I do volunteer work with some of the elderly Catholic residents at a nursing home. Few if any of them ever will leave. I got involved when I started serving as a eucharistic minister for the home two years ago, and discovered that some of the people to whom I bring Communion have other visitors only rarely if ever. I visit these people regularly, bring them little gifts, try to make friends with them, pray with them and encourage them to pray more, and, in general, try to brighten their lives. Some other volunteers have been working with the home’s administrators to provide more opportunities for worthwhile activities for long-term patients who are not terminally ill. I have encouraged the people I visit to participate in the new activities, and some are doing that and spending less time watching television.
Still, many of these elderly friends are bored and have little to look forward to in this life. Most are not dying or even sick with anything in particular. But they are debilitated, burdened with various handicaps and health problems, and more or less depressed. Some regularly speak of death and clearly look forward to it. Some who are devout pray to die soon.
I know wishing for something can be a sin of thought. Wishing to commit adultery is adultery in the heart, and wishing an enemy would get killed certainly seems to be a serious sin of hatred. Is it also wrong for these elderly friends of mine to wish for death? I am not asking whether they are sinning, for I realize only God knows that, but whether what they are doing is wrong in itself. If it is, what should I do?
Another point. Federal law requires the nursing home to give residents information about their rights to refuse treatment and to give advance directives excluding life-sustaining treatment in case they become terminally ill. Most have signed the directives. One of my friends told me signing makes sense because “we are just waiting here to die and don’t want to be kept alive longer than necessary.” Not knowing what to say, I changed the subject. What should I have said?
There are two related but distinct moral questions here. The first is whether wishing for death is the matter of a sin. The answer depends on whether the wish for death involves an unreasonable act of the will. The act of the will involved in a wish for death is reasonable if death is only accepted as a side effect or understood as a necessary condition in a choice or readiness to choose to act for an intelligible good. The act of the will involved in a wish for death can be unreasonable in either of two ways: if it is a conditional intention to kill oneself or if it endorses an unreasonable emotional desire to die. Thus, an adequate response to the question must clarify those two wrongful will acts. The second question presented here is how one ought to deal with persons whose state of mind seems to involve one of those wrongful will acts. The answer is that one should try to help them stop willing wrongly, if indeed they are, and encourage them to wish rightly for death.
I assume that, in saying your elderly friends are “more or less depressed,” you do not mean all of them are suffering from some degree of psychological illness. However, I suggest that you familiarize yourself, if you have not already done so, with the signs of depression, so that you will be able to encourage any needing treatment to get it. On this matter, of course, you should look for guidance to those responsible for the health care of the home’s residents. But it also would be helpful to call their attention to anyone whose apparent depression they seem to have overlooked.140
Many elderly people in nursing homes are victims of grave injustices. Some have been entirely or largely abandoned by their children and/or others who should be taking care of them or, at least, taking a greater interest in them, and such elderly people often are aware of the injustice and sometimes embittered by it. But many others are not even conscious that they are victims: they suffer not only from the attitudes and practices of a society that measures personal worth by economic productivity and consumption, vigor, attractiveness, and status, but from a self-appraisal, based on those false standards, that makes them feel useless, worthless, undeserving of care, and even guilty for continuing to live and burden others. In most cases, you probably can do little or nothing to overcome these injustices. But by gently asking appropriate questions and being a sympathetic listener, you can help your elderly friends articulate their experiences of injustice, acknowledge their feelings about them, accept those feelings as appropriate, gain self-esteem, and forgive those who have wronged them.
You are doing a good thing in visiting these elderly people, making friends with them, praying with them and encouraging them to pray, trying to cheer them up, and encouraging them to spend less time on television and more on worthwhile activities. The questions you raise about their attitudes concerning death are not incidental to your relationship with them. Indeed, these questions ought to be central to your effort to understand and help them. Since nothing is more important than that they go to heaven, you can do nothing better for them than help them live well and prepare properly for death—for example, by receiving the sacraments, learning to join their suffering to Jesus’ passion, and making peace with enemies. Still, do not focus exclusively on the prospect of their death, constantly initiate discussion of it, or stop doing any of the good things you have been doing. But do keep in view the all-important benefit to your elderly friends of being prepared to die in God’s love, do nothing incompatible with their sharing in this benefit, and try to do everything else you do for them in a way conducive to this benefit.
