Reflection on the Public Lecture

Reflection on the Public Lecture

 Marian Devotion in relation to Lumen Gentium and Marialis Cultus

The lecturer, fr. Roland Mactal, introduced the Vatican II convoked in 1962 by Pope John XXIII, and closed by Pope Paul VI in the year 1965. Concerning Marian Devotion or Theology of Mary, he explains the two major themes “Aggiornamento” and “Ressourcement”. Aggiornamento means renewal or updating and Ressourcement means going back to the sources, here the sources will be the Scriptures.

Theology of Mary or Marian Devotion is mainly discussed in Vatican II Document Lumen Gentium, chapter eight. The lecturer explains the Parameters of Marian Theology. He introduces four parameters on the theology of Mary. Firstly, Mary as Theological Person which indicates Mary’s life and work as a mission expressed in Lumen Gentium, numbers 54 to 59.

Secondly, Mary as the Spiritual Subject, in which Mary is considered as one of us who experiences what we experience. In other words, that is the Process of Individuation. This concept is expressed in Lumen Gentium, numbers 66 to 67.

The third parameter is Concrete Universal in which Mary is presented as Model, Archetype or Exemplar of the Church. This typology reveals the relation between Mary and the Church. This parameter is taken from Lumen Gentium, numbers 60 to 65.

The last parameter presents Mary as Historical Subject. This parameter concerns the Anthropological and cultural identity of Mary, regarding the questions of who Mary is and where she is from. This parameter leads us to understand that Mary is an anawim, which means she is a poor of YHWH. This parameter can be found in Lumen Gentium, numbers 52 to 53.

Another concept that the Lecturer discussed was Mary as Mediatrix. The Mediatrix is attributed to Mary only as a title. However, many people have been proposing it to become a dogma. He continues to explain that there are some opposite ideas on this issue. Some propose that Jesus Christ is the Only Mediator, quoting the Letter of St. Paul to Timothy 2:5-6.

The counterpart explanation of this is that the mediation of Jesus is unique and ontological and cannot be replaced. The mediation of Mary is intercessory and dynamic. Mary’s mediation is through intercession, because she participates in the life of Jesus Christ. It does not obscure or diminishes the unique mediation of Christ, rather shows His power. (L.G. # 60) Because of the superabundance of merits she received from Christ, she is the Mediatrix. Lumen Gentium, number 62 entitles Mary as “Advocate, Auxiliatrix, Benefactress”.

Concerning the Apostolic Exhortation Marialis Cultus of Pope Paul VI, the lecturer explains the role of Marian devotion in relation to the Liturgy. The Liturgy is the official public prayer of the Church. The Vatican II emphasizes to restore and enhance the Liturgy by active and fruitful participation of the faithful in it.

Marialis Cultus expresses in terms of renewal of private Marian devotion, such as the Rosary in relation to the Liturgy of the Eucharist and to the Liturgy of the Hours. Furthermore, in Marialis Cultus Marian teachings were the union of Mary with the mystery of Christ and the Church and the placement of Marian devotion in its right perspective.

Concerning Marian Devotion, Catholic veneration of the Mother of God has two aspects: Public (official) and Private (pious devotions and exercises). The Public Official Liturgical Prayers are the Holy Mass and the Liturgy of the Hours. Mary, the Mother of God, is commemorated in the daily celebration of the Eucharist. The Church has officially approved four solemnities, three feasts and nine memorials in honor of Mary within the Liturgical Year. Mary is featured in the liturgy in various ways such as Hymns, prayers and the readings.

As explained in Marialis Cultus, the Angelus and the Holy Rosary are the two exercises of piety, which are both biblically based. The substantial part of these devotions is primarily taken from the Gospel. The Angelus reminds us of the Paschal Mystery of Christ. The Holy Rosary which focusses on the salvific events of the life of Christ is called the Gospel prayer.

In Marialis Cultus, Pope Paul VI recognizes the Dominicans’ tradition on Holy Rosary as he mentions: “among these people special mention should be made of the sons of St. Dominic, by tradition the guardians and promoters of this very salutary practice, the praying of the Holy Rosary.” (43)

The lecturer concludes that “Marialis Cultus proposed Mary as model of the Church in divine worship, because she represents the Church at worship at its deepest level.”

Francis Nge Nge, OP

Meaning of Suffering and Death

Meaning of Suffering and Death


       Remember John, the patient with metastatic brain cancer? After discarding the option of euthanasia, which shortens life unethically, and of dysthanasia, which postpones death unduly, John has accepted orthothanasia or allowing to die, and signed a “living will.” He has also asked his elder brother physician to please continue taking care of his terrible pain, and to his daughter, not to leave him alone.

       Once in a medico-moral conference in Manila, I heard a psychiatrist say: “Ask not why a patient requests for euthanasia, but why life loses its meaning.”  Indeed, finding meaning to the end of life, and to suffering can make of euthanasia not an option.


       The word “suffering” is derived from the Latin word “sufferre” or” sub-ferre,” meaning to bear: the sufferer is a bearer of burdens. Although mainly physical in nature, pain is closely related to suffering, which is more than just bodily pain. As Eric Cassell says, pain is undergone by the body, while suffering by the person. Radically, however, the experience of pain and suffering belongs to the whole person, who is body-soul. Often, the terms pain and suffering are used interchangeably. Suffering may be physical and moral (cf. John Paul II, Salvifici Doloris).

       May suffering and pain be useful?  Do they have a positive meaning?  In the order of nature, pain and suffering especially severe and chronic are evils that attack our integrity as human beings, limit our freedom and independence, develop in many of us feelings of anger, rejection and guilt – and the fear of alienation.

       As an evil, suffering has to be avoided and fought.  As an inevitable part of our earthly life – sooner or later, an intruder into our life –, we are asked to face it humanely, that is, reasonably, responsibly, and – as much as possible – courageously.  In the order of divine grace, suffering is an evil, but it can become – when lovingly and patiently borne – an instrument of purification and salvation.

