A Do Not Resuscitate (DNR) order directs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient’s breathing or heart stops. This decision is made in advance to prevent aggressive interventions that may not align with a patient’s wishes or prognosis. The Catholic Church holds that human life is sacred from conception to natural death, and this belief shapes all end-of-life decision-making. The Church’s moral guidance on medical treatments revolves around a careful distinction between different types of medical care, rather than preserving life at all costs.
Defining Ordinary and Extraordinary Means
The Catholic moral tradition establishes a framework for medical choices by classifying interventions as either “ordinary” or “extraordinary” means of preserving life. “Ordinary means,” also known as proportionate means, are treatments that offer a reasonable expectation of benefit without imposing an excessive burden, cost, or inconvenience on the patient or family. The Church considers the use of ordinary means to be a moral obligation.
Conversely, “extraordinary means,” or disproportionate means, are treatments that are excessively burdensome, dangerous, painful, or expensive, or offer little reasonable hope of success. The term “disproportionate” highlights that the burdens of the treatment outweigh the benefits, often merely prolonging the dying process. The Catechism of the Catholic Church (CCC 2278) states that discontinuing procedures deemed burdensome or disproportionate is legitimate, representing a refusal of “over-zealous” treatment.
This distinction acknowledges that biological life is a profound gift, but it is not an absolute good that must be maintained by all possible technological means. The moral acceptability of refusing a treatment is determined by weighing the potential benefits against the specific burdens it imposes in the patient’s unique situation.
The Moral Distinction Between Refusing Treatment and Euthanasia
Refusing a burdensome medical treatment is morally distinct from euthanasia, which is the direct, intentional killing of a patient to eliminate suffering. Euthanasia, whether by action or omission, is considered morally unacceptable by the Catholic Church. The Church teaches that human beings are stewards of life, not absolute owners, and therefore cannot intentionally end life.
Refusing what is deemed extraordinary or disproportionate treatment is not considered suicide or murder. This choice is an acceptance of the natural limitations of mortality, especially when death is imminent. The intent behind the refusal is to halt suffering and the imposition of a futile procedure, not to directly cause the patient’s death. When such a treatment is forgone, one is simply accepting the inability to impede death, allowing the underlying illness to take its course naturally.
Applying Catholic Teaching to DNR Orders
A Do Not Resuscitate order must be evaluated using the moral framework of ordinary and extraordinary means. Since a DNR order specifically directs against Cardiopulmonary Resuscitation (CPR), the decision rests on whether CPR would be considered a proportionate or disproportionate means for that individual patient. For a relatively healthy person who suffers a sudden, unexpected cardiac arrest, CPR is generally considered an ordinary and obligatory means because it offers a reasonable hope of restoring health.
However, for a patient with a terminal illness, significant frailty, or advanced age, CPR often falls into the category of disproportionate means. In these cases, the procedure’s likelihood of success is very low, and it is likely to cause significant harm, such as broken ribs or internal injuries. When a patient is already in the final stages of a terminal condition, CPR is viewed as merely prolonging the dying process, not preserving life with a reasonable hope of benefit.
Consequently, a DNR order is morally permissible within Catholic teaching when the decision is rooted in the belief that resuscitation would be excessively burdensome and offer no reasonable hope of recovery. This decision is an exercise of moral prudence that respects the patient’s dignity by rejecting the insistence on useless or burdensome technology. The decision must be made in good conscience, focusing on the proportionality of the intervention.
The Role of Conscience and Spiritual Guidance
The determination of whether a specific treatment is ordinary or extraordinary must be made prudently by the patient or their legally appointed healthcare proxy. This decision requires an informed conscience, based on a careful assessment of the medical facts and the Church’s moral principles. The patient’s free and informed judgment regarding the use or withdrawal of life-sustaining procedures should always be respected, provided it aligns with Catholic moral teaching.
In these complex situations, the Church encourages patients and families to seek spiritual guidance from a priest or chaplain knowledgeable in Catholic medical ethics. Consulting with a spiritual advisor helps ensure the decision is made with the proper moral intent—to avoid a disproportionate burden rather than intentionally hasten death. The medical team should also be fully informed that the decision to implement a DNR order is based on the ethical principle of refusing disproportionate care.