ROME – Pope Francis reflected on the intersection between technological developments in the medical field and human mortality, saying that the new and powerful treatments at our disposal require “greater wisdom” in evaluating the good of the patient.

In a message sent to the president of the Pontifical Academy for Life, Archbishop Vincenzo Paglia, and the European representatives of the World Medical Association who are meeting Nov. 16-17 at the Vatican to discuss “end of life” issues, the pope addressed some of the major concerns regarding healthcare and morality today.

Francis started off by praising the “growing therapeutic capabilities of medical science,” which have been able to eliminate diseases, prolong life and improve health.

“While these developments have proved quite positive, it has also become possible nowadays to extend life by means that were inconceivable in the past,” he said in the message dated Nov. 7. “Greater wisdom is called for today, because of the temptation to insist on treatments that have powerful effects on the body, yet at times do not serve the integral good of the person.”

Francis continued by analyzing the issues tied to “overzealous treatment,” patient and doctor relationships, global inequality in healthcare, the need to be close to the sick and to pay attention to the needs of the most vulnerable.

Withdrawal from overzealous treatment

Citing Pope Pius XII’s address to anesthesiologists and intensive care specialists in 1957, Francis said his predecessor had proved “morally licit to decide not to adopt therapeutic measures, or to discontinue them, when their use does not meet that ethical and humanistic standard that would later be called ‘due proportion in the use of remedies.’”

Pius XII had stated that it is not necessary to resort to every single remedy, and that in some cases it is wiser to refrain from their use. “It thus makes possible a decision that is morally qualified as withdrawal of ‘overzealous treatment’,” Francis said, adding that “such a decision responsibly acknowledges the limitations of our mortality, once it becomes clear that opposition to it is futile.”

He underlined how this understanding promotes a focus on the accompaniment of the dying, and while it means ethically avoiding excessive treatments, “it is completely different from euthanasia, which is always wrong, in that the intent of euthanasia is to end life and cause death.”

Francis acknowledged that many cases and situations can be “difficult to evaluate,” and that there is no one-size-fits-all rule that can be adopted.

“There needs to be a careful discernment of the moral object, the attending circumstances, and the intentions of those involved,” he wrote.

Placing the patient at the center

Francis said “the patient has the primary role” in the discussion regarding his own health. It’s the patient, according to Catholic teaching, who has the right to decide on the necessary treatment by discussing with his or her doctors the proportionality of the remedy and “refusing it if such proportionality is judged lacking,” the pope added.

The personal and relational elements of the patient’s life and also death, which the pope referred to as being “after all the last moment in life,” must be considered when evaluating his or her accompaniment and care.

Francis underlined once again that such evaluations are “not easy to make in today’s medical context, where the doctor/patient relationship has become increasingly fragmented and medical care involves any number of technological and organizational aspects.”

Global Inequality in health care

Francis did not forget to mention that many costly treatments and remedies are not available to all in the world, creating a “gap in healthcare possibilities” born from the blend between technological developments and economic interests.

Such a combination raises issues concerning the sustainability of health care delivery, the pope said, adding that it points to “what might be called a systemic tendency toward growing inequality in health care.

“This tendency is clearly visible at a global level, particularly when different continents are compared,” he continued. “But it is also present within the more wealthy countries, where access to healthcare risks being more dependent on an individual’s economic resources than on their actual need for treatment.”

Responsible closeness

Drawing from the parable of the Good Samaritan, the pope said that the “supreme commandment of responsible closeness, must be kept uppermost in mind,” especially in light of the growing complexities and challenges in the medical field.

Francis said that while the first instinct may be to take a step back from the anguish and hardship of patients in the final phases of life, “the categorical imperative is to never abandon the sick.”

The deathbed invites all to show love, closeness and solidarity to the patient beyond medical and physical needs. “Let each of us give love in his or her own way—as a father, a mother, a son, a daughter, a brother or sister, a doctor or a nurse. But give it!” Francis said. “And even if we know that we cannot always guarantee healing or a cure, we can and must always care for the living, without ourselves shortening their life, but also without futilely resisting their death.”

Pain and loneliness, he continued, are part of what makes death terrifying and unwelcome, highlighting the importance of palliative care in our culture. “Within democratic societies, these sensitive issues must be addressed calmly, seriously and thoughtfully, in a way open to finding, to the extent possible, agreed solutions, also on the legal level,” Francis said.

He added that while on one hand all religious, cultural and ethical beliefs must be taken into consideration, on the other hand it is also the responsibility of the state to ensure the fundamental equality where everyone is considered the same under the law and within the society.

Attention to the most vulnerable

In line with the tone of his pontificate so far, Francis underscored the need for particular attention “to the most vulnerable, who need help in defending their own interests.”

He also pointed to how this is essential in order to foster dialogue and promote a healthy society. He appealed for a broader and more encompassing legislation regarding healthcare, one that “effectively promotes the common good in each concrete situation.”