       Suffering, including physical pain, is truly mysterious: mysterium doloris. Suffering is part of the project of human life that is realized in love.  God is not indifferent to our infirmities. In fact, in his Son Jesus Christ, he shared our sufferings, and is with us when we are in pain.   Out of love Christ died for all humanity. We, Jesus’ disciples, join our sufferings to the sufferings of Christ.  The deepest meaning of the mystery of suffering is co-redemptive suffering or suffering as an act of redeeming love (Col. 1:24). How do we bear our cross – our darkness? We try to bear it with courage, patience and hope – and prayer. How do we help others carry their cross, their pains and sufferings? By relieving their suffering and accompanying them with compassion and prayer.


       True compassion with the dying – with our brother John – is not the false compassion of euthanasia that kills, but the true compassion of charity as love of neighbor, of all neighbors, especially the poor and the sick neighbor – as Jesus witnessed and taught us.

       Following Christ, the Good Samaritan – the best paradigm of the healing and caring ministry –, we all have to be at the side of those who suffer in our families and communities, and to help them bear their sufferings. We have to accompany, in particular, the terminally and incurable ill.  In his play Caligula, Albert Camus put these words in the mouth of Scipio:  “Caligula often told me that the only mistake one makes in life is causing suffering to others.” We have to be at the side of the terminally ill in a nonjudgmental, non-paternalistic, but understanding, respectful and prayerful attitude.

       The terminally ill patients need not only pain relief, but also empathetic solidarity; need not philosophical or theological explanations but compassion. In general, health care professionals try to free patients from pain, while significant others – immediate family, friends, the pastoral team and also the healthcare team – provide support and protection, security – and “a warm heart.”

       Another important point to underline: those serving the terminally ill, in particular believers in Jesus, realize that the sick evangelize them, too, by silently inviting them to reflect on the gifts of health and relationships, on God, on our own sufferings, on the finitude of life, and on their loving union with the Crucified and Risen Lord.

       How do we help others to die? We help them to die peacefully by praying with them and their families, by being with them, by accompanying them. While we ask the Lord to help us face our own death with courage, we ask him to help us face the death of our loved ones and our neighbors with compassion, with sympathetic solidarity. The Lord is particularly present in those who suffer. When we visit patients like John, we believe that Jesus is present in them. Jesus keeps telling us: “I was sick and you visited me” (Mt 25:36).


       Death is inescapable, inevitable, and utterly undeniable:  “Man’s days are like those of the grass, like a flower of the fields it blooms; the wind sweeps over him and he is gone, and his place knows him no more (Ps 103:15-16).

       Pain and suffering are travelling companions on our journey of life. They appear as veiled or clear warnings of the reality of death. As the Catechism of the Catholic Church puts it, Illness “can make us glimpse death” (CCC, 1500).

       As Christians, we are asked not only to accept our death but also to help others accept theirs. Physicians, and other healthcare givers, are asked by their profession – and by their faith – to help the terminally ill and dying accept their death at the proper time.  To be able to do this responsibly, they must have accepted the reality of death not as a failure of medicine (except when there is a gross negligence), but as a natural end of earthly human life.

       For Christians, death is also a very important and difficult reality, but not the ultimate reality. The ultimate reality is eternal life with God: “Where might the human being seek the answer to dramatic questions such as pain, the suffering of the innocent and death, if not in the light streaming from the mystery of Christ’s Passion, Death and Resurrection?” (John Paul II). “I am not dying. I am entering life” (Saint Therese of the Child Jesus). “If you are an apostle, you will not die. You will change of house and nothing more” (St. Josemaría Escrivá).

       Objective ethical guidelines and answers are not hard, but personal decisions at the end of life are often extremely difficult. The bishops of Illinois advice: “We must not let some of the ambiguities of end-of-life decision making lead us, on one hand to a neurotic fear that we will incur Christ’s judgment for not acting with sufficient care and, on the other hand, to choose reckless or misguided care for our loved ones. In consulting with legitimate Church teaching, our conscience can be formed so that decisions made even in emotionally laden situations are moral, compassionate and appropriate.”

       On earth we are pilgrims, co-travelers on the way to the Father’s house: we are citizens of heaven. Our life is God’s gift which we must treasure from womb to tomb. Our faith, God’s unmerited gift, is hopeful. Our love – God’s love – makes of our life a faithful and hopeful journey to heaven. Certainly, love is stronger than death.

       At the end of his earthly life, John is suffering with continuing pains. He has signed his “living will.” His brother physician is helping him diminish his pains by prescribing the appropriate painkillers. His daughter, family and friends are giving him “a warm heart” so that he does not suffer from loneliness, from feeling alone, which would mean social death. They all, with the members of his parish are praying with and for him. John has asked for the Anointing of the Sick and Holy Communion. He is calm and at peace within and without. He is ready to go.

       “You, dear Lord, have made us for yourself, and our hearts are restless until they rest in you” (St. Augustine). May God bless us all!

(Published by O Clarim, June 23, p. 10)




John, our patient with metastatic cancer, had three possibilities of treatment: a lethal injection, aggressive treatment to prolong his dying, and allowing him to die peacefully. Ethically speaking, the first option is utterly immoral, and the second is optional but might also be immoral. How about allowing to die? His brother doctor asked John: What do you want? His answer: I  want to be relieved of my pain and suffering.

Allowing to die implies palliative care, or comfort care which is currently practiced in many countries of the world. There is a need of more public awareness on palliative care and of more specialized healthcare professionals.


Basic teaching from our Christian faith: Every human life, from the moment of conception until death, is sacred because the human person has been willed for its own sake in the image and likeness of the living and holy God (Catechism of the Catholic Church, CCC, 2319); Those whose lives are diminished or weakened deserve special respect. Sick or handicapped persons should be helped to lead lives as normal as possible (CCC, 2276).