I entirely agree with you that wishes have moral significance. You also are right in distinguishing between asking whether someone wishing for something is sinning, which only God knows, and whether the wishing is wrong in itself. Of course, deliberately to wish wrongly is to commit a sin, and anyone guilty of an unrepented sin is responsible for bad wishes arising from that sin, even if the wishes themselves are not deliberate. But most people, even those who are virtuous, very likely wish for many things that they should not, without ever choosing to do so. A wish simply comes to mind and is entertained, without the person ever asking: Is it wrong for me to wish this?
Nevertheless, your question remains important. Wishing wrongly, like any other kind of objectively bad act, is harmful at least to the one wishing, and is morally perilous even when not sinful, since bad wishes may eventually tempt one to make choices known to be wrong. Therefore, it is preferable that people reflect on the moral quality of their wishing and choose to set aside wishes that cannot be rightly entertained.
Since human life is a person’s concrete reality, it always retains its intrinsic goodness; since death is the privation of life, it is always bad. Therefore, in any straightforward choice between life and death, one always ought to choose life and may never choose to do anything precisely to bring about death (see LCL, 460–67).
Still, someone willing and acting for various goods that truly fulfill human beings may foresee that his or her own death will be an inevitable side effect or a necessary condition, or both, of attaining them, and so may and even should be willing to die, without ever intending death as an end, choosing it as a means, or doing anything to bring it about. When this willingness to die is allied with positive feelings toward some foreseen effect of death, such a person can be said to wish to die. Thus, St. Maximilian Kolbe can be said to have wished to die inasmuch as he chose to take a condemned man’s place; many martyrs wish to die inasmuch as they prefer death to infidelity and welcome it as an opportunity to bear witness to their faith; and every good Christian wishes to die inasmuch as he or she hopes for heaven, since only by dying is one born again to eternal life.
On this basis, many devout people, having prepared well for death, long for it and earnestly beg God to take them to himself. Thus, St. Paul says: “To me, living is Christ and dying is gain” (Phil 1.21), and: “We would rather be away from the body and at home with the Lord” (2 Cor 5.8). Yet Paul plainly judges death, as not itself something good, but only a necessary condition for the fulfillment of Christian hope: “I want to know Christ and the power of his resurrection and the sharing of his sufferings by becoming like him in his death, if somehow I may attain the resurrection from the dead” (Phil 3.10–11, emphasis added), and: “While we are still in this tent, we groan under our burden, because we wish not to be unclothed [deprived of our bodies by death] but to be further clothed, so that what is mortal may be swallowed up by life” (2 Cor 5.4).
Moreover, inasmuch as death itself, as the privation of the great good of life, is a real evil, the process of dying that ends in death also is evil, and one can rightly wish it not to be prolonged. Similarly, faced with death, one can rightly wish that the stressful period of anticipating it be short. Thus Jesus, anticipating his passion and death, said: “I have a baptism with which to be baptized, and what stress I am under until it is completed!” (Lk 12.50). Still, Jesus by no means regarded the suffering and death he foresaw as good; he only accepted them and endured the cross “for the sake of the joy that was set before him” (Heb 12.2).
Plainly, both Paul and Jesus wished principally for life. Yet as part of their wish for life they wished for death: the gateway to resurrection and the life of the world to come. In the same way, every faithful Christian, hoping for heaven, rightly wishes for death.
But it also is possible to wish wrongly for death. One can do wrong in conditionally accepting death by taking unreasonable risks and engaging in self-destructive behavior, thinking that death, if it results, will be welcome. One can conditionally choose to kill oneself or can refuse care not only foreseeing death but intending to bring it about.
Moreover, one can wrongly wish for death by accepting and endorsing an unreasonable emotional desire to die. Life always includes various sorts of suffering: physical pain, boredom, frustration, fruitless anger, grief over losses, and so on. Most people during most of their lives feel that various satisfactions and enjoyments more or less outweigh sufferings or at least balance them, so that life seems “worth living.” However, for some people at each stage of life and for many elderly people, satisfactions are few and sufferings many, so that life as a whole may seem empty and meaningless. At this point, death begins to seem attractive as a way to escape suffering, and this apparent attractiveness generates an emotional desire for death. This psychology is understandable, but such a desire is unreasonable insofar as it is based on false judgments: that life no longer is worth living, that pain and suffering are evils to be escaped at all costs, or that death itself can be good.141 Therefore, nobody should willingly entertain that desire and in that way wish for death. Moreover, if one does, one approves the unreasonable motive and, having approved it, is likely to be tempted to follow it out in action, that is, by choosing to do or omit doing something in order to die, or, at least, conditionally choosing to end one’s life. In either case, one commits suicide in one’s heart, and in both cases one may actually carry out the choice and kill oneself.
