary and inescapable clinical and human attention.^[62] provided that it is not harmful to the patient or causes unacceptable suffering for the patient .^[63] 

4.     Palliative care

Of Continuity it is part of the constant duty of Patients' understanding needs: care needs, pain relief, emotional needs, emotional and spiritual. As demonstrated by the broadest clinical experience, palliative medicine is a precious and indispensable tool to accompany the patient in the most painful, suffered, chronic and terminal phases of the disease. The so-called palliative care is the most authentic expression of the human and Christian action of caring, the tangible symbol of compassionate "being" next to those who suffer. They aim "to alleviate suffering in the final phase of the disease and at the same time to ensure the patient adequate human support" ^[64]dignified, improving - as far as possible - the quality of life and overall well-being. Experience shows that the application of palliative care drastically decreases the number of people requesting euthanasia. To this end, a decisive commitment, according to economic possibilities, appears useful to spread such treatments to those who will need them, to be implemented not only in the terminal phases of life, but as an integrated approach to treatment in relation to any chronic pathology and / or degenerative, which may have a complex, painful and poor prognosis for the patient and his family. ^[65]

Palliative care includes spiritual assistance to the sick and their families. It instills trust and hope in God in the dying person and in their families, helping them to accept the death of the relative. It is an essential contribution that belongs to pastoral workers and to the entire Christian community, following the example of the Good Samaritan, so that rejection may be replaced by acceptance and hope prevails over anguish, ^[66]especially when the suffering is prolonged due to the degeneration of the pathology, as the end approaches. At this stage, determining effective pain relief therapy allows the patient to cope with illness and death without the fear of unbearable pain. This remedy must necessarily be associated with fraternal support that can overcome the patient's sense of loneliness, often caused by not feeling sufficiently accompanied and understood in his difficult situation.

Technology does not give a radical answer to suffering and it cannot be assumed that it can remove it from human life. ^[67] Such a claim generates a false hope, the cause of even greater despair in the suffering. Medical science is able to learn more about physical pain and must use the best technical resources to treat it; but the vital horizon of a terminal illness generates a deep suffering in the patient, which requires attention that is not merely technical. Spe salvi facti sumus , in hope , the theological one, addressed to God, we have been saved, says St. Paul ( Rom 8:24 ).

"The wine of hope" is the specific contribution of the Christian faith in the care of the sick and refers to the way in which God overcomes evil in the world. In suffering, man must be able to experience a solidarity and a love that assumes suffering by offering a meaning to life, which extends beyond death. All this has a great social significance: "A society that is unable to accept the suffering and is not capable of contributing through compassion to ensuring that suffering is shared and also carried internally is a cruel and inhuman society". ^[68]

However, it should be noted that the definition of palliative care has taken on a connotation in recent years that may be equivocal. In some countries of the world, the national regulations governing palliative care ( Palliative Care Act ) as well as the laws on the "end of life" ( End-of-Life Law ), provide, in addition to palliative care, the so-called Medical Assistance to Death ( MAiD ), which may include the ability to request euthanasia and assisted suicide. This normative provision constitutes a reason for serious cultural confusion, since it leads us to believe that medical assistance for voluntary death is an integral part of palliative care and that it is therefore morally legitimate to request euthanasia or assisted suicide.

Furthermore, in these same regulatory contexts, palliative interventions to reduce the suffering of serious or dying patients may consist in the administration of drugs intended to anticipate death or in the suspension / interruption of hydration and nutrition, even where there is a prognosis of weeks or months. However, these practices are equivalent to an action or omission aimed at causing death and are therefore illegal. The progressive spread of these regulations, also through the guidelines of national and international scientific societies, in addition to inducing a growing number of vulnerable people to choose euthanasia or suicide, constitutes a social de-responsibility towards many people, who would have they just need to be better looked after and comforted.

5.     The role of the family and hospices

The role of the family is central to the care of the terminally ill. ^[69] In it, the person leans on solid relationships, is appreciated in himself and not only for his productivity or the pleasure he can generate. In fact, in the treatment it is essential that the patient does not feel a burden, but that he has the closeness and appreciation of his loved ones. In this mission, the family needs help and adequate means. It is therefore necessary that the States recognize the primary and fundamental social function of the family and its irreplaceable role, also in this area, by providing the resources and structures necessary to support it. Furthermore, the human and spiritual accompaniment of the family is a duty in health structures of Christian inspiration; it must never be neglected, since it constitutesa single unit of care with the patient .

Alongside the family, the institution of hospices , where to welcome the terminally ill to ensure their care until the last moment, is a good thing and a great help. Moreover, "the Christian response to the mystery of death and suffering is not an explanation, but a Presence" ^[70] which takes on pain, accompanies it and opens it to a reliable hope. These structures stand as an example of humanity in society, sanctuaries of a pain experienced with fullness of meaning. For this reason they must be equipped with specialized personnel and their own material means of care, always open to families: "In this regard, I think about how well hospices dofor palliative care, where the terminally ill are accompanied with qualified medical, psychological and spiritual support, so that they can live the final phase of their earthly life with dignity, comforted by the closeness of loved ones. I hope that these centers will continue to be places in which “dignity therapy” is practiced with commitment, thus nourishing love and respect for life ». ^[71] In these contexts, as well as in any Catholic health facility, it is a duty that there be the presence of health and pastoral workers trained not only from a clinical point of view, but also exercising a true theological life of faith and hope, directed towards God , since it constitutes the highest form of humanization of dying. ^[72]

6.     Accompaniment and care in prenatal and pediatric age

In relation to the accompaniment of infants and children affected by chronic degenerative diseases incompatible with life or in the terminal stages of life itself, it is necessary to reiterate the following, in the awareness of the need to develop an operational strategy capable of guaranteeing quality and well-being to the child and his family.

From conception, children suffering from malformations or pathologies of any kind are small patients that medicine today is always able to assist and accompany in a respectful way of life. Their life is sacred, unique, unrepeatable and inviolable, just like that of any adult person.