Palliative care refers to holistic care of incurable and terminal patients. It comprises medical, psychological, social, and spiritual dimensions of care. Holistic care focuses on the patient as a human person, not on the symptoms of his or her illness. Pope Francis says: Palliative care means support for the elderly (and patients) in the last stages of illness. Palliative care recognizes something equally important: recognizing the value of the person. While healthcare professionals take care especially of physical and psychological suffering, significant others, of the social and spiritual dimensions of palliative care for patient and family. The World Health Organization (WHO) describes palliative care as follows:

Palliative care

  • Affirms life and regards dying as a normal process.
  • Neither hastens nor postpones death.
  • Provides relief from pain and other distressing symptoms.
  • Integrates the psychological and spiritual aspects of patient care.
  • Offers a support system to help patients live as actively as possible until death.
  • Offers a support system to help the family cope during the patient  illness and in the family bereavement

(World Health organization (WHO), Cancer: Pain Relief and Palliative Care).

Cardinal Thomas Collins, archbishop of Toronto writes: We need to make available for all Canadians (not just 30% of us) real medical assistance in dying: palliative care, where people who are dying are surrounded with love, and where any pain they experience is countered with the most advanced medical care available.”

Currently, hospice care is generally considered an outstanding model of palliative care. It may be provided at home, in the hospital or in a nursing home. Echoing Christian tradition, the Catechism of the Catholic Church encourages palliative care, and calls it a form of disinterested charity (CCC, 2279). It is important to note that the spiritual aspect, which includes pastoral care, should not treated as an added footnote, or an accidental aspect, but as what it is: an essential dimension of holistic care of the terminally ill persons.


According to some, there is among a good number of doctors a certain opiophobia, or reluctance to prescribe opioids analgesics to alleviate pain. In a study done in France some time ago, only three per cent of internists and seven per cent of specialists prescribed an adequate dosage of morphine. It is widely accepted that today there is an urgent need to improve palliative medicine. After all medicine goal is to care always and to cure when possible. Caring implies palliative or comfort care.

In Christian perspective, Pius XII was the first Pope to articulate concrete ethical guidelines on pain relief.  In Evangelium Vitae, John Paul II presents the main points of this traditional teaching.

Pius XII affirmed that it is licit to relieve pain by narcotics, even when the result is decreased consciousness and a shortening of life, if no other means exists, and if, in the given circumstances, this does not prevent the carrying out of other religious and moral duties. In such a case, death is not willed or sought, even though for reasonable motives one runs the risk of it.  There is simply a desire to ease pain effectively by using analgesics which medicine provides. Pope Pius XII adds: it is not right to deprive the dying person of consciousness without a serious reason. As they approach death, people ought to be able to satisfy their moral and family duties, and above all they ought to be able to prepare in a fully conscious way for their definitive meeting with God (St. John Paul II).

If a capable patient, a Christian decides to reject treatment with painkillers in order to offer his suffering to Christ, his free and responsible decision ought to be respected.  A surrogate, however, may not decide in a similar manner, for this would be against the best interest of incapable patients.


Connected with orthothanasia or allowing to die and palliative care are the so-called living wills, or anticipated wills, or advanced directives. A living will is described thus: A signed, witnessed or notarized document that allows a patient to direct that specified life-sustaining treatments be withheld or withdrawn if the patient is in a terminal condition and unable to make healthcare decisions (William May). Actually many hospitals offer their patients a living will form that the patient freely may or may not sign. Likewise, some local Conferences of Bishops of the Catholic Church have also proposed forms for an advanced will. These statements usually request doctors to remove or not to start unduly aggressive treatment, and to provide instead terminal or palliative sedation with the direct intention of relieving pain.

Recently (May 2017), the Korean bishops released some guidelines on end-of-life treatment and palliative care. The bishops teach: “Catholics should make the declaration as part of their will to implement Catholic teaching that life should be cherished up to the last moment.” They underline, furthermore, that the supply of nutrition and water is an essential part of humane treatment and does not count as a medical intervention. The bishops recommend to Catholics to express their intention to have spiritual care as well as medical care. They added: “Hospice and palliative care is an effective way to help patients spend their last days with dignity. At the same time, when they prepare for death, they need to reflect on their lives and reconcile with God.”

The living will that a free and responsible patient signs is only a temporary statement in the sense that it can be re-affirmed or changed during his or her stay in the hospital or later. This change of will does happen some times and is usually respected  as it should. Unfortunately, there are cases when the change in the advance directives – done with due knowledge, freedom and responsibility – was not respected by surrogate decision-makers. This lack of due respect is unethical.

Catholics with many other women and men of good will are against assisted suicide. They are also against prolonging dying and for letting die the incurable patient. Taught by their faith and tradition, Christians are with many other men and women of good will for palliative or comfort care, which relieves pain directly, may shorten life indirectly and unintendedly, and provides compassion in solidarity.

Another argument in favor of euthanasia we are told is that pain is against a good quality of life, and therefore it should be eliminated at all costs. In our final piece on the end of life mini-series, we shall converse briefly on the meaning of suffering and death. (Published by O Clarim, June 16, 2017).



The two Articles about “the end of life”

The two Articles about “the end of life”






                John is 48 years old. He is terminally ill with brain cancer – and suffering terribly. His older brother who is a physician has accepted, and convinced John, that euthanasia is unethical and unchristian. Now the only daughter of John cannot accept his approaching death, and wants to continue treatment by all means available. Out of love for her, her father has consented to start aggressive treatment. Now the physician asks: May I give to my brother all the medical means available to keep him alive?

                The doctor is asking for what is called dysthanasia.  Is dysthanasia ethical and Christian?


               What is dysthanasia? Etymologically, dysthanasia means faulty, imperfect death.  It may be defined as the medical process through which the moment of death is postponed by all means available.  Dysthanasia is the undue prolongation of life – of dying -, the postponement of death.

