End of Life Issues
Planning for compassionate care
By Dr. Samir Jamil
“When fear knocks, let faith answer the door.”
— Robin Roberts, American broadcaster
In addressing this difficult subject, I must first make a clarification: I am not a theologian or an ethicist. I am a physician who has faced end-of-life issues many times over my 37-year career in pediatric oncology. This article is guided by the teachings of the Catholic Church—its Catechism and moral tradition—and by the Catholic Medical Association, of which I was a member. If I have made any errors, I welcome correction and comment.
The Cambridge Dictionary defines “end-of-life issues” as matters related to someone’s death and the time just before it, when it is known that they are likely to die soon from an illness or condition. More broadly, it includes care for all those with terminal illnesses that are advanced, progressive, and incurable. These questions touch the depths of our humanity, stir strong emotions, and—more importantly—demand careful moral reasoning.
Human life possesses inherent dignity, rooted in who we are, not in what we do. Life is sacred, a gift from God, and deserves respect and reverence. Yet, life is not the ultimate good; our relationship with God is the greater good. In Catholic belief, death is not an end but a transformation to eternal life. This faith does not deny the pain of physical death—its suffering and separation—but views it as a passage. Life is changed, not ended.
The Bible offers three essential truths about the end of life:
• Life is a basic but not absolute good.
• We are stewards of life, not its masters.
• Death is understood within faith in new life—the afterlife.
Planning for the End of Life
Planning ahead is difficult but important. Deciding one’s wishes while healthy can spare loved ones confusion and stress later. End-of-life planning allows individuals to choose:
• Where they wish to spend their final days (home, hospital, hospice, etc.)
• What kinds of treatment they want—or do not want—such as palliative care.
Key elements of end-of-life planning include:
1. Advance Directives — Legal documents that outline one’s medical care preferences if they become unable to make decisions. These directives guide doctors and caregivers in cases of coma, severe injury, late-stage dementia, or terminal illness.
2. Living Will — A written statement of which treatments one would accept or refuse if dying or permanently unconscious. It can specify preferences about:
• Dialysis or breathing machines
• Resuscitation if the heart or breathing stops
• Tube feeding
• Organ or tissue donation
3. Durable Power of Attorney — A document naming a trusted person as a healthcare proxy to make medical decisions when the patient cannot.
Faith, Morality, and the End of Life
End-of-life decisions are painful for patients and loved ones alike. Yet even in suffering, we are called to make choices grounded in faith and moral clarity.
Catholic teaching provides guiding principles:
Human Dignity — Every life is sacred because we are made in the image and likeness of God and called to share in His divine nature.
The Redemptive Value of Suffering — Suffering and death are not good in themselves, but through the Cross they can become redemptive, drawing us closer to God and holiness.
We Cannot Use Evil Means for a Good End — The Fifth Commandment forbids intentionally killing the innocent. Euthanasia, which seeks to end suffering by ending life, is morally unacceptable. As the Catechism states: “Whatever its motives and means, direct euthanasia consists in putting an end to the lives of disabled, sick, or dying persons. It is morally unacceptable” (CCC 2277). The Hippocratic Oath also affirms: “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan.”
Ordinary vs. Extraordinary Means — The sick and dying are not required to undergo extraordinary treatments that are excessively burdensome, dangerous, or disproportionate to the expected benefit (CCC 2278). For example, giving chemotherapy to a patient who is imminently dying may be extraordinary. Nutrition and hydration, however, are considered ordinary care until they no longer provide benefit.
Challenge of Compassionate Care
Palliative care remains underused in the United States. Despite advances in medicine, a “save at all costs” mentality persists among healthcare professionals, often reinforced in medical training. Our healthcare system tends to favor aggressive interventions over compassionate, reasonable care at the end of life.
Returning to natural moral law and Catholic teaching:
Any action that directly and intentionally kills an innocent person is unjust. Withdrawing food and water from someone who is not near death and can tolerate it is morally equivalent to murder. St. John Paul II wrote, “The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act.”
Patients must receive full, honest information about their condition, proposed treatments, risks, side effects, and costs (Ethical and Religious Directives for Catholic Healthcare Services, U.S. Conference of Catholic Bishops, 1994, No. 27).
Patients should be informed of all morally legitimate treatment options.
The patient, in consultation with the physician, decides the course of treatment.
The patient’s judgment should normally guide others’ decisions, unless it is medically unwarranted or morally wrong.
Treatment may be stopped when it no longer provides benefit or imposes excessive burden. Pain management is essential and must not be neglected.
When death is imminent, patients may forgo treatments that only prolong dying.
Food and water may be withheld only when they no longer provide benefit.
Ordinary care remains morally obligatory; refusing extraordinary treatment when death is imminent is not suicide.
“Fear knocked at the door. Faith answered. There was no one there.”
— Martin Luther King Jr.