Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude

Charter for Health Care Workers

Pontifical Council for Pastoral Assistance to Health Care Workers

New Charter for health Care Workers
In 2017 the Charter was superseded by the New Charter for Health Care Workers

114. For the health care worker, serving life means assisting it right up to its natural completion.

Life is in God's hands: He is the Lord, He alone decides the final moment. Every faithful servant guards this fulfillment of God's will in the life of every person entrusted to his care. He does not consider himself the arbiter of death, just as and because he does not consider himself the arbiter of anyone's life.

Terminal illnesses

115. When the state of one's health deteriorates to an irreversible and fatal condition, a person enters into a terminal state of earthly existence. For him life is particularly and progressively precarious and painful. To illness and physical suffering is added the psychological and spiritual drama of detachment which death signifies and implies.

As such, the terminally ill patient is one who needs human and Christian accompaniment, and it is here that doctors and nurses are called on to make their expert and unrenounceable contribution. What is in question is special medical assistance for the dying person, so that also in dying he must know and will as a living human being. "Never more than in the proximity of death and in death itself is life to be celebrated and extolled. This must be fully respected, protected and assisted even in one who is experiencing its natural end.... The attitude to the terminally ill is often the acid test of a sense of justice and charity, of the nobility of mind, of the responsibility and professional ability of health care workers, beginning with doctors."[221]

116. Dying is part of life as its ultimate phase. It should be cared for, then, as belonging to it. Hence it calls for the therapeutic responsibility of the health care worker just as much and no less than every other moment in human life.

The dying person should not be dismissed as incurable and abandoned to his own resources and those of the family, but should be re-entrusted to the care of doctors and nurses. These, interacting and integrating with the assistance given by chaplains, social workers, relatives and friends, allow the dying person to accept and live out his death.[222]To help one to die means to help him to live intensely the final experience of his life. Where possible and when the one concerned wishes, he should be given the opportunity of spending his last days at home with suitable medical assistance.

117. A terminally ill person should be given whatever medical assistance helps to alleviate the pain accompanying death. This would include the so-called palliative or symptomatic treatment.

The most important assistance is "loving presence" at the bedside of the dying person.[223] There is a proper medical-health presence which, though not deceiving him, makes him feel alive, a person among persons, because he is receiving, like every being in need, attention and care. This caring attention gives confidence and hope to the patient and makes him reconciled to death.[224] This is the unique contribution which doctors and nurses, by their being human and Christian-more than by their expertise-can and should make to the dying person, so that rejection becomes acceptance and anguish gives way to hope.

In this way human dying is withdrawn from the phenomenon of "being overly medicalized," in which the terminal phase of life "takes place in crowded and activity-dominated environments, controlled by medical health personnel whose principal concern is the biophysical aspect of the illness." All of this "is being seen increasingly as disrespectful to the complex human state of the suffering person."[225]

118. "Before the mystery of death we are powerless; human certainties waver. But it is precisely in the face of such a checkmate that Christian faith...becomes a fount of serenity and peace.... What seems meaningless takes on meaning and worth."[226]

When this "checkmate" takes place in the life of a person, in this decisive hour of his existence, the witness of the health care worker's faith and hope in Christ has a determining role. It displays new horizons of meaning, that is, of resurrection and life, to the one who sees the prospects of earthly existence being closed to him.

"Over and above all human consolations, no one can be blind to the enormous help given to the dying and to their families by faith in God and the hope of eternal life."[227] To make faith and hope present is for doctors and nurses the highest form of humanizing death. It is more than alleviating a suffering. It means applying one's skills in order to "make going to God easy for the patient."[228]

Death with dignity

119. The right to life is specified in the terminally ill person as "a right to die in total serenity, with human and Christian dignity."[229]

This cannot be interpreted as the power to kill oneself or to give this power to others, but to experience dying in a human and Christian way and not flee from it "at any cost." This right is being explicitly expressed by people today in order to safeguard themselves at the point of death against "the use of techniques that run the risk of becoming abusive."[230]

Contemporary medicine, in fact, has at its disposal methods which artificially delay death, without any real benefit to the patient. It is merely keeping one alive or prolonging life for a time, at the cost of further, severe suffering. This is the so-called "therapeutic tyranny," which consists "in the use of methods which are particularly exhausting and painful for the patient, condemning him in fact to an artificially prolonged agony."[231]