                The fundamental ethical distinction to apply in the case of the terminally ill is the distinction between ordinary and extraordinary means of treatment. In the words of the National Conference of American Bishops (USA), ordinary or proportionate means “are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.” On the other hand, extraordinary or disproportionate means refer to “those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive expense on the family or the community.” This important distinction should be applied fairly and not in a discriminatory manner – in a different way for rich and poor, for men or women, for children and the elderly, for the able and the differently able.

               Another important and enlightening distinction on the case refers to the kind of treatment, which can be beneficial, useless or doubtful. If the treatment is beneficial it must be generally given, except when it is too burdensome for the patient or the family. Useless treatment is futile treatment, which is not really beneficial but futile. When the doctor is not sure if it is beneficial or useless, the treatment is called doubtful treatment.


                Human life must be protected and dutifully prolonged.  From a humanist and Christian perspective, human beings are obliged to take care of and prolong their lives through ordinary, proportionate, beneficial means. It is our duty to care for our life and try to be healthy. For believers in God, the use of beneficial treatment is connected with the principle of stewardship, which states that we are stewards of our life which belongs to God, our creator, who is the Lord of life and death.

                 When the medical treatment is doubtful or uncertain, the “best-interest of the patient” principle seems to demand providing treatment, which has a potential benefit – to health and life.

                When the treatment is futile, or too burdensome, it is not obligatory to use it, but generally optional. However, it appears more humane and Christian not to try a useless therapy. Indeed, if it is truly useless, why should it be used at all? The poet Jorge Manrique wrote: Que querer hombre vivir / cuando Dios quiere que muera / es locura (“For man to want to live when God wants him to die is madness”). Therefore, death should not be caused, neither should it be absurdly delayed (Spanish Episcopal Conference). St. John Paul II said: “Both the artificial extension of human life and the hastening of death, although they stem from different principles, conceal the same assumption: the conviction that life and death are realities entrusted to human beings to be disposed of at will.”

               When facilities are scarce, when the poor do not have primary health care, may we squander funds and resources by providing futile high-tech procedures? The use of extraordinary means is at most optional and, at times, it may be obligatory not to use them. In some cases – or more than some -, it may also be against social justice: medical resources are limited and ought to be used rationally and ethically by those who really need them.  Furthermore, very often the use of extraordinary means entails for the patient, who is hooked to machines and heavily intubated with multiple tubes, an incredible isolation from his or her loved one.

               Dysthanasia is generally unethical because it is not the due prolongation of life, but the undue postponement of death, which usually ends up in an “undignified death,” after an abusive use of extraordinary means of treatment, provoked by the technological imperative. The doctor is obliged to treat, but not to over-treat.

               Another basic question: Who decides to use or not use disproportionate means of treatment? When possible, the patient gives informed consent: the patient gives free and responsible consent after knowing and understanding his medical facts, treatments available to him and their consequences). When not possible, proper surrogates (the closest relative or the family representative) provide proxy or substitute consent, which must respect the principle of the best interest of the patient.


               The daughter of John is really asking for the undue prolongation of life, for the continuation of artificial life for her dear father. Life has a beginning and an end for all humans. There is a time to live. Last medical report: John’s terminal cancer of the brain has metastasized to other parts of his body. The daughter is asking for the postponement of his death through useless and futile means of treatment. For each one of us, there is a time to die (Ecl3:2), neither earlier through euthanasia, nor later through dysthanasia.

               Another major point! Objectively speaking, the ethical principles are clear and neat – and helpful. The problem is we are speaking of subjects, of persons, of a concrete persons, of John who has a loving daughter, and a brother who is a doctor. We cannot leave John with cold bioethical principles and their application to his case. Against his pains, doctors give painkillers. Against his loneliness, the daughter and the “significant “others” offer love, solidarity and compassion. Accompaniment and love will also aid John’s daughter. Praying with him and for him is a fraternal Christian duty.

               We add a final significant point: our humanity and our faith urge us to defend life. We respect people with different stands on the matter.

             The elder brother of John, the physician should not provide his younger brother John with extraordinary means of treatment. What else can he do for John? In our next conversation we hope to share with you, dear reader, some more thoughts on this sensitive matter. Until then take it easy, be compassionate – and smell the flowers on your way!

(Published by O Clarim, June 2, 2017)








               Our friend John is dying of metastatic terminal brain cancer. His elder brother, a physician is helping him face, as a human being and as a Christian, his complicated situation. After rejecting the options of euthanasia and dysthanasia as unethical, the doctor offers his brother John the option of orthothanasia, or allowing to or letting him die.

               Is orthothanasia, or allowing to die ethical?



               The word orthothanasia was used for the first time in the 1950s. It means correct dying, or allowing to die or letting die.   

               It is vital to note the difference between allowing death to occur and intending death to happen. While in euthanasia the death of the patient is directly intended and caused, in allowing to die his death is directly caused by a grave pathology: the morphine administered to the patient in pain directly causes the relief of his pain and indirectly and unintendedly may perhaps advance his death, which is merely foreseen and tolerated.

               Let us underline that in the case of letting die, what is directly intended is the relief of the acute pain of the patient. In allowing to or letting die, therefore, death is neither directly caused nor intended or postponed. It merely happens. It is an event, part of the temporal life of every human being. Hence, allowing to die is anti-euthanasia, which unethically anticipates death, and anti-dysthanasia, which unduly postpones it.


                 Allowing to die includes, in particular, three possibilities.

                First possibility: when the treatment to prolong life is useless or futile for the patient, and therefore ought not to be given. We remember the world of the poet: For man to want to live when God wants him to die is madness.

               Second possibility for letting die: when the prolongation of life or the postponement of death is unduly burdensome in the first place for the patient – also for the family. On this point, the Catechism of the Catholic Church summarizes the traditional teaching of the magisterium: “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘over-zealous’ treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted” (CCC, 2278).

                Third possibility for allowing to die: when the patient needs painkillers or medical sedation, which does not intend the death of the patient. These painkillers directly mitigate suffering and indirectly may shorten life.  Physicians and significant others are committed to relieve pain and suffering, which is their professional commitment, or moral duty limited only by the prohibition against direct killing. Summing up the traditional teaching of the Church, the Catechism states: “The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable” (CCC, 2279).

