A Do Not Resuscitate (DNR) order instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient’s heart or breathing stops. This legal tool allows patients to express their wishes regarding aggressive, life-saving measures at the end of life. The Catholic Church teaches that human life is sacred and must be protected from conception to natural death, obligating individuals to take reasonable steps to preserve their lives. However, the Church also recognizes that death is an inevitable part of the human condition. Whether a DNR order aligns with the Catholic faith depends entirely on the nature of the treatment being refused, centering on the distinction between morally obligatory and morally optional medical interventions.
The Moral Distinction Between Ordinary and Extraordinary Means
The Church’s moral tradition differentiates between “ordinary” and “extraordinary” means of preserving life, which provides the framework for assessing the morality of a DNR. Ordinary means are those forms of care that are morally obligatory, offering a reasonable hope of benefit without imposing an excessive burden or expense. This category typically includes basic care such as standard nutrition, hydration, and comfort measures, even if medically assisted. A patient is morally bound to accept and utilize these ordinary means to sustain life.
In contrast, extraordinary means are medical interventions that do not offer a reasonable hope of benefit or impose an excessive burden on the patient, family, or community. Such treatments are considered morally optional, and a patient may refuse them without guilt. A DNR order, which refuses the aggressive intervention of CPR, generally falls under the permissible refusal of extraordinary means, especially when the patient is seriously ill or near the end of life. Refusing extraordinary means is not considered suicide or euthanasia; it is an acceptance of the natural progression of an illness.
Determining When Care Becomes Proportionately Burdensome
The practical decision of whether an intervention, like CPR, constitutes “extraordinary means” relies on the Principle of Proportionality. This principle requires judging whether the expected benefits of the intervention are proportionate to the burdens it will impose on the patient. Burdens may include physical pain, excessive expense, psychological distress, or severe inconvenience. A treatment is considered disproportionate if it offers only an insignificant extension of life at the cost of immense suffering.
Even medically common interventions, such as chemotherapy, can become morally “extraordinary” if they no longer offer a reasonable hope of success for a patient in the late stages of a terminal illness. The determination of proportionality must be made on a case-by-case basis, considering the patient’s physical condition and circumstances. The moral permissibility of a DNR rests on the intention to accept natural, imminent death, not to intentionally hasten it.
CPR has a statistically low success rate, particularly for frail patients with chronic or terminal illnesses, often resulting in fractured ribs, internal injuries, and poor quality of life afterward. In these scenarios, the burden of the procedure clearly outweighs the expected benefit, making CPR an extraordinary means that can be morally refused through a DNR order.
Official Church Guidance
The moral guidelines for end-of-life decisions, including DNR orders, are formalized in authoritative Church documents. The Catechism of the Catholic Church (CCC) explicitly addresses the morality of refusing aggressive medical treatment. Paragraphs 2278 and 2279 state that discontinuing medical procedures that are “burdensome, dangerous, extraordinary, or disproportionate to the expected outcome” can be legitimate. This clarifies that accepting death is permissible when the inability to impede it is merely accepted, not actively willed.
Further guidance is provided by the United States Conference of Catholic Bishops (USCCB) in their Ethical and Religious Directives for Catholic Health Care Services (ERDs). Directive 57 affirms that a person may forgo “extraordinary or disproportionate means of preserving life,” defining them as those that do not offer reasonable hope of benefit or entail an excessive burden. The ERDs require Catholic healthcare institutions to respect a competent adult patient’s free and informed judgment concerning the use or withdrawal of life-sustaining procedures, provided the decision is not contrary to Catholic moral teaching.
The Church’s position permits a DNR order when it reflects a refusal of medical technology judged to be disproportionately burdensome, while still requiring the continuation of basic comfort and palliative care. The directives emphasize that the patient’s dignity must be respected by neither imposing futile treatments nor abandoning the patient by withdrawing ordinary care.