To my elderly brothers and sisters!

Seventy is the sum of our years,
or eighty if we are strong,
and most of them are fruitless toil,
for they pass quickly and we drift away
” (Ps 90:10)

1. Seventy years was an advanced age when the Psalmist wrote these words, and few people lived beyond it. Nowadays, thanks to medical progress and improved social and economic conditions, life expectancy has increased significantly in many parts of the world. Still, it remains true that the years pass quickly, and the gift of life, for all the effort and pain it involves, is too beautiful and precious for us ever to grow tired of it.

As an older person myself, I have felt the desire to engage in a conversation with you. I do so first of all by thanking God for the gifts and the opportunities which he has abundantly bestowed upon me up to now. In my memory I recall the stages of my life, which is bound up with the history of much of this century, and I see before me the faces of countless people, some particularly dear to me: they remind me of ordinary and extraordinary events, of happy times and of situations touched by suffering. Above all else, though, I see outstretched the provident and merciful hand of God the Father, who “cares in the best way possible for all that exists” (1) and who “hears us whenever we ask for anything according to his will” (1 Jn 5:14). With the Psalmist, I say to him: “You have taught me, O God, from my youth, and till the present I proclaim your wondrous deeds. And now that I am old and grey, O God, forsake me not, till I proclaim your strength to every generation that is to come” (Ps 71:17-18).

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Advances in medical technologies bring with them new means of curing disease and living longer, healthier lives than ever before. But they can also be the source of heightened patient anxiety about a needlessly prolonged, painful and expensive dying process. Medical advances bring with them new and complex questions with regard to medical treatments and moral decision-making.

Our Catholic faith offers both a long tradition of reflection and Church teaching to help guide us through these multifaceted issues. It is important not to let the struggle over such questions eclipse what should be transcendent and grace-filled moments in the dying process: attending to spiritual needs, healing broken relationships, and saying good-bye.

Difficult decisions about the use of medical technology at the end of life may be made easier if we take the time to express our wishes about end-of-life treatments before illness strikes. This guide is designed to explain the moral principles of Catholic teaching with regard to end-of-life decision-making and to outline the options that exist in New York State for advance care planning.

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To live in a manner worthy of our human dignity, and to spend our final days on this earth in peace and comfort, surrounded by loved ones—that is the hope of each of us. In particular, Christian hope sees these final days as a time to prepare for our eternal destiny.

Today, however, many people fear the dying process. They are afraid of being kept alive past life’s natural limits by burdensome medical technology. They fear experiencing intolerable pain and suffering, losing control over bodily functions, or lingering with severe dementia. They worry about being abandoned or becoming a burden on others.

Our society can be judged by how we respond to these fears. A caring community devotes more attention, not less, to members facing the most vulnerable times in their lives. When people are tempted to see their own lives as diminished in value or meaning, they most need the love and assistance of others to assure them of their inherent worth.

The healing art of medicine is an important part of this assistance. Even when a cure is not possible, medicine plays a critical role in providing “palliative care”—alleviating pain and other symptoms and meeting basic needs. Such care should combine medical skill with attention to the emotional as well as spiritual needs of those facing the end of life.

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Health care in the United States is marked by extraordinary change. Not only is there continuing change in clinical practice due to technological advances, but the health care system in the United States is being challenged by both institutional and social factors as well. At the same time, there are a number of developments within the Catholic Church affecting the ecclesial mission of health care. Among these are significant changes in religious orders and congregations, the increased involvement of lay men and women, a heightened awareness of the Church’s social role in the world, and developments in moral theology since the Second Vatican Council. A contemporary understanding of the Catholic health care ministry must take into account the new challenges presented by transitions both in the Church and in American society.

Throughout the centuries, with the aid of other sciences, a body of moral principles has emerged that expresses the Church’s teaching on medical and moral matters and has proven to be pertinent and applicable to the ever-changing circumstances of health care and its delivery. In response to today’s challenges, these same moral principles of Catholic teaching provide the rationale and direction for this revision of the Ethical and Religious Directives for Catholic Health Care Services.

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If anyone speaks, they should do so as one who speaks the very words of God. If anyone serves, they should do so with the strength God provides, so that in all things God may be praised through Jesus Christ. To him be the glory and the power for ever and ever. Amen. – 1 Perter 4:11