                 Related to the option of allowing to or letting die, we usually face, among others, three objections: one objection refers to doubtful treatment, another to the real meaning of death with dignity, and the third to patients in persistent vegetative state (PVS).

                How about a doubtful treatment? If treatment is beneficial to the patient and not unduly burdensome, it ought to be given: we are to administer our life well. If treatment is truly useless, generally it should not be given.  Moreover, if the treatment is doubtful or uncertain, the “best-interest of the patient” principle suggests providing treatment for it might have a potential benefit: in doubt, it is good to be on the side of life.

                “DEATH WITH DIGNITY”

                Another objection is: How may we understand ‘death with dignity’? It is often understood wrongly as “death without pain,” as if those who die with pain cannot have a death with dignity. The word dignity is often – as someone put it – “high-jacked” by those who favor euthanasia. For believers and others, to die with dignity means respect for the dying, preparing for death and accepting it when it comes. The saintly Pope John Paul II says that the elderly – and all human beings – have “the right to a worthy life and to a worthy death.” Palliative or comfort, or hospice are is a way to a worthy death, or a death with true dignity.

                Death with dignity then is an ambiguous expression that may mean two opposite things. One meaning is the justification of killing – of euthanasia and assisted suicide – based upon the unethical principle of absolute personal autonomy. A second meaning is this:  “letting die in peace” or allowing to die, which is ethical.  Death with dignity means for the Christian a good and dignified death that respects the principles of stewardship (God is the Lord of Life and Death), of solidarity (we are members of the human family and God’s family), and the principle of respect for all persons, beginning with the respect due to our own person, dignity and rights, including the basic right to life, which ends with a dignified death. Palliative care helps achieve a death with dignity that is, a death that comes after achieving peace with God, with ourselves, loved ones, and neighbors.

                The final objection we wish to face: How about patients in deeply comatose or a persistent vegetative state (PVS)? What kind of treatment should they be given? The main problem here is reliable and true diagnosis: How certain may we be of the diagnosis?  Certainly, these permanently comatose patients have to be given beneficial and not too aggressive or undue burdensome treatment. Food and drink should always be given. These are not medical treatment, but a human need of every person. The basic teaching of the Church is well formulated by the American Bishops (USA) in their significant Ethical and Religious Directives for Catholic Health Care Services: “There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient.”

              A final radical question: Is there any equivalence between killing and allowing to die? There is, indeed, no equivalence at all but profound difference between killing and allowing to die: while killing is intrinsically and objectively evil, allowing to die is the moral option that respects life and considers death as inevitable part of human life.

             Most probably our patient John is soon to die of metastatic brain cancer. So far three options were presented to him: assisted suicide, prolonging dying with useless aggressive treatment, and allowing him to die with dignity. From a humanist and Christian perspective, the ethical possibility is the third, which is allowing or letting him to die. (In parenthesis: When we are in doubt regarding the application of the ethical guidelines at the end of our own life and the life of our loved ones, we ask those who may know better than us. However, we decide on our own cases; others advise but should not decide for us)

                Our dear patient John is asking his brother physician: “Please, let me die in peace, but remove or at least decrease substantially my terrible pains.” John is asking for comfort or palliative care. What is the meaning and implications of palliative care? We shall try to answer this question in our next conversation with our dear readers.  Many thanks for walking with us.

(Published by O Clarim, June 9, 2017)






















 A doctor writes: My younger brother John is suffering terribly due to a terminal brain cancer. Â He is asking me: Please, let me go. Watching him suffer so much, I am inclined to help him end his life.

 I wish to share with you dear readers some thoughts on euthanasia and assisted suicide.


 There are different definitions of euthanasia. Etymologically, euthanasia means “good or happy death. From a humanist and Christian perspective, we define euthanasia as “An action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated (Vatican Congregation for the Doctrine of Faith; cf. CCC, no. 2277). Euthanasia, or direct killing, includes then a positive act (giving an overdose of painkillers) or an omission of obligatory treatment (a failure to feed). The writer speaks of euthanasia as direct or procured euthanasia that intends the death of a suffering patient.

  A helpful and important distinction of euthanasia refers to the presence or absence of freedom on the part of the suffering patient: voluntary euthanasia, when the competent patient asks for it; involuntary euthanasia, when others choose death for the patient against his will, and non-voluntary euthanasia, when the stand of the patient is not known  the case of children and those mentally disable – and surrogate decision makers or the courts impose it on him.

  Objectively speaking, voluntary euthanasia (or self-killing) is suicide, while involuntary euthanasia (killing imposed on suffering patients by others) is cooperation in evil.

  Connected with euthanasia is physician assisted suicide (PAS), that is, when a physician assists a gravely suffering patient by providing him with the instruments (terminal sedation with the purpose of ending  his life) the patient needs to terminate his life.


 Unfortunately, the movement in favor of euthanasia is growing throughout the world, particularly in countries of the so West. The growing campaign for the legalization of euthanasia worldwide appears to be grounded on individualism ( choose how to live and how to die, a physically disable patient said recently); on hedonism (suffering is useless); on relativism (truth is relative and morality situational); and utilitarianism (the terminally ill may feel or be considered by others a useless burden).

The basic ethical principle of autonomy is generally used to defend and promote euthanasia and assisted suicide in our world. The recourse to voluntary euthanasia we are told – is an expression of individual autonomy and as a right to a dignified death.

 Some authors and terminal patients defend the right to die.

 Who can stop the slippery slope that is devaluing life in our secular world? With many other men and women – promoters of the culture of life -, we try to change the tide. “Yes, together we can!”

 Fortunately, there is also today a growing movement among believers and many others in favor of life and against the culture of death, including euthanasia and assisted suicide. We strongly believe in God’s Providence and grace.