Someone might argue that one can rightly regard death as good and wish for it as a way of escaping suffering by pointing out that saintly Christians who wish for death as the gateway to eternal life look forward to freedom from pain and suffering as one of heaven’s blessings. Certainly, when devout people anticipate death they often speak about being freed of suffering, and, in general, Christians are aware that death will in fact put an end to earthly suffering, regard that as an advantage, and hope for it. This is very different, however, from thinking of death as a way of escaping suffering—as a possible means that could be rightly regarded as good. Saintly Christians realize that death always is bad: “God did not make death, and he does not delight in the death of the living. For he created all things so that they might exist” (Wis 1.13–14). Unlike the ungodly, devout Christians, though rightly wishing for death, do not consider it “a friend” (Wis 1.16), but “the last enemy to be destroyed” (1 Cor 15.26).
The preceding explanation makes clear the possible ambiguity in a wish for death. When rooted in hope for heaven and accompanied by docility to God’s providential plan, the wish is good and in no way at odds with reverence for life and determination to preserve it and make the most of it. But when rooted in sadness and/or anger about the poor quality of daily experience and accompanied by a will unsubmissive to God’s plan, the wish for death is bad and is the seed of the contralife will that uses death as a means to escape suffering. Doing that is suicide, which, freely chosen despite awareness of its gravity and unrepented, leads to hell. In your relationships with the elderly, therefore, encourage and support their uprightly wishing for death but avoid in any way fostering or condoning their wrongly wishing for it.
Someone might object that the alternatives just mentioned are not exhaustive, since a person’s wish for death, though rooted in negative feelings toward the poor quality of his or her daily experience, can be accompanied by docility to God’s law forbidding suicide. But such a wish is confused: objectively bad inasmuch as not rooted in hope for heaven, but subjectively blameless inasmuch as limited by an upright will to avoid sin. With such a confused wish, a person will be vulnerable to the temptation to choose suicide, perhaps persuading himself or herself that God will understand. The suicidal choice sometimes will take the form of an unreasonable decision to refuse treatment, rationalized by excluding death-dealing behavior: “Though I never would do anything to kill myself, that treatment would only prevent nature from taking her course.”
The appropriate response to your elderly friends’ expressions of a wish for death will vary in particular situations, depending on precisely what someone says, his or her beliefs and problems, and how you think you can help. Your friend’s explanation of signing advance directives excluding life-sustaining treatment—“We are just waiting here to die and don’t want to be kept alive longer than necessary”—perhaps expresses a feeling of uselessness. Just waiting suggests that nothing of value remains to be done. That certainly is a mistake. Those capable of doing so should exercise their creative gifts, help care for themselves and one another, and so on. No matter how severely handicapped and debilitated, anyone able to communicate with others can share in intrinsically valuable communion with them, and even when the ability to communicate is lost, a person may be able to pray and offer up his or her suffering. However, just waiting also might express not only negative feelings but a wrongful wish for death and even an immoral choice to forgo treatment as a means of hastening death. In the latter case, your friend has chosen suicide—though probably without sufficient reflection, and so probably without the guilt of mortal sin.
Confronted with ambiguity of this sort, your first responsibility as a friend is to be a good and sympathetic listener, to show interest proportionate to the great importance of what has been said, and then very gently to draw out the thinking and feelings behind the remark. If these turn out to be morally acceptable, try to reinforce and perfect them. But if they point to a morally unacceptable conditional intention or unreasonable emotional motive, kindly admonish the apparent sinner, leading him or her to see the wrongness of that wishing, to repent it, and to replace it with hope for heaven and a commitment to make the most of his or her remaining life.
Your goal in every case should be to get your friends eventually to say sincerely: “We remain here in order to finish the work God has given us; we are living out the life of good deeds he prepared for us in advance; still, since we hope to go to heaven, we would welcome death.” Given that outlook and attitude, an elderly person often may forgo medical treatment because of its costliness or other serious disadvantages, not arrogantly choosing to escape suffering by suicide but humbly willing to complete suffering by accepting its consummation in death: “Master, now you are dismissing your servant in peace, according to your word” (Lk 2.29). To help your friends come to this way of thinking, your message should contain the following ideas.