This is contrary to the dignity of the dying person and to the moral obligation of accepting death and allowing it at last to take its course. "Death is an inevitable fact of human life":[232]it cannot be uselessly delayed, fleeing from it by every means.[233]

120. Aware that he is "neither the lord of life nor the conqueror of death," the health care worker, in evaluating means, "should make appropriate choices, that is, relate to the patient and be guided by his real condition."[234]

Here he will apply the principle-already stated-of "appropriate medical treatment," which can be specified thus: "When inevitable death is imminent, despite the means used, it is lawful in conscience to decide to refuse treatment that would only secure a precarious and painful prolongation of life, but without interrupting the normal treatment due to the patient in similar cases. Hence the doctor need have no concern; it is not as if he had failed to assist the person in danger."[235]

The administration of food and liquids, even artificially, is part of the normal treatment always due to the patient when this is not burdensome for him: their undue suspension could be real and properly so-called euthanasia.

121. For the doctors and their assistants it is not a question of deciding the life or death of an individual. It is simply a question of being a doctor, that is, of posing the question and then deciding according to one's expertise and one's conscience regarding a respectful care of the living and the dying of the patient entrusted to him. This responsibility does not always and in all cases involve recourse to every means. It might also require the renunciation of certain means to make way for a serene and Christian acceptance of death which is inherent in life. It might also mean respect for the wishes of the patient who refuses the use of such means.[236]

The use of painkillers for the terminally ill

122. Among the medicines administered to terminally ill patients are painkillers. These, which help to make the course of the illness less dramatic, contribute to the humanization and acceptance of death.[237]

This, however, does not constitute a general norm of behavior.[238] "Heroic behavior" cannot be imposed on everyone.[239]And then, very often, "pain diminishes the moral strength" of the person:[240] sufferings "aggravate the state of weakness and physical exhaustion, impeding the impulse of the spirit and debilitating the moral powers instead of supporting them. The suppression of pain, instead, brings organic and psychic relief making prayer easier and enabling one to give oneself more generously."[241]

"Human and Christian prudence suggests the use for most patients of medicines which alleviate or suppress pain, even if this causes torpor or reduced lucidity. With regard to those who are unable to express their wishes, one can reasonably suppose that they wish to take painkillers and these can be administered according to medical advice."[242]

The use of painkillers with the dying, however, is not without its problems.

123. First, their use might have the effect, of not only alleviating pain, but also of hastening death.

When "proportionate reasons" so require, "it is permitted to use with moderation narcotics which alleviate suffering, but which also hasten death."[243] In this case "death is not intended or sought in any way, although there is a risk of it for a reasonable cause: what is intended is simply the alleviation of pain in an effective way, using for that purpose those painkillers available to medicine."[244]

124. There is also the possibility that painkillers will cause unconsciousness in the dying person. This use must receive special consideration.[245]

"Without serious reasons, the dying person must not be deprived of consciousness."[246] Sometimes the systematic use of narcotics which reduce the consciousness of the patient is a cloak for the frequently unconscious wish of the health care worker to discontinue relating to the dying person. In this case it is not so much the alleviation of the patient's suffering that is sought as the convenience of those in attendance. The dying person is deprived of the possibility of "living his own life," by reducing him to a state of unconsciousness unworthy of a human being.[247]This is why the administration of narcotics for the sole purpose of depriving the dying person of a conscious end is "a truly deplorable practice "[248]

It is a different matter when there is a serious clinical case for the administration of analgesics which suppress consciousness, as when there is violent and unbearable pain. In this case the anesthetic is said to be licit, provided certain conditions are fulfilled: that the dying person has fulfilled or could still fulfill his moral, family and religious obligations.[249]

Telling the truth to a dying person

125. Telling the truth about the diagnosis and prognosis to the dying person, and more generally to those suffering from an incurable illness, poses a problem of communication.

To inform someone that they are dying is difficult and dramatic, but this is not an exemption from being truthful. Communication between a dying person and those in attendance cannot be based on pretense. This is never a human possibility for the dying person and does not contribute to the humanization of dying.

The person has a right to be informed of their condition. This right is not lessened where there is a diagnosis and prognosis of a terminal illness, rather, it is heightened.

This information, in fact, is linked to important responsibilities which cannot be delegated to another. There are responsibilities bearing on the treatment to be applied with the informed consent of the patient.

