The difference between killing and allowing to die

The one thing that proponents and opponents of euthanasia both agree on is that no one should have to die in pain.

In formulating its teaching on care at the end of life the Catholic tradition takes into account the absolute importance of effective pain relief and also makes a clear moral distinction between 'direct killing' and 'allowing to die'. At the core of these issues is intention.

Direct killing is any action or omission that intends the death of another i.e. the cause of death is the human intervention or omission. By contrast, withholding or withdrawing futile or overly burdensome treatment is judged as 'allowing to die' i.e. the disease or fatal condition overtaking the person is ultimately the cause of death. This is not euthanasia.

Administering pain relief is an action that can have the foreseen effect of shortening a person’s life. If a health professional directly intends the death of the patient, then the provision of such medication (at a dose level that is greater than what is needed to relieve the patient's pain) is wrong and is considered to be an act of killing, regardless of how well-meaning the person’s actions may be.

If, however, the health professional's sole intention is the relief of pain, the fact that the administration of the pain medication has more than one outcome – one positive (relief of pain) and one negative (earlier death) – does not make their action wrong; it is not act of 'direct killing' because, while an earlier death may be foreseen, it is an unintended consequence. Once again, this is not euthanasia and it is misleading and confusing to refer to such actions as “passive euthanasia” as some do.

When medicine can no longer provide a cure for persons at the end of life the proper management of a patient’s pain and other physical symptoms is vital if the spiritual and relational aspects of the person are to be addressed. All those who are dying should have the opportunity to proper health care and pain relief based on a universal and unconditional respect for the fundamental equality of all persons.

John Kleinsman 
The Nathaniel Centre