 In the Bible, God tells us: Thou shall not kill (Ex 20:13). As God creatures and children, we are custodians or administrators of our life under God, who is the Lord of life and death. For religious people, including Christians, human life is sacred, that is, precious, holy,  worthy of reverence.The life of every person is sacred because he or she comes from God.

   With all due respect, we affirm that euthanasia cannot be considered a dignified death, but Intentional killing, which entails a lack of true respect of human dignity and rights. It is against the fundamental right to life of every human being. Every human being has the right to life from the moment of conception to the moment of natural death.]

  As human beings and as Christians, we defend and promote a consistent life-ethicshuman life is like a seamless garment that ought to be respected at the beginning (against abortion) and at the end (against homicide, suicide and euthanasia – also against the death penalty).  Vatican II says that euthanasia is one of the infamies of our time, and a grave violation of God law.  St. John Paul II writes:  The right to life means the right to be born and then continue to live until one natural end. Pope Francis keeps repeating that euthanasia and assisted suicide are evil manifestations of a throw away culture.

How may we speak of the right to die? As human creatures, we all have to die; we are mortal human beings. For each one of us, there is a time to be born, a time to live, and a time to die (cf. Eccl 3:2). There can be no right to die: killing is wrong, whether one does it (suicide), or others do it (homicide, abortion), or one does it with the help of others (assisted suicide).  We decry the anti-life campaign which, based on a pragmatic and immoral notion of quality of life, appears to view some elderly persons, the handicapped and the vulnerable members of society as useless burdens to a family, a community, a nation: How could they not feel guilty for still being here, for costing so much, and for being so useless?  That is a market mentality that leads to death (Eric Fuchs).

  Regarding the argument of the autonomy of the patient, we may ask, what kind of autonomy may a deeply suffering patient have? As has been said, how may a patient use his autonomy to end with his life – and with his autonomy?  More than patient autonomy, it might be a question of paternalism or eve manipulation of the patient by those others – be scientists, bioethicists, politicians and/or healthcare professionals or at times a family member.

  The human person is not only free but also responsible, that is, he or she is autonomous and relational. His or her life is linked to others in solidarity. Every person belongs to a family, a community, a nation, the world. We remember an adult man who wanted to jump from a tenth floor of a condominium. He was using the phone. Someone shouted to him: “Remember you have a lovely daughter. Love convinced him not to jump. Individualism? No man is an island.


  Euthanasia is also called mercy killing. May helping others commit suicide be merciful? Formal cooperation in suicide cannot be considered an act of genuine but of misplaced compassion, or false mercy. True compassion is a quality of genuine love – of love of neighbor. True compassion leads to sharing another pain; it does not kill the person   whose suffering we cannot bear (St. John Paul II).

 Although not always, generally assisted suicide is carried out by healthcare providers, particularly nurses and doctors. Ethically speaking, Physician assisted suicide (PAS) implies immoral formal cooperation in suicide. The physicians are asked by their profession to promote life and health: they are healers! The doctors (and nurses) most radical duty to their patients is primum non nocere, that is, first of all, do not harm. Compassion, Pope Francis says, is the soul of medicine. When Catholic physicians, or others, are asked to assist in suicide, they ought to reject it, following their right to conscientious objection, which a universal human right  the right to follow personal conscience and/or the right to religious freedom.

  Terminally ill patient John asks: Please, let me go. As a human being, as a Christian we are absolutely against euthanasia and assisted suicide. We are also united in compassionate and prayerful love with those who suffer, with the terminally ill patients, with John.

  To the doctor we say: euthanasia is not an ethical but gravely unethical option  and un-Christian. But, indeed, we are compassionately with John and in solidarity with his family. Euthanasia  and assisted suicide – is not a moral answer to his terrible suffering from brain cancer. Certainly, there is for every human being a time to die, but not earlier through euthanasia and assisted suicide.

 The doctor brother of John comments sadly: So my younger brother John continues suffering terribly! Just like that! Are there other options for him?  Yes, doctor, there are. We shall continue our conversation next time.

(Published by O Clarim, Macau Catholic Weekly, May 26, 2017)




A reader asks: My cousin John is 48 years old. He is terminally ill with metastatic cancer and is suffering terribly. In this situation, what kind of “treatment may healthcare professionals offer to John?

Doctors may have three possibilities to choose from, namely, euthanasia (or killing), dysthanasia (or prolonging dying), and orthothanasia (or allowing to die, with palliative care). A more important question is this: I any of the three possibilities ethical? treatment may John be given?

 Indeed, end-of-life issues are focused today on these three main problems: killing, prolonging dying and allowing to die. On this occasion, I have been asked to consider with you the following question: What is the difference between killing and allowing to die?

  On this occasion, I shall study first killing (or euthanasia), secondly prolonging dying, third allowing to die, and fourth palliative care. Let us begin our journey by reflecting on euthanasia. What is the meaning and morality of euthanasia?


  In the middle of the night, a sleepy gynecology resident is called to attend Debbie, a young woman, who is dying of ovarian cancer.  He is horrified by her severe distress (“It was a gallows scene, he said later, âa cruel mockery of her youth and unfulfilled potential).  Her only words to him were: Let get this over with.1


  There are different definitions of euthanasia. Etymologically, euthanasia means  good or happy death.From a humanist and Christian perspective, we define euthanasia as: An action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated2  This point is substantially important: “If the aim is to bring about death, it is euthanasia, whether this is done by an omission (such as failure to feed or to cancel an order not to feed) or by a positive act.3

  Regarding euthanasia, the main distinction is between active (or direct) and passive (or indirect) euthanasia. (When we speak of euthanasia without adjectives, we understand it as real euthanasia, that is, active euthanasia.)

  What is active euthanasia? It is the directly willed inducement of death for merciful reasons;4 the death of the suffering patient may be done by commission, a positive act (for instance, giving an overdose of painkillers), or by omission of obligatory means (e. gr., failure to feed).