With the approach of death comes the responsibility to fulfill certain duties in one's relationship with the family, settling possible legal matters, resolving obligations to a third party. For a believer the approach of death requires that he be fully aware when he performs certain actions, especially the reconciling encounter with God in the sacrament of Penance.

The person cannot be abandoned to unconsciousness in the decisive "hour" of his life, taking him away from himself and from his final and most important decisions. "Death is too essential a moment for its prospect to be avoided."[250]

126. The duty of being truthful with the terminally ill patient demands discernment and human tact on the part of medical personnel.

It cannot consist of a detached and indifferent communication of the diagnosis and relevant prognosis. The truth must not remain unspoken, but neither must it be given in all its bare, crude reality. It should be given in line with love and charity, calling all those who assist the patient in various ways to be attuned to this communion.

There is the need to establish a relationship of trust, receptivity and dialogue with the patient, seeking the appropriate time and words. There is a way of speaking that is discerning and respectful of the patient's moods, and it should be in harmony with these. There is a form of conversation wherein questions are tactfully handled and even provoked, so that the patient is gradually brought to an awareness of his condition. If one tries to be present to the patient and sensitive to his lot one will find the words and the replies which make it possible to communicate in truth and in charity: "giving the truth in love" (Eph 4:15).

127. "Each case has its own requirements, depending on the sensitivity and ability of each person, of his or her relationship with the patient and the patient's condition; to provide for the patient's possible reactions (rebellion, depression, resignation, etc.), one will prepare oneself to face them calmly and tactfully."[251]It is not the exactness of what is said that is important, but the relationship of solidarity with the patient. It is not simply a matter of giving clinical facts, but of meaningful communication.

In this relationship the prospect of death is not presented as inescapable, and it loses its anguishing power: the patient does not feel isolated and condemned to death. When the truth is presented to him in this way he is not left without hope, because it makes him feel alive in a relationship of sharing and communion. He is not alone with his illness: he feels truly understood, and he is at peace with himself and with others. He is himself as a person. His life, despite everything, has meaning, and dying unfolds with optimistic and transcendent meaning.

The moment of death

128. The use of resuscitative technology and the need for vital organs for transplant operations pose anew today the problem of diagnosing when death occurs.

Death is seen and experienced by people as a decomposition, a dissolution, a rupture.[252] "It comes when the spiritual principle which governs the unity of the individual is no longer able to exercise its functions on and in the organism and the elements of the latter, left to themselves, dissociate.

Certainly, this destruction does not effect the entire human being. The Christian faith-and not it alone-affirms the continuance, beyond death, of man's spiritual principle." Faith nourishes in the Christian the hope of again finding his personal integrity transfigured and definitively possessed in Christ" (1 Cor 15:22).[253]

This faith filled with hope does not prevent "death [from] being a painful rupture." But "the moment of this rupture is not directly perceptible, and the problem is to identify the signs."[254] To ascertain and interpret these signs is not a matter for faith or morals but for medical science: "it is for the give a clear, precise definition of death and of the moment of death."[255] "Scientists, analysts and scholars must continue their research and their studies to determine in the most precise way possible the exact moment and the irrefutable sign of death."[256]

Once this determination has been achieved, in its light the questions and moral conflicts arising from new technologies and new therapeutic possibilities can be resolved. Moral theology, in fact, cannot but acknowledge the biomedical determination as the decisive criterion.

129. With regard to this determination, the Pontifical Academy of Sciences has made an authoritative contribution. First with regard to the biomedical definition of death: "a person is dead when he has irreversibly lost all ability to integrate and coordinate the physical and mental functions of the body."

Second, with regard to the precise moment of death: "death comes when: a) the spontaneous functions of the heart and breathing have definitively ceased, or b) the irreversible arrest of all brain activity." In reality "brain death is the true criterion of death, although the definitive arrest of cardio-respiratory activity very quickly leads to brain death."[257]

Faith and morals accept these findings of science. However, they demand of health care workers the most accurate use of the various clinical and instrumental methods for a certain diagnosis of death so that a patient is not declared dead and treated as such when in fact he is not dead.

Religious assistance for the dying

130. The crisis which the approach of death involves prompts the Christian and the Church to be a bearer of the light of truth which faith alone can cast on the mystery of death.