In the case of so-called "incompatible with life" prenatal pathologies - that is, which will surely lead to death within a short period of time - and in the absence of fetal or neonatal therapies capable of improving the health conditions of these children, in no way should they be abandoned on the welfare level, but must be accompanied like any other patient until natural death occurs; the care perinatal comfort favors in this sense, an integrated care pathway, which alongside the support of doctors and pastoral workers is the constant presence of the family. The child is a special patient and requires particular preparation from the carer both in terms of knowledge and presence. The empathic accompaniment of a child in the terminal phase, which is among the most delicate, is aimed at adding life to the child's years and not years to his life.

The Perinatal Hospices, in particular, provide essential support to families who welcome the birth of a child in conditions of fragility. In such contexts, competent medical accompaniment and the support of other families-witnesses who have gone through the same experience of pain and loss constitute an essential resource, alongside the necessary spiritual accompaniment of these families. It is the pastoral duty of health workers of Christian inspiration to work to promote its maximum diffusion in the world.

All this is particularly necessary for those children who, in the current state of scientific knowledge, are destined to die immediately after childbirth or within a short time. Taking care of these children helps parents to mourn and to conceive it not only as a loss, but as a stage in a journey of love traveled together with their child.

Unfortunately, the dominant culture today does not promote this approach: on a social level, the sometimes obsessive use of prenatal diagnosis and the emergence of a culture hostile to disability often lead to the choice of abortion, coming to configure it as a practice of "prevention" . It consists in the deliberate killing of an innocent human life and as such is never lawful. The use of prenatal diagnoses for selective purposes, therefore, is contrary to the dignity of the person and gravely illicit because it is the expression of a eugenic mentality. In other cases, after birth, the same culture leads to the suspension or non-initiation of care for the newborn child, due to the presence or even only due to the possibility of developing a disability in the future. Even this utilitarian approach cannot be approved.

The fundamental principle of pediatric care is that the child in the final phase of life has the right to respect and care for his person, avoiding both therapeutic persistence and unreasonable obstinacy and any intentional anticipation of his death. From a Christian perspective, the pastoral care of a terminally ill child invokes participation in the divine life in Baptism and Confirmation.

In the terminal phase of the course of an incurable disease, even if pharmacological or other therapies are suspended, aimed at combating the pathology from which the child suffers, as they are no longer appropriate to his deteriorated clinical condition and considered by doctors to be futile or excessively burdensome for him, as a cause of further suffering, however, the integral care of the person of the little sick person must never fail, in its various physiological, psychological, affective-relational and spiritual dimensions. Healing is not just about therapy and healing; just as interrupting a therapy, when it no longer benefits the incurable child, does not imply suspending effective treatments to support the physiological functions essential for the life of the little patient, as long as your body is able to benefit from them (supports hydration, nutrition, thermoregulation and others, to the extent that these are required to support body homeostasis and reduce organ and systemic suffering). Refraining from any therapeutic obstinacy in administering treatments judged to be ineffectiveit must not be curative withdrawal , but must keep the path of accompaniment to death open. If anything, it must be considered that even routine interventions, such as breathing aid, are provided in a painless and proportionate way, personalizing the appropriate type of help on the patient, to avoid that the right concern for life does not conflict with an unjust imposition of avoidable pain.

In this context, the assessment and management of the physical pain of the newborn and the child is essential to respect it and accompany it in the most stressful phases of the disease. Personalized and gentle care, now verified in pediatric clinical care, flanked by the presence of parents, make possible an integrated and more effective management of any assistance intervention.

Maintaining the emotional bond between parents and child is an integral part of the care process. The parent-child care and accompaniment relationship must be fostered with all the necessary tools and is a fundamental part of the treatment, even for non-curable pathologies and situations with terminal evolution. In addition to emotional contact, the spiritual moment must not be forgotten. The prayer of close people, to the intention of the sick child, has a supernatural value that surpasses and deepens the emotional relationship.

The ethical / legal concept of the "best interests of the child" - today used to carry out the cost-benefit assessment of the treatments to be carried out - in no way can constitute the basis for deciding to shorten his life in order to avoid suffering, with actions or omissions which by their nature or intention can be configured as euthanasia. As has been said, the suspension of disproportionate therapies cannot lead to the suspension of those basic treatments necessary to accompany him to a dignified natural death, including those to alleviate pain, nor to the suspension of that spiritual attention that is offered to him. who will soon meet God.

7.      Analgesic therapies and suppression of consciousness

Some specialized treatments require special attention and skills from health professionals to perform the best medical practice from an ethical point of view, always aware of approaching people in their concrete pain situation.

To ease the pain of the patient, analgesic therapy uses drugs that can cause suppression of consciousness (sedation). A profound religious sense can allow the patient to experience pain as a special offering to God, with a view to Redemption; ^[73] however, the Church affirms the lawfulness of sedation as part of the care offered to the patient, so that the end of life may come in the greatest possible peace and in the best interior conditions. This is also true in the case of treatments that approach the time of death (deep palliative sedation in the terminal phase), ^[74]always, to the extent possible, with the patient's informed consent. From the pastoral point of view, it is good to take care of the sick person's spiritual preparation so that he or she arrives consciously at death as well as at the encounter with God. ^[75] The use of analgesics is, therefore, part of the patient's care, but any administration that directly causes and intentionally death is a euthanasia practice and is unacceptable. ^[76] Sedation must therefore exclude, as its direct purpose, the intention to kill, even if with it a conditioning on death, however inevitable, is possible. ^[77]

A clarification is needed here in relation to pediatric contexts: in the case of the child who is unable to understand, such as a newborn, for example, one must not make the mistake of assuming that the child can bear pain and accept it, when there are systems to relieve it. . For this reason, it is a medical duty to work to reduce the child's suffering as much as possible, so that he can reach natural death in peace and being able to perceive as much as possible the loving presence of doctors and, above all, of the family.