  What is passive euthanasia? It is allowing to die.  Active euthanasia is procuring death, while passive euthanasia, or allowing to die, is allowing death.5 Therefore, for us there is no equivalence between active and passive euthanasia; there is really a profound moral difference.

 Some authors describe passive euthanasia thus: Passive euthanasia intends death by withholding (including withdrawing or refusing) available medical treatment or other care that clearly could enable a person to live significantly longer.6 From a Catholic perspective, this description speaks not of passive but of active euthanasia: it is active euthanasia by omission of beneficial obligatory treatment and by even intending death.

  Is terminal sedation passive euthanasia? In our understanding of passive euthanasia, it is not, but active euthanasia. Terminal sedation is described as “administering morphine in doses that are intended to hasten death.

  Another important distinction of euthanasia (meaning real euthanasia, that is, active, direct) refers to the presence or absence of freedom on the part of the patient.  Thus, we speak of voluntary euthanasia, when the competent patient asks for it; and of involuntary euthanasia, when others choose death for the patient against his will. (There might also be non-voluntary euthanasia, that is when the stand of the patient is not known the case of children and those like children  – or presumed to be in favor of it, and surrogate decision makers or the courts impose it on him/her).

 At present, euthanasia is legal in Holland and in Belgium, and in the states of Oregon and Washington, of the United States of America.  There is a growing campaign for the legalization of euthanasia worldwide.  This loud campaign appears to be grounded on individualism (my life is mine), hedonism (suffering is useless), relativism (morality is plural and relative); and utilitarianism (the terminally ill may be useless burden). Who can stop the slippery slopethat is devaluing life in our secular world?

  Assisted suicide is legal in Switzerland and Estonia. Assisted suicide is voluntary suicidal euthanasia (on the part of the patient) and homicidal euthanasia (on the part of the assisting person). (The case if Vincent Humbert, a 22 years-old Frenchman quadriplegic, whom his mother helped die in November 2003.)


The recourse to voluntary euthanasia is presented as an expression of individual autonomy and as a right to a dignified death; some speak even of a right to die!

  The basic ethical principle of autonomy is generally used to defend and promote euthanasia in our world. But really, what kind of autonomy may a deeply suffering patient have? As has been said, how may a patient use his/her autonomy to end with his/her life and with that autonomy?  Under the appearance of patient autonomy others perhaps, including the social environment, persuade certain patients to end their lives. More than patient autonomy, it might be paternalism or even the manipulation of the patient by those others  be scientists, bioethicists, politicians and healthcare professionals.

  Euthanasia (active, direct, intentional) is killing, one of the infamies of our time, and a grave violation of the law of God. And God said, “Thou shall not kill (Ex 20:13).  Human life is sacred, that is,precious,  holy,  worthy of reverence; all human life is sacred, and not only at a certain level of the so-called quality of life, which is discriminatory against the weak and vulnerable members of society.

 Every human being has the right to life from the moment of conception to the moment of natural death.  As human beings and as Christians, we defend and promote a consistent life ethics:  human life is like a seamless garment that ought to be respected at the beginning (against abortion) and at the end (against homicide, suicide and euthanasia and also against the death penalty).  In his popular book Crossing the Threshold of Hope, Pope John Paul II writes: The right to life means the right to be born and then continue to live until one natural end.7 (Does capital punishment respect this natural end? It does not!).

  The right to life, however, is not an absolute right for the person, because he is a steward of life.  Only God is the Lord of life and death.  Objectively, therefore, not only involuntary euthanasia (others choose) is immoral; voluntary euthanasia (patient asks for it) is immoral, too.  In 1985, the French Bishops wrote: Active euthanasia, consisting in provoking directly the death of the sick person – including the laudable intention of removing his suffering introduces us into a world where very soon it will not be possible to live. Are we approaching this world?

  How may we speak of a right to die? As human creatures, we all have to die; we are mortal human beings. As there is no “right to abortion, there can be no right to die: killing is wrong, whether one does it (suicide), or others do it (homicide, abortion), or one does it with the help of others  (assisted suicide).

  Connected with voluntary euthanasia is Physician Assisted Suicide (PAS), that is, when a physician assists a gravely suffering patient by providing him/her with the instruments this patient needs to terminate his/her life. Ethically, PAS implies formal or immediate material cooperation in suicide.  The fact that a physician invented the so-called suicide machine is really tragic; it is ironic that this machine’s name is Mercitron. (Dr. Jack Kevorkian is the physician, who once was asked:What will happen after we die? His answer: We rot). Let us face it: mercy killing (another name for euthanasia) is merciless. While respecting the conscience of those who are in favor on euthanasia  and loving them I add my voice to denounce the social campaign promoting euthanasia and physician-assisted suicide.

  The doctors, in particular, are asked by their profession to promote life and health: they are the healers!  How can patients (the whole wounded humanity) trust their doctors if they practice euthanasia or assist in suicide?  The physician most radical duty to his/her patient is primum non nocere, that is, above all, do not harm. To kill is to harm. Killing cannot be considered a therapy, and, therefore, it cannot be a valid option for healthcare professionals. Cooperation in euthanasia, in killing, in suicide cannot be considered  as it is often done an act of genuine but of misplaced compassion, or false mercy. It is a sin that cries out to heaven for vengeance and is always gravely immoral. True compassion is a quality of genuine love of neighbor.  It means to be moved by the neighbor suffering and do something about it: True compassion leads to sharing another pain; it does not kill the person  whose suffering we cannot bear.8 (On this point I disagree with Hans Jonas, who accepted the possibility of shortening, but never by a physician, the suffering and life  of a dear one, out of love.)

  True compassion, a quality of charity as love of neighbor, is totally opposed to assisted suicide. When physicians, or others, are asked to assist in suicide, they ought to appeal to their conscience and faith, and practice conscientious objection.