Death is an event which brings one into the life of God, and revelation alone can pronounce a word of truth about it. This truth must be brought in faith to the dying person. The annunciation "full of grace and truth" (Jn 1:14) of the Gospel accompanies the Christian from the beginning to the end of life. The last word of the Gospel is the word of life that conquers death and opens up the greatest hope to the dying person.

131. Death, then, must be evangelized: the Gospel must be announced to the dying person. It is a pastoral duty of the ecclesial community in each one of its members, according to the responsibilities of each. The hospital chaplain has a special obligation here, since he is called to minister to the dying within the broader limits of the pastoral care of the sick.

For him this duty implies not only the role he personally carries out at the side of the dying entrusted to his care, but also the promotion of this pastoral activity, through organizing religious services, forming and sensitizing health care workers and involving relatives and friends.

The announcement of the Gospel to the dying finds especially expressive and effective forms in charity, prayer and the sacraments.

132. Charity means that giving and receptive presence which establishes with the dying person a communion born of attention, comprehension, concern, patience, sharing and selflessness.

Charity sees in the dying person, as in no other, the face of the suffering and dying Christ calling out for love. Charity to the dying person-this "poor one" who is renouncing all the goods of this world-is a privileged expression of love of God in one's neighbor (cf. Mt 25:31-40).

Loving the dying with Christian charity is helping them to recognize and feel vividly the mysterious presence of God at their side: in the charity of a brother the love of God becomes visible.

133. Charity enables the relationship with the dying person to expand in prayer, that is, in communion with God. In this communion one relates to God as the Father who welcomes his children returning to Him.

To help the dying person to pray and to pray with him means opening up to him the horizons of divine life. It means, at the same time, entering into that "communion of saints" in which all the relationships, which death seems to break irreparably, are re-knit in a new way.

134. A privileged moment of prayer with the dying person is the celebration of the sacraments: the grace-filled signs of God's salvific presence.

Foremost is the sacrament of the Anointing of the Sick through which the Holy Spirit, completing in the Christian his assimilation to Christ begun in baptism, makes him participate definitively in the paschal triumph over sickness and death.

Viaticum is eucharistic nourishment, the bread of communion with Christ which gives the dying person the strength to face the final and decisive stage of life's journey.

Penance is the sacrament of reconciliation: at peace with God, the dying person is at peace with himself and with his neighbor

135. In this faith, filled with charity the powerlessness experienced when faced with the mystery of death is not agonizing and paralyzing. The Christian finds hope and in it the possibility, despite everything, to live and not suffer death.

The suppression of life

136. The inviolability of human life means and implies in the last analysis the unlawfulness of every act which directly suppresses human life. "The inviolability of the right to life of the innocent human being from conception to death is a sign and a requirement of the very inviolability of the person, to whom the Creator has given the gift of life."[258]

God himself "is the vindicator of every innocent life." "He will call man to account for the life of man: each one will have to answer for his brother" (Gen 9:5; cf. Mt 19:18; Rom 13:9). And his commandment is categorical: "Thou shalt not kill" (Ex 20:13): "Do not kill the innocent or the just one because I will not absolve the guilty one" (Ex 23:7).[259]

137. This is why "no one can make an attempt on the life of an innocent person without opposing God's love for that person, without violating a fundamental, unrenouncable and inalienable right."[260]

This is a right that one has come directly from God (not from others: parents, society, human authority). "Hence there is no one, no human authority, no science, no medical, eugenic, social, economic or moral 'indicator' which can show or give a valid juridical justification for direct, deliberate disposal of an innocent human life, that is, a disposal aimed at its destruction, either as an end or as a means to another end which in itself may not be at all illicit."[261]

In particular "nothing and no one can authorize the killing of an innocent human being, whether it is a fetus or an embryo, a child or an adult, elderly, ill, incurable or dying. Moreover, no one can request this homicidal act for themselves or for another for whom they are responsible, nor can they consent to it explicitly or implicitly. No authority can legitimately impose it or permit it. It is, in fact, a violation of divine law. an insult to the dignity of the human person, a anti-life crime, an attempt on humankind "[262]

138. "Ministers of life and never agents of death,"[263] it is for health care workers "to safeguard life, to be watchful over its evolution and development throughout its whole existence, respecting the plan drawn up by the Creator."[264]

This vigilant ministry of safeguarding human life rejects homicide as a morally grave act, contrary to the medical mission, and opposes voluntary death, suicide, as "unacceptable," dissuading anyone tempted to do so from carrying it out[265]

Among the modalities of the suppression of life, homicide or suicide, there are two-abortion and euthanasia-against which this ministry should be particularly vigilant and in a certain way prophetic, due to the cultural and legislative context which is rather frequently insensitive if not, indeed, favorable to their propagation.