8.     The vegetative state and the state of minimal consciousness

Other relevant situations are that of the patient in a persistent lack of consciousness, the so-called "vegetative state", and that of the patient in a state of "minimal consciousness". It is always completely misleading to think that the vegetative state and the state of minimal consciousness, in subjects who breathe autonomously, are a sign that the patient has ceased to be a human person with all the dignity that is proper to him. ^[78] On the contrary, in these states of maximum weakness, it must be recognized in its value and assisted with adequate care. The fact that the patient can remain in this painful situation for years without a clear hope of recovery implies undoubted suffering for those who care for them.

First of all, it may be useful to recall how much one must ever lose sight of in relation to this painful situation. That is to say: the patient in these states has the right to nutrition and hydration; Artificial nutrition and hydration are in principle ordinary measures; in some cases, such measures may become disproportionate, either because their administration is no longer effective, or because the means of administering them create excessive weight and provide negative effects that outweigh the benefits.

From the point of view of these principles, the commitment of the health worker cannot be limited to the patient but must also extend to the family or to those responsible for the care of the patient, for whom appropriate pastoral accompaniment must also be provided. It is therefore necessary to provide adequate support for family members in carrying the prolonged burden of assistance to the sick in these states, ensuring them the closeness that helps them not to be discouraged and above all not to see interruption of care as the only solution. It is necessary to be adequately prepared for this, just as it is necessary that family members are dutifully supported.

9.     Conscientious objection by health workers and Catholic health institutions

In the face of laws that legitimize - in any form of medical assistance - euthanasia or assisted suicide, any immediate formal or material cooperation must always be denied. These contexts constitute a specific area for Christian witness, in which "we must obey God rather than men" ( Acts5, 29). There is no right to suicide or to euthanasia: the right exists to protect life and co-existence among men, not to cause death. It is therefore never lawful for anyone to collaborate with such immoral actions or to suggest that one can be accomplices with words, works or omissions. The only true right is that of the sick person to be accompanied and treated with humanity. This is the only way to protect his dignity until natural death occurs. "No health worker, therefore, can become the executive guardian of a non-existent right, even when euthanasia is requested in full conscience by the person concerned". ^[79]

In this regard, the general principles regarding cooperation in evil, that is to say unlawful actions, are reaffirmed as follows: "Christians, like all men of good will, are called, out of a grave duty of conscience, not to give their formal collaboration to those practices which, although admitted by civil legislation, are in contrast with the Law of God. In fact, from a moral point of view, it is never lawful to formally cooperate in evil. This cooperation occurs when the action performed, either by its very nature or by the configuration it assumes in a concrete context, qualifies as a direct participation in an act against innocent human life or as a sharing of the immoral intention of principal agent. This cooperation can never be justified or by invoking respect for the freedom of others,Rom 2, 6; 14, 12) ". ^[80]

States need to recognize conscientious objection in the medical and health fields, in compliance with the principles of the natural moral law, and especially where the service to life challenges the human conscience daily. ^[81] Where this is not recognized, it can lead to the situation of having to disobey the law, in order not to add injustice to injustice, conditioning people's conscience. Healthcare professionals must not hesitate to ask for it as their own right and as a specific contribution to the common good.

Likewise, health institutions must overcome the strong economic pressures that sometimes lead them to accept the practice of euthanasia. And if the difficulty in finding the necessary means makes the commitment of public institutions very burdensome, society as a whole is called to an additional responsibility so that the incurable patients are not abandoned to themselves or to the resources of their families. All this requires a clear and unified stance on the part of the Episcopal Conferences, the local Churches, as well as the Catholic communities and institutions in order to protect their right to conscientious objection in the legal contexts that provide for euthanasia and suicide.

Catholic health institutions are a concrete sign of the way in which the ecclesial community, following the example of the Good Samaritan, takes care of the sick. Jesus' command, "heal the sick" ( Lk 10 : 9), finds its concrete implementation not only by laying hands on them, but also by picking them up from the street, assisting them in their homes and creating suitable reception and hospitality facilities. Faithful to the Lord's command, the Church has created, over the centuries, various reception facilities, where medical care finds its specific declination in the dimension of integral service to the sick person.

Catholic health institutions are called to be faithful witnesses of the inalienable ethical attention to respect for fundamental human values ​​and the Christian values ​​constituting their identity, by refraining from behaviors of evident moral illegitimacy and the declared and formal obedience to the teachings of the Ecclesial Magisterium. Any other action, which does not correspond to the aims and values ​​to which Catholic health institutions are inspired, is not ethically acceptable and, therefore, prejudices the attribution, to the health institution itself, of the qualification of "Catholic".

In this sense, institutional collaboration with other hospitals to which people seeking euthanasia can be guided and directed is not ethically admissible. Such choices cannot be morally admitted or supported in their concrete realization, even if they are legally possible. In fact, the laws that approve euthanasia «not only create no obligation for conscience, but rather raise a serious and precise obligation to oppose them through conscientious objection. From the origins of the Church, apostolic preaching has inculcated in Christians the duty to obey legitimately constituted public authorities (cf. Rom 13 : 1-7; 1 Pt2, 13-14), but at the same time he firmly warned that "we must obey God rather than men" ( Acts 5:29) ». ^[82]

The right to conscientious objection must not make us forget that Christians do not reject these laws by virtue of a private religious conviction, but of a fundamental and inviolable right of every person, essential to the common good of the whole of society. In fact, these are laws that are contrary to natural law in that they undermine the very foundations of human dignity and of coexistence marked by justice.

10.     Pastoral accompaniment and the support of the sacraments

The moment of death is a decisive step for man in his encounter with God the Savior. The Church is called to accompany the faithful spiritually in this situation, offering them the "healing resources" of prayer and the sacraments. Helping the Christian to live it in a context of spiritual accompaniment is a supreme act of charity. Precisely because "no believer should die in solitude and abandonment", ^{[83] it} is necessary to create around the patient a solid platform of human and humanizing relationships that accompany him and open him to hope.

The parable of the Good Samaritan indicates what the relationship with the suffering neighbor should be, which attitudes to avoid - indifference, apathy, prejudice, fear of getting one's hands dirty, closure in one's affairs - and which ones to undertake - attention, listening, understanding, compassion, discretion.