God is a loving Father who always knows what is best for us. We would not remain alive if there were no good reason for us to be here. Up to now and at this moment, God wants us to continue to live for some purpose. We must try to see what that purpose is and do our best to cooperate in realizing it. Perhaps a spouse or someone else still needs us, and we may not abandon that person. But even if not, as long as we are able to control our thoughts, one thing we can do is pray for ourselves and others, and offer our difficult lives as a sacrifice in union with Jesus’ suffering. God may be calling us to save someone’s soul in that way. There may be other ways in which we can help others less blessed than we are, and God also may be calling us to those forms of service. In any case, God is calling each of us to continue living a good Christian life, and in doing so to become the saints he wants us to be, not only by growing in faith and love, but by becoming exactly the way we are to be forever in heaven—unique saints who persevered through the precise set of difficulties each of us faces and who, by God’s grace, won the victory. Thus, we should look at ebbing life with the eye of hope: “So we do not lose heart. Even though our outer nature is wasting away, our inner nature is being renewed day by day. For this slight momentary affliction is preparing us for an eternal weight of glory beyond all measure” (2 Cor 4.16–17).
At the same time, we rightly long to enjoy that glory. Having prepared ourselves to die in God’s friendship, we look forward to death with hope of heaven. But heaven is God’s to give, not ours to take, and we must not despise this present life or let ourselves become impatient, much less even think of doing or omitting anything in order to hasten death. Rather, as in other things, so also in this, we must submit entirely to God: “We do not live to ourselves, and we do not die to ourselves. If we live, we live to the Lord, and if we die, we die to the Lord; so then, whether we live or whether we die, we are the Lord’s” (Rom 14.7–8). With this attitude, we rightly pray for death, not at a time of our choosing, but in God’s good time.
These Christian ideas contrast sharply with the secularist views spread by proponents of assisted suicide and euthanasia. When they talk about “quality of life,” they mean, not a person’s holiness and readiness to do God’s will, but only the proportion between his or her enjoyable experiences and sufferings. Insofar as suffering becomes unavoidable and cannot be eased, they consider it as meaningless, useless, degrading. And so they advocate “death with dignity,” by which they mean ending life when and as one chooses so as to avoid physical pain, debility, bowel and bladder incontinence, and so on142—harms that, despite their repulsiveness and unfittingness for persons, cannot detract from anyone’s essential human dignity.
Such secularist views are widespread, and both the staff and the residents of the nursing home undoubtedly are being influenced by them. You must counter them, especially by reminding your friends of the dignity with which Jesus suffered and died, of the salvific meaning of his doing so, and of the Easter glory to which his obedience brought him. Made in God’s image and likeness, and called to share in Jesus’ glory, we too enjoy a dignity that cannot be taken from us—though we can violate it by sin, not least the terrible sin of deliberately ending human life, whether another’s or our own (see CCC, 2268, 2276–83). And we too, invited by Jesus to take up our cross and follow him, can accept unavoidable suffering as part of our noble vocation, share by that acceptance in the salvific meaning of Jesus’ suffering, and hope confidently to share in his glory.143
140. Primary care physicians often fail to diagnose depression; see Leon Eisenberg, “Treating Depression and Anxiety in Primary Care: Closing the Gap between Knowledge and Practice,” New England Journal of Medicine, 326 (1992): 1080–84. A helpful booklet on depression: Depression Guideline Panel, Depression in Primary Care: Detection, Diagnosis, and Treatment, Quick Reference Guide for Clinicians, no. 5, AHCPR pub. no. 93–0552 (Rockville, Md.: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; Apr. 1993). Practitioners should first use volumes one and two of Depression in Primary Care: Clinical Practice Guideline, publications 93–0550 and 93–0551.
141. On the falsity of these judgments, see John Paul II, Evangelium vitae, 34–39, AAS 87 (1995) 438–44, OR, 5 Apr. 1995, vii–viii. On the relationship of pain and suffering to what is truly evil, see CMP, 119–20; LCL, 31–32, including n. 54.
142. For a concise and sound treatment of how to deal with such problems, see Cicely Saunders and Mary Baines, Living with Dying: The Management of Terminal Disease, 2nd ed. (Oxford: Oxford University Press, 1989).
143. See John Paul II, Salvifici doloris (On the Christian Meaning of Human Suffering), 19–27, AAS 76 (1984) 225–42, OR, 20 Feb. 1984, 4–7. With regard to advanced directives, see LCL, 528–30, and q. 44, below.