  I am absolutely against euthanasia and assisted suicide, not only because I am a Christian, but also because I am a member of the human family. “Personal autonomy has as its first premise being alive and requires the responsibility of the individual, who is free in order to do good according to truth. He or she will come to affirm himself or herself, without contradiction, only in recognizing (even from a purely rational perspective) that he or she has received the gift of his or her life, of which, therefore, he or she cannot be the absolute master. To end life means in definite terms, to destroy the very roots of the freedom and the autonomy of the person.9

  I decry that anti-life campaign which appears to view some elderly persons and the handicapped as useless burdens in a family, a community, a nation: How could they not feel guilty for still being here, for costing so much, and for being so useless?  That is a market mentality that leads to death.10 Again I ask: what kind of autonomy do patients who ask for suicide really have?

 Debbie, a 20-year-old woman with ovarian cancer has asked a gynecology resident to hasten her death.  Her request: Let get this over with, doctor. His answer:  a lethal injection of morphine!  After reading this story (fictitious it appeared) involving physician-assisted suicide, four well-known American physicians questioned: What in the world is going on? And they commented:  This issue touches medicine at its very moral center; if this moral center collapses, if physicians become killers or are even merely licensed to kill, the profession and, therewith, each physician – will never again be worthy of trust and respect as healer and comforter and promoter of life in all its frailty.11

  We read in the Catechism of the Catholic Church:  Direct euthanasia consists in putting an end to the lives of handicapped, sick or dying persons. It is morally unacceptable. It implies not only euthanasia by a positive act, but also by an act of omission: An act of omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator.12

1 W. Gaylin, M.D., Leon R. Kass, M. D. Pellegrino, M. D., M. Siegler, M. D., Doctors Must Not Kill, JAMA, Vol. 259, No. 14, April 8, 1988, p. 2139.

2 Congregation for the Doctrine of Faith, Declaration on Euthanasia, Vatican City, 1980, Part II.

3 Helen Watt, Life and Death in Healthcare Ethics, London/New York: Routledge, 2000, p. 8.

4 William E. May, Human Existence, Medicine and Ethics, Chicago, Illinois: Franciscan Herald Press, 1977, p. 132.

5 Pontifical Academy for Life, Respect for the Dignity of the Dying Person, Vatican City, 2000, no. 6; in Osservatore Romano, 11-12 December 2000, p. 6.

6 G. P. Steward and Others, Basic Questions on Suicide and Euthanasia. Are They Ever Right? “Bioethics Series,Manila: Christian Literature Crusade 1998, p. 24.

7 John Paul II, Crossing the Threshold of Hope, New York: Alfred A. Knopf, 1994, p. 205.

8 John Paul II, Evangelium  Vitae (EV), nos. 15, 57, 66; Catechism of the Catholic Church(CCC), no. 2268.

9 Pontifical Academy for Life, Respect for the Dignity of the Dying person, l.c., no. 5.

10 Eric Fuchs, “Social Justice in Health Care, Theology Digest, Vol. 45, No. 3, 1998, p. 217.

11 W. Gaylin, M.D., Leon R. Kass, M.D, E. D. Pellegrino, M.D., M. Siegler, M.D., Doctors Must Not Kill,” l.c., p. 2140.

12 CCC, no. 2277.

Dominic of Guzmán

Dominic of Guzmán

José Luis de Miguel, OP


Dominic of Guzmán

“He arrived as fire.

He left as light”

  Io-Ann Ianotti, O.P.

     Dominic was a sensitive person, attentive to the aspirations and distresses of his contemporaries, for whom he was ready to relinquish his most precious possessions – his books, for example – and turn them into gift, a gift of life.

     His heart was as the large altar where God’s mercy and the miseries of his sons and daughters had a daily appointment. Deeply human and brotherly, left us as legacy and task, a great sense of admiration and defense of the dignity of the person, of all persons, and an attitude of intense Evangelical compassion for those most in need.

     Free man, he bequeathed to his brethren the indelible mark of his inner freedom, fruit of the action of the Spirit of Jesus. Free to dream, free to fly,  free to serve. Centuries before the cry of “liberté, fraternité, et égalité” was launched to the air, Dominic with his brothers and sisters lived already in democracy, without adjectives, as their normal way of life.

     He knew how to harmonize, eminently, and in an almost instinctive way, a great fidelity to the will of God with a lucid analysis of the reality of his time, including the reality of his beloved Church, without, nevertheless, closing his eyes of Prophet, which pierced deeply where lights and shadows nest. As a Prophet, he knew well how to look deep and far, and how to interpret the signs of the times.

     Sharp observer of life, had, in addition, a clairvoyant vision of the future, ahead of history, and the knowledge to provide answers to the most pressing questions that concerned his contemporaries. These answers did not come to him by art of magic, but by a firm and constant dedication to study, as a means to help other people to know more about God, the mysteries of his love, and the project of his Kingdom.

     Profound seeker of truth (the truth of God, the truth of the world and the truth of the others, brothers and sisters), after the manner of his Master Jesus, he came to love it, as our Brother Yves Marie Congar says, “as one loves a dear friend”.

     Dominic was, above all, a deep lover of the Word of God, which he sought to listen, study, teach, and share. To the Word of God he devoted, in a particular way, his life. That has been his most precious legacy for all of us, his brothers and sisters of the Dominican Family. Legacy that has become today a real concern, challenge and task for us his sisters and brothers: how to follow Dominic’s original inspiration, re-reading it at the light of the Gospel and the challenges of contemporary society, with its countless lights and joys, with its shadows and pains. And be pilgrims, like him, leaving behind the wake in flames of hope, and the desire to embrace, the friendly face that invites us go to him…, smiling.

     In the message dated on July 15, 2016, sent by Pope Francis to the Order of Preachers, on the occasion of our General Chapter of Bologna,

     “The Holy Father hopes that all who follow the charisma of Saint Dominic, tireless apostle of grace and forgiveness, compassion for the poor and staunch defender of truth, rediscover the urgency of solidarity, love and forgiveness, and are testimonies of mercy, professed and incarnated in their lives, and indicative of the closeness and tenderness of God for today’s society”.