The invitation to imitation, "Go and do the same" ( Lk 10:37), is a warning not to underestimate all the human potential of presence, availability, acceptance, discernment, involvement, that proximity to those in need requires and is essential in the integral care of the sick person.

The quality of love and care of people in critical and terminal situations of life contributes to averting in these the terrible and extreme desire to put an end to one's life. Only a context of human warmth and evangelical fraternity, in fact, is able to open a positive horizon and to support the sick in hope and in a confident trust.

This accompaniment is part of the path defined by palliative care and must include the patient and his family.

The family has always played an important role in care, whose presence, support, affection, constitute an essential therapeutic factor for the patient. In fact, Pope Francis recalls, “it has always been the closest“ hospital ”. Even today, in many parts of the world, the hospital is a privilege for the few, and it is often far away. They are the mother, the father, the brothers, the sisters, the grandmothers who guarantee the care and help to heal ». ^[84]

Taking on the responsibility of others or taking care of the sufferings of others is a commitment that involves not only some, but embraces the responsibility of all, of the whole Christian community. St. Paul affirms that, when a member suffers, the whole body is in suffering (cf. 1 Cor 12:26 ) and the whole body bends over the sick member to bring him relief. Each, for his part, is called to be a "servant of consolation" in the face of any human situation of desolation and despair.

Pastoral accompaniment calls into question the exercise of the human and Christian virtues of empathy ( en-pathos ), of compassion ( cum-passio ), of taking charge of his suffering by sharing it, and of consolation ( cum-solacium ), of 'entering the solitude of the other to make him feel loved, welcomed, accompanied, supported.

The ministry of listening and consolation that the priest is called to offer, making himself a sign of the compassionate concern of Christ and the Church, can and must play a decisive role. In this important mission it is extremely important to witness and combine that truth and charity with which the gaze of the Good Shepherd never ceases to accompany all his children. Given the importance of the figure of the priest in the human, pastoral and spiritual accompaniment of the sick in the terminal stages of life, an updated and targeted preparation in this regard needs to be provided in his path of formation. It is also important that doctors and health professionals are also trained in such Christian accompaniment,

Being men and women experts in humanity means promoting, through the attitudes with which one takes care of the suffering neighbor, the encounter with the Lord of life, the only one capable of pouring, in an effective way, the oil of consolation and the wine of hope.

Every man has the natural right to be assisted in this supreme hour according to the expressions of the religion he professes.

The sacramental moment is always the culmination of all the pastoral care commitment that precedes and the source of all that follows.

The Church calls "healing" sacraments ^[85] Penance and the Anointing of the Sick, which culminate in the Eucharist as "viaticum" for eternal life. ^[86] Through the closeness of the Church, the sick person lives the closeness of Christ who accompanies him on his journey to the house of the Father (cf. Jn 14 : 6) and helps him not to fall into despair, ^[87] supporting him in hope, especially when the journey becomes more tiring. ^[88]

11.     Pastoral discernment of those who ask for euthanasia or assisted suicide

A very special case in which today it is necessary to reaffirm the teaching of the Church is the pastoral accompaniment of the one who has expressly requested euthanasia or assisted suicide. With respect to the sacrament of Reconciliation, the confessor must ensure that there is contrition, which is necessary for the validity of absolution , and which consists in the "pain of the soul and the reprobation of the sin committed, accompanied by the resolution not to sin again in future ". ^[89] In our case, we are faced with a person who, beyond his subjective dispositions, has made the choice of a gravely immoral act and perseveres in it freely. It is a manifest non-disposition for the reception of the sacraments of Penance, with absolution,^[90] and the Anointing, ^[91] as well as the Viaticum. ^[92] He will be able to receive these sacraments when his disposition to take concrete steps allows the minister to conclude that the penitent has changed his decision. This also implies that a person who has registered in an association to receive euthanasia or assisted suicide must show the intention to cancel such registration, before receiving the sacraments. Remember that the need to postpone the acquittal does not imply a judgment on the imputability of the fault, as personal responsibility could be diminished or even not exist. ^[93]In the event that the patient was by now unconscious, the priest could administer the sacraments sub condicione if repentance can be presumed starting from some sign previously given by the sick person.

This position of the Church is not a sign of the sick person's lack of acceptance. In fact, it must be combined with the offer of help and listening that are always possible, always granted, together with a thorough explanation of the content of the sacrament, in order to give the person, until the last moment, the tools to be able to do so. choose and desire. Indeed, the Church is careful to scrutinize the signs of conversion that are sufficient for the faithful to reasonably ask for the reception of the sacraments. Remember that postponing absolution is also a medicinal act of the Church, aimed not at condemning the sinner, but at moving him and accompanying him towards conversion.

Thus, even if a person is not in the objective conditions to receive the sacraments, a closeness that always invites conversion is necessary. Especially if euthanasia, requested or accepted, is not practiced in a short time. There will then be the possibility of an accompaniment to revive hope and change the erroneous choice, so that access to the sacraments is open to the sick.

However, it is not admissible on the part of those who spiritually assist these sick any external gesture that can be interpreted as an approval of the euthanasia action, such as remaining present in the instant of its realization. This presence can only be interpreted as complicity. This principle concerns in particular, but not limited to, the chaplains of health structures where euthanasia can be practiced, who must not cause scandal by showing themselves in any way complicit in the suppression of human life.

12.     Reform of the education system and training of health workers

In today's social and cultural context, so full of challenges in relation to the protection of human life in the most critical phases of existence, the role of education is unavoidable . The family, school, other educational institutions and parish communities must work with perseverance to awaken and refine that sensitivity towards others and their suffering, of which the figure of the evangelical Samaritan has become a symbol. ^[94]

Hospital chaplaincies are required to expand the spiritual and moral training of health workers, including doctors and nurses, as well as hospital volunteer groups, so that they are able to provide the human and psychological assistance necessary in the final stages of life. The psychological and spiritual care of the patient throughout the course of the disease must be a priority for pastoral and health workers, taking care to put the patient and his family at the center.

