Ethicists, doctors, and governments across the West continue to roll out physician-assisted suicide as a medical option — causing heated debate about human dignity, the nature of human life, and what Pope Francis has consistently called “throwaway culture.”

As part of this conversation, the Vatican’s Pontifical Academy for Life issued a new text, titled “Little Lexicon on the End-of-Life,” with a view to offering clarity on terminology and concepts in a morally fraught subject amid an increasingly “secular” context.

Prepared by a study group from within the academy, published last month and circulated to all members of the Italian bishops’ conference, the text addresses some of the most controversial end-of-life subjects, including euthanasia and the moral norms around providing — and possibly withdrawing — food and water in some cases.

According to the academy’s president, Archbishop Vincenzo Paglia, the text is not meant to offer new teaching, but instead aims to cut through confusion over key terms and offer clarity for those navigating the most complicated and sensitive situations.

Yet on the issue of basic care for unresponsive patients, the 88-page booklet seems instead to raise real questions about its understanding of and alignment with previous Church teaching documents, and the mandate of the Church, as articulated by Vatican Council II, to read and respond to the signs of the times.

In some cases, it appears to fall short of even secular thinkers' appreciation for the need to protect vulnerable human life.

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Practices like physician assisted suicide and so-called medical assistance in dying are now well advanced in countries like Canada, Belgium, the Netherlands, and Switzerland, with Spain and Italy are well on their way to joining them. 

Ethical, legal, and political debates over the very nature of human life and dignity have been underway for some time in France, the UK, and the United States — where physician assisted suicide is legal in nine states.

Seen through the lens of what Pope Francis calls a “throwaway culture,” there are also clear social and structural factors which push Western cultures towards a devaluing of human life as it reaches its end. 

In Canada, for instance, assisted suicide has ramped up — it is now the fifth leading cause of death there — putting disabled populations at considerable risk. At the same time, there is known to be severely inadequate social support for people with disabilities. 

Sometimes those already at risk for suicide in this context are pushed to give their life meaning and value by donating organs after their death. One woman even reported that she was contacted by an organ donation group before she had set a date for her assisted suicide.

The social and structural pressure to end one’s life this way will also soon face a dementia crisis. 

Western countries already treat this population terribly, often by warehousing them in tiny lonely rooms with only TVs and robots to keep them company. With the number of people with dementia expected to increase in future decades, the resource pressure put on the culture will be massive.

It is into this context that the Pontifical Academy for Life (PAL) recently released its “Little Lexicon on End of Life.” 

The Little Lexicon of the End of Life is not available in English translation, but the contents have been covered by numerous outlets around the world. 

Its release has been anticipated with interest, particularly since the PAL’s president, Archbishop Vincenzo Paglia, has voiced a commitment to speak boldly and open up new questions in moral theology more generally—even calling for “paradigm shift” in which older approaches would be dismissed as a simplistic “handbook of formulas.”

Paglia has previously raised questions for prominent Catholic commentators like Bishop Robert Barron and others, when he said, “Personally, I would not practice suicide assistance, but I understand that legal mediation may be the greatest good concretely possible under the conditions we find ourselves in.” 

Some warned this could open a return for “proportionalism”—a version of Catholic moral theology, condemned explicitly by St. John Paul II’s encyclical Vertiatis Splendor, in which the longstanding principle and presumption of nonviolence (that it is always wrong to kill the innocent) would be jettisoned as too rigid and formulaic.

Though the new document focuses on a range of bioethical issues, and sets out to reaffirm a “blanket” rejection of euthanasia and assisted suicide, the more novel parts of the text seem to focus on what would constitute so-called “aggressive” treatment—and “especially the requirement to provide food and hydration to patients in a vegetative state.”

The Little Lexicon invokes the 2020 letter from the DDF, Samaritanus bonus, which also addressed end-of-life issues. 