139. The inviolability of the human person from conception prohibits abortion as the suppression of prenatal life. This is "a direct violation of the fundamental right to life of the human being"[266] and is "an abominable crime."[267]

There is need to make explicit reference to suppression of life by abortion and its moral gravity because of the ease of recourse to this homicidal practice today and the ethical indifference towards it induced by a hedonistic and utilitarian culture-offspring of theoretical and practical materialism-which has spawned a truly abortionist mentality.

The elimination of the unwanted pregnancy has become a wide-spread phenomenon, financed by taxpayer's money and facilitated by permissive and guaranteed legislation.[268] All of this is the fatal cause for many people to avoid taking responsibility for the expected child and so to banalize a serious sin.[269]

"Unfortunately, this disturbing state of affairs, far from decreasing, is expanding.... At the same time a new cultural climate is developing and taking hold, which gives crimes against life a new and-if possible-even more sinister character, giving rise to further grave concern: broad sectors of public opinion justify certain crimes against life in the name of the rights of individual freedom, and on this basis they claim not only exemption from punishment but even authorization by the state, so that these things can be done with total freedom and indeed with the free assistance of health care systems."[270]

140. The Church, like every person who holds life dear, cannot become accustomed to this mentality, and she raises her voice in defense of life, especially that of the defenseless and unknown, which embryonic and fetal life is.

She calls health care workers to professional loyalty, which does not tolerate any action which suppresses life, despite "the Ask of incomprehension, misunderstanding, and serious discrimination" which this consistency might cause.[271]Fidelity to medical health de-legitimizes every intervention, surgical or pharmaceutical, intended to interrupt the pregnancy at any stage.

141. It is also true that in certain cases, by refusing an abortion, other important goods-which it is only normal that one would want to safeguard-are put in jeopardy. These could be: danger to the mother's health, the burden of another child, a serious malformation of the fetus, a pregnancy caused by rape.

These problems cannot be ignored or minimized, nor the reasons supporting them. But it must also be affirmed that none of them can objectively give the right to dispose of another's life, even in the initial phase. "Life, in fact, is too fundamental a good for it to be compared with certain disadvantages, even if they be very great."[272]

142. Ethical delegitimization applies to all forms of direct abortion, since it is an intrinsically blameworthy act. The use of substances or means which impede the implantation of the fertilized embryo or which cause its premature detachment is also an act of abortion. A doctor who would knowingly prescribe or apply such substances or means would cooperate in the abortion.

If the abortion follows as a foreseen but nor intended or willed but merely tolerated consequence of a therapeutic act essential for the mother's health, this is morally legitimate. The abortion in this case is the indirect result of an act which is not in itself abortive.[273]

143. If the health care worker is faced with legislation favorable to abortion he "must refuse politely but firmly."[274] "One can never obey a law that is intrinsically immoral, and this is so in the case of a law which admits, in principle, the lawfulness of abortion."[275]

As a result, doctors and nurses are obliged to be conscientious objectors. The great, fundamental value of life makes this obligation a grave moral duty for medical personnel who are encouraged by the law to carry out abortions or to cooperate proximately in direct abortion.

Awareness of the inviolable value of life and of God's law protecting it, is antecedent to all positive human law. When the latter is contrary to God's law, conscience affirms its primary right and the primacy of God's law: "One must obey God rather than men" (Acts 5:29).

"It is not always easy to follow one's conscience in obedience to God's law. It may entail sacrifice and disadvantages, and one can in no way discount this cost; sometimes heroism is called for if one is to be faithful to these demands. Nevertheless, it must be clearly stated that the road of genuine progress for the human person passes through this constant fidelity to a conscience upholding rectitude and truth."[276]

144. As well as being a mark of professional loyalty, conscientious objection on the part of the health care worker, for the right reasons, is highly meaningful as a social condemnation of a legal injustice against innocent and defenseless life.