Palliative care must be spread throughout the world and it is a duty to prepare for this purpose degree courses for the specialized training of health workers. Priority is also the dissemination of correct and widespread information on the efficacy of authentic palliative care for a dignified accompaniment of the person until natural death. Christian-inspired health care institutions must develop guidelines for their health care professionals that include appropriate psychological, moral and spiritual assistance as an essential component of palliative care.

Human and spiritual assistance must be part of the academic training courses of all health professionals and hospital internships.

In addition to this, health and care structures must prepare models of psychological and spiritual assistance to health workers who care for patients in the terminal stages of human life. Taking care of the caregiver is essential to avoid the burden on operators and doctors ( burn out) of the suffering and death of incurable patients. They need support and adequate moments of discussion and listening to be able to elaborate not only values ​​and emotions, but also the sense of anguish, suffering and death in the context of their service to life. They must be able to perceive the profound sense of hope and the awareness that their mission is a true vocation to support and accompany the mystery of life and grace in the painful and terminal phases of existence. ^[95]

Conclusion

The mystery of man's Redemption is surprisingly rooted in God's loving involvement with human suffering. This is why we can trust in God and transmit this certainty in faith to man who is suffering and afraid of pain and death.

Christian witness shows how hope is always possible, even within the throwaway culture. "The eloquence of the parable of the Good Samaritan, as well as of the whole Gospel, is in particular this: man must feel as if he is called in the first person to bear witness to love in suffering". ^[96]

The Church learns from the Good Samaritan the care of the terminally ill and thus obeys the commandment connected with the gift of life: “ respect, defend, love and serve life, every human life! ". ^[97] The gospel of life is a gospel of compassion and mercy addressed to concrete, weak and sinful man, to relieve him, keep him in the life of grace and, if possible, heal him from every possible wound.

However, it is not enough to share the pain, it is necessary to immerse oneself in the fruits of the Paschal Mystery of Christ to overcome sin and evil, with the desire to "remove the misery of others as if it were one's own". ^[98] The greatest misery, however, consists in the lack of hope in the face of death. This is the hope announced by Christian witness, which, to be effective, must be lived in faith, involving everyone, family members, nurses, doctors, and the pastoral care of dioceses and Catholic hospital centers, called to faithfully live the duty of '' accompaniment of the sick in all phases of the disease, and in particular in the critical and terminal phases of life, as defined in this document.

The Good Samaritan, who places the face of his brother in difficulty at the center of his heart, knows how to see his need, offers him all the good necessary to relieve him from the wound of desolation and opens bright slits of hope in his heart.

The Samaritan's "wanting good", who makes himself a neighbor to the wounded man not in words or with the tongue, but with deeds and in truth (cf. 1 Jn 3:18 ), takes the form of care, on example of Christ who passed by benefiting and healing everyone (cf. Acts 10:38).

Healed by Jesus, we become men and women called to announce his healing power, to love and take care of our neighbor as he testified to us.

This vocation to love and care for the other, ^[99] which brings with it gains of eternity, is made explicit by the Lord of life in the paraphrase of the final judgment: you inherit the kingdom, because I was sick and you visited me . When ever, Lord? Every time you have done this to your younger brother, to your suffering brother, you have done it to me (cf. Mt 25: 31-46).

The Supreme Pontiff Francis, on 25 June 2020, approved this Letter, decided in the Plenary Session of this Congregation on 29 January 2020, and ordered its publication.

Given in Rome, from the headquarters of the Congregation for the Doctrine of the Faith, on 14 July 2020, the liturgical memorial of St. Camillus de Lellis.

__________________

^[1] Roman Missal reformed in accordance with the decrees of the Second Vatican Ecumenical Council, promulgated by Pope Paul VI and revised by Pope John Paul II , Italian Episcopal Conference - Foundation of Religion Saints Francis of Assisi and Catherine of Siena, Rome 2020, Preface municipality VIII, p. 404.

^[2] See Pontifical Council for Health Care Workers, New Charter for Health Workers , Libreria Editrice Vaticana, Vatican City 2016, n. 6.

^[3] Cf. Benedict XVI, Encyclical Letter. Spe salvi (30 November 2007), n. 22: AAS 99 (2007), 1004: "If technical progress does not correspond to a progress in the ethical formation of man, in the growth of the interior man (cf. Eph 3:16 ; 2 Cor 4:16 ), then it does not it is progress, but a threat to man and to the world ”.

^[4] See Francesco, Speech to the Italian Association against leukemia-lymphomas and myeloma (AIL) (2 March 2019): L'Osservatore Romano , 3 March 2019, 7.

^[5] Francis, Exhortation. Ap. Amoris laetitia (19 March 2016), n. 3: AAS 108 (2016), 312.

^[6] Cf. Second Vatican Ecumenical Council, Past Constitution. Gaudium et spes (7 December 1965), n. 10: AAS 58 (1966), 1032-1033.

^[7] Cf. John Paul II, Letter Ap. Salvifici doloris (11 February 1984), n. 4: AAS 76 (1984), 203.

^[8] Cf. Pontifical Council for Healthcare Workers, New Charter for Healthcare Workers , n. 144.

^[9] Francis, Message for the XLVIII World Communications Day (24 January 2014): AAS 106 (2014), 114.

^[10] John Paul II, Encyclical Lett. Evangelium vitae (25 March 1995), n. 87: AAS 87 (1995), 500.

^[11] Cf. John Paul II, Encyclical Letter. Centesimus annus (1 May 1991), n. 37: AAS 83 (1991), 840.

^[12] John Paul II, Encyclical Lett. Veritatis splendor (6 August 1993), n. 50: AAS 85 (1993), 1173.

^[13] John Paul II, Address to the participants in the International Congress on “Life support treatments and the vegetative state. Scientific progress and ethical dilemmas " (20 March 2004), n. 7: AAS 96 (2004), 489.

^[14] Cf. Congregation for the Doctrine of the Faith, Lett. Placuit Deo (22 February 2018), n. 6: AAS 110 (2018), 430.

^[15] Cf. Pontifical Council for Healthcare Workers, New Charter for Healthcare Workers , n. 9.

^[16] Cf. Paul VI, Allocution in the last public session of the Council (7 December 1965): AAS 58 (1966), 55-56.