That document reaffirms the Church’s longstanding teaching that, as long as one is not aiming at death, it can be morally legitimate to remove or forego extraordinary, disproportionate, or “aggressive” medical treatment.

However, the DDF text limited such cases of legitimately removing or forgoing these treatments to situations  “when death is imminent.” The doctrinal dicastery also insisted that “it is not lawful to suspend treatments that are required to maintain essential physiological functions, as long as the body can benefit from them,” and gives examples that include hydration and nutrition. 

“The suspension of futile treatments,” the DDF teaches, “must not involve the withdrawal of therapeutic care.” This teaching was also reaffirmed, nearly word-for-word, in the declaration Dignitas Infinita earlier this year.

In contrast, the pontifical academy’s new text appears to suggest that, because the food and hydration given to disabled, so-called “vegetative” patients is prepared in a laboratory and administered through technology, offering them to such patients does not amount to “simple care procedures.” 

It could therefore be thought of as a medical treatment which could, in principle, be withdrawn, rather than the kind of basic care which can never be withheld.

From a bioethical perspective, this would strike many ethicists as an odd framing of the issue, to say the least. 

The nutrition given to such disabled human beings is no more made in a laboratory than a protein shake powder. And feeding tubes are extremely simple devices that don’t require any machine or other special technology. 

Many Catholic bioethicists would see feeding a disabled person through a tube as little different from feeding them with a spoon. Both are “technology” in a strict sense, but both are examples of basic Christian care for the needy (“feeding the hungry”), not medical treatment.

Another important matter here involves the status of disabled people sometimes described as being in a “vegetative state.” Such individuals have a very serious brain injury, but they are in no way “dying.” 

Many medical professionals now use totally different terms, preferring to think of these patients as having various kinds of disorders of consciousness—rather than referencing vegetables—something that has understandably been rejected by much of the disability rights community.

Indeed, even the concept of “brain death” is something increasingly disputed by medical scientists and ethicists alike.

We’ve known since at least 2006 that a significant portion of patients lumped into the imprecise and offensive category of “vegetative state” were actually conscious and could respond to some simple commands. 

But it has only been in the last 10 years or so that, from a number of secular sources, we have learned that with the right therapies a significant percentage of these patients can get better and even learn to communicate. 

As a result, renowned physician and bioethicist Joe Fins (who is generally regarded as no friend of the pro-life movement) has said that this new research calls out for a new civil rights movement for those with these disorders of consciousness.   

Indeed, the conclusion of Fins and many others is that those who want to withhold food and water from such patients do so not because food and water are disproportionate treatment or burdensome care —but because they presume that it is better that such disabled populations die. 

Given that even secular bioethicists like Fins have such concerns, this raises urgent questions about why and how the PAL came to approach the same issue — of offering food and water to this vulnerable population — from a very different direction. 

In some contexts, aggressive treatment and grasping to preserve life at any cost do present real ethical problems. Our Lord and the great martyrs, while never aiming at their own deaths, nevertheless clearly understood that certain goods are more important than grasping for more life. This is not in dispute.

But many Catholic moral theologians and bioethicists will question if the PAL is refusing to follow Vatican II’s instruction to read and respond to the signs of the times with the witness of Christ. 

Instead of addressing the main threat of the end-of-life debate now raging —a consumerist throwaway culture which tries to hide the value of disabled people with consciousness disorders and making it easier to aim at their deaths — the academy appears to be focused on other matters. 

And those matters — like the withholding of food and water from the medically most vulnerable — are articulated in a way that at least appears to be at odds with what the Vatican’s doctrinal department has taught in two recent documents.

Of course, the “Little Lexicon on the End of Life” has only been published in one language so far, and is not intended as a definitive text, or a total answer to a wide-ranging debate. 

But, according to Archbishop Paglia’s introduction, the text aims to arm clerics to navigate “the jungle of intricate issues” around the end of life. 

In that, it seems to offer, at best, confusion on some of the most sensitive cases.