145. The gravity of the sin of abortion and the ease with which it is carried out, supported by law and the modern mentality, prompts the Church to threaten the penalty of excommunication for the Christian who procures it: "One who procures an effective abortion incurs latae sententiae excommunication."[277]

The excommunication has an essentially preventative and pedagogical significance. It is a forceful call from the Church, meant to arouse insensitive consciences, to dissuade people from an act which is absolutely incompatible with Gospel demands, and to awaken unreserved fidelity to life. One cannot be in ecclesial communion and at the same time disregard the Gospel of life through the practice of abortion.

The protection and acceptance of the expected child, its preference to all other values, is a decisive and credible witness which the Christian must give no matter what.

146. Health care workers have special obligations with regard to aborted fetuses.

An aborted fetus, if it is still alive, should be baptized if at all possible.[278]

A dead aborted fetus must be given the same respect as a human corpse. This means that it cannot be disposed of as just another item of rubbish. If at all possible it should be appropriately interred.

Likewise, the fetus cannot be used for experimentation or transplant if the abortion was caused voluntarily. To do so would be an unworthy instrumentalization of a human life.


147. A mentality ever less ready to recognize life as a value in itself, relative to God alone, independent of how it came into being; a concept of the quality of life in terms of efficiency and psychophysical satisfaction, incapable of seeing any meaning in suffering and handicap, and hence to be avoided at any cost and by every means; a vision of death as an absurd end to a life still to be enjoyed, or as a liberation from an existence already considered meaningless; all of this-within a culture which, leaving God aside, makes man responsible to himself alone and to freely established laws of society-is the soil of the euthanasia culture. Where these convictions are disseminated "it could seem logical and 'human' to end one's own life or that of another 'peacefully', when all that is left to it is suffering and serious impairment."[279]

"But this is really absurd and inhuman."[280] Euthanasia is a homicidal act, which no end can justify. By euthanasia is meant an action or omission which of its nature or by intention causes death, in order that all suffering may be eliminated. Euthanasia's terms of reference, therefore, are to be found in the intention of the will and in the methods used."[281]

The pity aroused by the pain and suffering of terminally ill persons, abnormal babies, the mentally ill, the elderly, those suffering from incurable diseases, does not authorize any form of direct euthanasia, active or passive. This is not a question of helping a sick person, but rather the intentional killing of a person.

148. Medical and paramedical personnel-faithful to the task of "always being at the service of life and assisting it to the end"[282] cannot cooperate in any euthanistic practice even at the request of the one concerned, and much less at the request of the relatives. In fact, the individual does not have the right to euthanasia, because he does not have a right to dispose arbitrarily of his own life. Hence no health care worker can be the executive guardian of a non-existent right.

It is a different matter when there is question of the right, already mentioned, of dying with human and Christian dignity. This is a real and legitimate right which medical personnel are called on to safeguard by caring for the patient and accepting the natural termination of life. There is a radical difference between "death dealing" and "consent to dying": the former is an act suppressing life, the latter means accepting life until death.

149. "The pleas of gravely ill persons who sometimes ask for death are not to be understood as implying a true desire for euthanasia; in fact it is almost always a case of an anguished plea for help and love. What a sick person needs, besides medical care, is love, the human and supernatural warmth with which the sick person can and ought to be surrounded by those close to him or her, parents and children, doctors and nurses."[283]

The sick person who feels surrounded by a loving human and Christian presence does not give way to depression and anguish as would be the case if one were left to suffer and die alone and wanting to be done with life. This is why euthanasia is a defeat for the one who proposes it, decides it and carries it out. Far from being an act of mercy to the patient, euthanasia is a gesture of individual and social self-pity and an escape from an unbearable situation.

150. Euthanasia upsets the doctor-patient relationship. On the part of the patient, because he relates to the doctor as one who can assure him of death. On the part of the doctor, because he is no longer the absolute guarantor of life: the sick person will be afraid that the doctor may cause his death. The doctor-patient relationship is a life-trusting one and this is how it should remain.

Euthanasia is a "crime" in which health care workers, who are always and only guardians of life, can in no way cooperate.[284]

For medical science it marks "a backward step of surrender, as well as an insult to the personal dignity of the one who is dying."[285] Its being depicted as a "further harbor of death after abortion" should be understood as a "dramatic appeal" for effective, unreserved fidelity to life.[286]