^[17] Pontifical Council for Health Care Workers, New Charter for Health Workers , n. 9.

^[18] Cf. Congregation for the Doctrine of the Faith, Lett. Placuit Deo (22 February 2018), n. 12: AAS 110 (2018), 433-434.

^[19] Francis, Address to the participants in the Plenary Assembly of the Congregation for the Doctrine of the Faith (30 January 2020): L'Osservatore Romano , 31 January 2020, 7.

^[20] Cf. Benedict XVI, Encyclical Letter. Deus caritas est (25 December 2005), n. 31: AAS 98 (2006), 245.

^[21] Cf. Benedict XVI, Encyclical Letter. Caritas in veritate (29 June 2009), n. 76: AAS 101 (2009), 707.

^[22] Cf. John Paul II, Encyclical Lett. Evangelium vitae (25 March 1995), n. 49: AAS 87 (1995), 455: "The truest and deepest meaning of life: that of being a gift that is accomplished in giving oneself ".

^[23] Second Vatican Ecumenical Council, Dogmatic Constitution. Dei Verbum (November 8, 1965), n. 2: AAS 58 (1966), 818.

^[24] John Paul II, Encyclical Lett. Evangelium vitae (25 March 1995), n. 34: AAS 87 (1995), 438.

^[25] Cf. Joint Declaration of Monotheistic Abrahamic Religions on End of Life Problems , Vatican City, 28 October 2019: "We oppose any form of euthanasia - which is a direct, deliberate and intentional act of taking life - as well as to medically assisted suicide which is a direct, deliberate and intentional support to suicide - as they are acts completely in contradiction with the value of human life and therefore consequently they are wrong actions from both a moral and religious point of view and should be prohibited without exception " .

^[26] Cf. Francis, Address to the Congress of the Italian Catholic Doctors Association on the 70th anniversary of its foundation (15 November 2014): AAS 106 (2014), 976.

^[27] Cf. Pontifical Council for Healthcare Workers. New charter of health workers , n. 1; Congregation for the Doctrine of the Faith, Instr. Dignitas personae (8 September 2008), n. 8: AAS 100 (2008), 863.

^[28] Francis, Encyclical Lett. Laudato si ' (24 May 2015), n. 65: AAS 107 (2015), 873.

^[29] Second Vatican Ecumenical Council, Past Constitution. Gaudium et spes (7 December 1965), n. 27: AAS 58 (1966), 1047-1048.

^[30] Francis, Address to the Congress of the Italian Catholic Doctors Association on the 70th anniversary of its foundation (15 November 2014): AAS 106 (2014), 976.

^[31] See Francis, Address to the National Federation of the Orders of Physicians and Dentists (20 September 2019): L'Osservatore Romano, 21 September 2019, 8: "These are hasty roads in the face of choices that are not, as they might seem, an expression of freedom of the person, when they include the rejection of the sick as a possibility, or false compassion in the face of the request to be helped to anticipate death ».

^[32] Congregation for the Doctrine of the Faith, Lett. Placuit Deo (22 February 2018), n. 3: AAS 110 (2018), 428-429; cf. Francis, Encyclical Letter Laudato si ' (24 May 2015), n. 162: AAS 107 (2015), 912.

^[33] Cf. Benedict XVI, Encyclical Letter. Caritas in veritate (29 June 2009), n. 53: AAS 101 (2009), 688: «One of the deepest poverty that man can experience is loneliness. On closer inspection, other poverties, including material ones, are born from isolation, from not being loved or from the difficulty of loving ».

^[34] Cf. Francis, Exhortation. Ap. Evangelii gaudium (24 November 2013), n. 53: AAS 105 (2013), 1042; see also: Id., Address to the delegation of the “Dignitatis Humanae” Institute (7 December 2013): AAS 106 (2014), 14-15; Id., Meeting with the elderly (28 September 2014): AAS 106 (2014), 759-760.

^[35] Cf. John Paul II, Encyclical Letter. Evangelium vitae (25 March 1995), n. 12: AAS 87 (1995), 414.

^[36] Congregation for the Doctrine of the Faith, Decl. Iura et bona (May 5, 1980), II: AAS 72 (1980), 546.

^[37] John Paul II, Encyclical Lett. Evangelium vitae (25 March 1995), n. 65: AAS 87 (1995), 475; cf. Congregation for the Doctrine of the Faith, Decl. Iura et bona (May 5, 1980), II: AAS 72 (1980), 546.

^[38] John Paul II, Encyclical Lett. Evangelium vitae (25 March 1995), n. 65: AAS 87 (1995), 477. It is a doctrine proposed in a definitive way in which the Church commits her infallibility: cf. Congregation for the Doctrine of the Faith, Illustrative doctrinal note of the concluding formula of the Professio fidei (29 June 1998), n. 11: AAS 90 (1998), 550.

^[39] Congregation for the Doctrine of the Faith, Decl. Iura et bona (May 5, 1980), II: AAS 72 (1980), 546.

^[40] Cf. Catechism of the Catholic Church , n. 2286.

^[41] Cf. ibidem , nn. 1735 and 2282.

^[42] Congregation for the Doctrine of the Faith, Decl. Iura et bona (May 5, 1980), II: AAS 72 (1980), 546.

^[43] Pontifical Council for Healthcare Workers, New Charter for Healthcare Workers , n. 169.

^[44] Cf. ibidem , n. 170.

^[45] Cf. John Paul II, Encyclical Letter. Evangelium vitae (25 March 1995), n. 72: AAS 87 (1995), 484-485.

^[46] Francis, Address to the participants in the Plenary Assembly of the Congregation for the Doctrine of the Faith (30 January 2020): L'Osservatore Romano , 31 January 2020, 7.

^[47] John Paul II, Encyclical Lett. Veritatis splendor (6 August 1993), n. 15: AAS 85 (1993), 1145.

^[48] Cf. Benedict XVI, Encyclical Letter. Spe salvi (30 November 2007), nos. 36-37: AAS 99 (2007), 1014-1016.

^[49] Congregation for the Doctrine of the Faith, Decl. Iura et bona (May 5, 1980), II: AAS 72 (1980), 546.

^[50] John Paul II, Letter Ap. Salvifici doloris (11 February 1984), n. 5: AAS 76 (1984), 204.

^[51] Cf. Benedict XVI, Encyclical Letter. Spe salvi (30 November 2007), n. 38: AAS 99 (2007), 1016.

^[52] Cf. John Paul II, Letter Ap. Salvifici doloris (11 February 1984), n. 29: AAS 76 (1984), 244: «The" neighbor "man cannot pass with indifference before the suffering of others in the name of fundamental human solidarity, much less in the name of love of neighbor. He must "stop", "be moved", thus acting like the Samaritan in the Gospel parable. The parable in itself expresses a profoundly Christian truth , but at the same time very universally human ”.

^[53] Cf. Congregation for the Doctrine of the Faith, Decl. Iura et bona (May 5, 1980), IV: AAS 72 (1980), 549-551.

^[54] Cf. Catechism of the Catholic Church , n. 2278; Pontifical Council for Health Care Workers, Charter of Health Care Workers , Libreria Editrice Vaticana, Vatican City 1995, n. 119; John Paul II, Encyclical Letter Evangelium vitae (25 March 1995), n. 65: AAS 87 (1995), 475; Francesco, Message to the participants in the European regional meeting of the World Medical Association (7 November 2017): "And if we know that we cannot always guarantee the healing of the disease, we can and must always take care of the living person: without shortening his life ourselves , but also without uselessly raging against his death "; Pontifical Council for Healthcare Workers,New charter of health workers , n. 149.

^[55] Cf. Catechism of the Catholic Church , n. 2278; Congregation for the Doctrine of the Faith, Decl. Iura et bona (May 5, 1980), IV: AAS 72 (1980), 550-551; John Paul II, Encyclical Letter Evangelium vitae (25 March 1995), n. 65: AAS 87 (1995), 475; Pontifical Council for Healthcare Workers, New Charter for Healthcare Workers , n. 150.

^[56] John Paul II, Encyclical Lett. Evangelium vitae (25 March 1995), n. 65: AAS 87 (1995), 476.

^[57] Cf. Pontifical Council for Healthcare Workers , New Charter for Healthcare Workers , n. 150.

^[58] Cf. John Paul II, Address to participants in a study meeting on responsible procreation (5 June 1987), n. 1: Teachings of John Paul II , X / 2 (1987), 1962: "To speak of a" conflict of values ​​or goods "and the consequent need to perform as a sort of" balancing "of the same, choosing one and rejecting the other , it is not morally correct ».

^[59] Cf. John Paul II, Address to the Italian Catholic Doctors Association (28 December 1978): Teachings of John Paul II , I (1978), 438.

^[60] Cf. Pontifical Council for Healthcare Workers , New Charter for Healthcare Workers , n. 150.

^[61] Cf. Congregation for the Doctrine of the Faith, Answers to questions from the US Bishops' Conference on artificial nutrition and hydration (1 August 2007): AAS 99 (2007), 820.

^[62] Cf. ibidem .

^[63] Cf. Pontifical Council for Healthcare Workers, New Charter for Healthcare Workers , n. 152. " Nutrition and hydration, even artificially administered, fall within the basic care due to the dying, when they are not too burdensome or of any benefit. Their unjustified suspension can have the meaning of a real euthanasia act: “The administration of food and water, even by artificial means, is in principle an ordinary and proportionate means of preserving life. It is therefore obligatory, insofar as and as long as it proves that it has achieved its proper purpose, which consists in providing the patient with hydration and nourishment. In this way, suffering and death due to starvation and dehydration are avoided ”».

^[64] Francis, Address to the Plenary of the Pontifical Academy for Life (5 March 2015): AAS 107 (2015), 274, with reference to: John Paul II, Encyclical Letter. Evangelium vitae (25 March 1995), n. 65: AAS 87 (1995), 476. Cf. Catechism of the Catholic Church , n. 2279.

^[65] Cf. Francis, Address to the Plenary of the Pontifical Academy for Life (5 March 2015): AAS 107 (2015), 275.

^[66] Cf. Pontifical Council for Healthcare Workers , New Charter for Healthcare Workers , n. 147.

^[67] Cf. John Paul II, Letter Ap. Salvifici doloris (11 February 1984), n. 2: AAS 76 (1984), 202: "Suffering seems to belong to the transcendence of man: it is one of those points in which man is in a certain sense" destined "to overcome himself, and comes to this called in a mysterious way ».

^[68] Benedict XVI, Enc. Lett. Spe salvi (30 November 2007), n. 38: AAS 99 (2007), 1016.

^[69] Cf. Francis, Exhortation. Ap. Amoris laetitia (19 March 2016), n. 48: AAS 108 (2016), 330.

^[70] C. Saunders, Watch with Me: Inspiration for a life in hospice care , Observatory House, Lancaster, UK, 2005, p. 29.

^[71] Francis, Address to the participants in the Plenary Assembly of the Congregation for the Doctrine of the Faith (30 January 2020): L'Osservatore Romano , 31 January 2020, 7.

^[72] Cf. Pontifical Council for Healthcare Workers , New Charter for Healthcare Workers , n. 148.

^[73] Cf. Pius XII, Allocutio. Trois questions religieuses et morales concernant l'analgésie (February 24, 1957): AAS 49 (1957) 134-136; Congregation for the Doctrine of the Faith, Decl. Iura et bona (May 5, 1980), III: AAS 72 (1980), 547; John Paul II, Letter Ap. Salvifici doloris (11 February 1984), n. 19: AAS 76 (1984), 226.

^[74] Cf. Pius XII, Allocutio. Iis qui interfuerunt Conventui Internationali. Romae habito, at "Collegio Internationali Neuro-Psycho-Pharmacologico" indicated (9 September 1958): AAS 50 (1958), 694; Congregation for the Doctrine of the Faith, Decl. Iura et bona (May 5, 1980), III: AAS 72 (1980), 548; Catechism of the Catholic Church , n. 2779; Pontifical Council for Health Workers, New charter for Health Workers, no. 155: «There is also the possibility of causing the suppression of consciousness in the dying person with analgesics and narcotics. This use deserves special consideration. In the presence of unbearable pain, refractory to the usual analgesic therapies, close to the moment of death, or in the well-founded prediction of a particular crisis at the moment of death, a serious clinical indication may involve, with the consent of the patient, the administration of drugs suppressive of consciousness. This clinically motivated deep palliative sedation in the terminal phase can be morally acceptable provided that it is done with the consent of the patient, that appropriate information is given to family members, that any euthanasia intentionality is excluded and that the patient has been able to satisfy the his moral duties, family and religious: "approaching death, men must be able to satisfy their moral and family obligations and above all they must be able to prepare themselves with full awareness for the definitive encounter with God". Therefore, "the dying person must not be deprived of self-awareness without a grave reason" ”.

^[75] Cf. Pius XII, Allocutio. Trois questions religieuses et morales concernant l'analgésie (February 24, 1957): AAS 49 (1957) 145; Congregation for the Doctrine of the Faith, Decl. Iura et bona (May 5, 1980), III: AAS 72 (1980), 548; John Paul II, Encyclical Letter Evangelium vitae (25 March 1995), n. 65: AAS 87 (1995), 476.

^[76] Cf. Francesco, Address to the Congress of the Italian Catholic Doctors Association on the 70th anniversary of its foundation (15 November 2014): AAS 106 (2014), 978.

^[77] Cf. Pius XII, Allocutio. Trois questions religieuses et morales concernant l'analgésie (February 24, 1957): AAS 49 (1957), 146; Id., Allocutio. Iis qui interfuerunt Conventui Internationali. Romae habito, to "Collegio Internationali Neuro-Psycho-Pharmacologico" indicated (9 September 1958): AAS 50 (1958), 695; Congregation for the Doctrine of the Faith, Decl. Iura et bona (May 5, 1980), III: AAS 72 (1980), 548; Catechism of the Catholic Church , n. 2279; John Paul II, Encyclical Letter Evangelium vitae (25 March 1995), n. 65: AAS 87 (1995), 476; Pontifical Council for Healthcare Workers,New charter of health workers , n. 154.

^[78] Cf. John Paul II, Address to the participants in the International Congress on “Life-sustaining treatments and the vegetative state. Scientific progress and ethical dilemmas " (20 March 2004), n. 3: AAS 96 (2004), 487: «A man, even if seriously ill or impeded in the exercise of his highest functions, is and will always be a man, never will he become a 'vegetable' or an 'animal'».

^[79] Pontifical Council for Healthcare Workers , New Charter for Healthcare Workers , n. 151.

^[80] Ibidem , n. 151; John Paul II, Encyclical Letter Evangelium vitae (25 March 1995), n. 74: AAS 87 (1995), 487.

^[81] Cf. Francis, Address to the Congress of the Italian Catholic Doctors Association on the 70th anniversary of its foundation (15 November 2014): AAS 106 (2014), 977.

^[82] John Paul II, Encyclical Lett. Evangelium vitae (25 March 1995), n. 73: AAS 87 (1995), 486.

^[83] Benedict XVI, Address to the Congress of the Pontifical Academy for Life on the theme "Alongside the incurable sick and the dying: ethical and operational guidelines" (25 February 2008): AAS 100 (2008), 171.

^[84] Francis, General Audience (10 June 2015): L'Osservatore Romano , 11 June 2015, 8.

^[85] Catechism of the Catholic Church , n. 1420.

^[86] Cf. Ritual Romanum ex decree Sacrosancti Oecumenici Vatican Councils II instauratum auctoritate Pauli PP. VI promulgatum, Ordo unctionis infirmorum eorumque pastoralis curae , Editio typica , Praenotanda , Typis Polyglottis Vaticanis, Civitate Vaticana 1972, n. 26; Catechism of the Catholic Church , n. 1524.

^[87] Cf. Francis, Encyclical Lett. Laudato si ' (24 May 2015), n. 235: AAS 107 (2015), 939.

^[88] Cf. John Paul II, Encyclical Letter. Evangelium vitae (25 March 1995), n. 67: AAS 87 (1995), 478-479.

^[89] Council of Trent, Sess. XIV, De sacramento paenitentiae , chap. 4: DH 1676.

^[90] Cf. CIC , can. 987.

^[91] Cf. CIC , can. 1007: "The anointing of the sick is not to be conferred on those who obstinately persevere in manifest grave sin".

^[92] Cf. CIC , can. 915 and can. 843 § 1.

^[93] Cf. Congregation for the Doctrine of the Faith, Decl. Iura et bona (May 5, 1980), II: AAS 72 (1980), 546.

^[94] Cf. John Paul II, Letter Ap. Salvifici doloris (11 February 1984), n. 29: AAS 76 (1984), 244-246.

^[95] Cf. Francis, Address to the leaders of the Medical Orders of Spain and Latin America (9 June 2016): AAS 108 (2016), 727-728: "Fragility, pain and illness are a severe test for all , even for medical personnel, they are an appeal to patience, to suffer-with; therefore we cannot give in to the functionalist temptation to apply quick and drastic solutions, moved by a false compassion or by mere criteria of efficiency and economic savings. The dignity of human life is at stake; what is at stake is the dignity of the medical vocation ".

^[96] John Paul II, Letter Ap. Salvifici doloris (11 February 1984), n. 29: AAS 76 (1984), 246.

^[97] John Paul II, Encyclical Lett. Evangelium vitae (25 March 1995), n. 5: AAS 87 (1995), 407.

^[98] Thomas Aquinas, Summa Theologiae , I, q. 21, a. 3.

^[99] Cf. Benedict XVI, Encyclical Letter. Spe salvi (30 November 2007), n. 39: AAS 99 (2007), 1016: “Suffering with the other, for others; suffer for the sake of truth and justice; to suffer because of love and to become a person who truly loves - these are fundamental elements of humanity, the abandonment of which would destroy man himself ».

[01077-EN.01] [Original text: Italian]