Praised are you, my Lord, for our sister bodily Death,
From whom no living person can escape.
---St. Francis of Assisi

Carlos is 79 years old. He has been in the hospital for the past 11 days, all of that time on life support. His wife, children and grandchildren have kept a round-the-clock vigil in shifts at the Catholic hospital.

This morning Carlos' physician informed the family that Carlos is clinically dead. They asked what that meant. She told them that it meant that he was legally dead by standards accepted by the state and by the medical profession. They were shocked since he looked like he was sleeping, even though a machine was helping him breathe.

Immediately they asked to talk to the Catholic chaplain at the hospital. A wonderful team of three dedicated Catholic chaplains immediately came to see them --- a lay woman (director of chaplain services), a brother and a priest. During a lengthy visit they informed the family that indeed Carlos was dead and that the Church would agree that the time had come for the family to mourn his loss and celebrate his new life.

It has often been said that for any of us who identifies our self as a believing Christian, the death of someone we have loved and were close to can be the greatest test of the reality of our faith. Death of a loved one can be accompanied by a great sense of loss, of being "left behind," and can lead to periods of sadness and even depression.

These are very normal feelings and should be expected. However, at the same time, the truth of God's revelation in Jesus challenges us to move beyond Good Friday to the celebration of the Resurrection. For some this transition is a long struggle while for others it is much less so.

The meaning of death for the Christian is primarily theological, but it also includes significant pastoral and moral aspects.

Physical death and its theological meaning often quickly moves to the generation of a myriad of moral questions for Catholics who find themselves surrounded during the final days of their loved one by a medical world that can be bewildering and all too often foreign and frightening. Medical personnel can appear to be too busy to have much time to spend with families and answer medical questions and respond to any number of concerns that a family might have during such an experience. Individuals and families are confronted with forms to sign and decisions to make that can seem overwhelming.

For many Catholics doing the right thing, making a good moral decision, is extremely important especially because the decision is being made for someone who would want all decisions made in accord with Church teaching. At the center of many of the end-of-life moral questions is the very definition of death. Moral issues like brain death, futile care and organ transplantation all revolve around the definition of death. Even questions about the propriety of dispensing sacraments to a person who is clinically dead have significant moral ramifications.

What does the Church teach about how the "moment" of death is identified? Can a heart be pumping and the lungs breathing and still the person is really, truly dead?

'Let me receive pure light'
First let's briefly review the Church's theology of death. We can find in Sacred Scripture several passages that help us understand the Christian vision of death. In St. Paul's letter to the Philippians we hear:

"It is better for me to die in Christ Jesus than to reign over the ends of the earth. Him it is I seek --- who died for us. Him it is I desire --- who rose for us. I am on the point of giving birth… Let me receive pure light; when I shall have arrived there, then shall I be a man" (1:23).

Similarly, in Paul's first letter to the Corinthians he teaches:

"The body is meant for the Lord, and the Lord for the body. And God raised the Lord and will also raise us up by his power. Do you not know that your bodies are members of Christ? … You are not your own; …So glorify God in your body" (6: 13-15, 19-20).

In the Church's funeral liturgy we find the beautiful passage, "Lord, for your faithful people life is changed, not ended. When the body of our earthly dwelling lies in death we gain an everlasting dwelling place in heaven." And the Catechism of the Catholic Church reminds us:

"Death is the end of our earthly pilgrimage, of the time of grace and mercy which God offers us so as to work out our earthly life in keeping with the divine plan, and to decide our ultimate destiny. When 'the single course of our earthly life' is completed, we shall not return to other earthly lives: 'It is appointed for us to die once'" (n. 1013).

Finally, the United States Conference of Catholic Bishops states: "In the face of death --- for many, a time when hope seems lost --- the Church witnesses to her belief that God has created each person for eternal life" (Ethical and Religious Directives, fourth ed., p. 29).

The Church's theology of death reminds us that as Catholics we are challenged to place death itself in the horizon of our profoundly pro-life vision. To be a pro-life Catholic is to accept, believe and teach that the goal of human life is not found primarily or principally in our physical existence on earth but in sharing in the eternal life of the Resurrection after our sojourn on earth. To deny the reality of death, either by believing in reincarnation on one extreme, or on the other by fighting against God's call through the employment of futile and useless medicine in vain attempts to delay the inevitability of death is a refusal to acknowledge the truth that God created each of His children for an eternal life beyond the confines of earthly existence.

As our Bishops remind us: "We have a duty to preserve our life and to use it for the glory of God, but the duty to preserve life is not absolute…" (ERD, p. 29).

'The complete and final separation'
Secondly, let's review the Church's teaching about the medical definition of death. Does the Church, in fact, accept that a medical determination of "brain death" is real death? Pope Pius XII in 1957 reiterated the Church's classical definition of death: "One can accept the usual concept of the complete and final separation of the soul from the body."

However, even then the specter of brain death was looming on the medical horizon. In 1975 the United States Catholic Conference addressed the growing issue of defining death: "Recent advances in technologic methods for maintaining certain physiologic functions have frequently made it difficult to determine at what point death has occurred. The determination of clinical death can be a problem particularly in those cases relating to certain illnesses of the central nervous system" (Guidelines for the Determination of Brain Death, p. 26).

Finally, in 1985 the Pontifical Academy of Sciences responded to the issue. "Death has occurred when: A. The spontaneous cardiac and respiratory functions have definitively ceased; or B. An irreversible cessation of every brain function is verified. …cerebral death is the true criterion of death, since the definitive arrest of the cardio respiratory functions leads very quickly to cerebral death" (Report on Prolonging Life and Determining Death, p. 31).

In light of this teaching the USCCB teaches: "The determination of death should be made by the physician or competent medical authority in accordance with responsible and commonly accepted scientific criteria" (ERD, p. 32).

The Church's acceptance of brain death criteria must be understood as "total brain death" which includes the death of the brain stem. Partial brain death, in other words, where a person can maintain spontaneous breathing and heartbeat, even where there has been a permanent loss of higher functions, does not constitute brain death in the Catholic understanding. This was reinforced in 2004 by Pope John Paul II:

"I feel the duty to affirm strongly that the intrinsic value and personal dignity of every human being do not change, no matter what the concrete circumstances of his or her life. A person, even if seriously ill or disabled in the exercise of their highest function is and always will be a person…Even our brothers and sisters who find themselves in the clinical condition of a vegetative state retain their human dignity in all its fullness. The loving gaze of God the Father continues to fall upon them, acknowledging them as his sons and daughters, especially in need of help" (Care of Patients in a Permanent Vegetative State, no. 3).

When the time is past…
Lastly we are brought to the issue of organ transplantation. In general, the desire to donate one's organs upon death is based in one's love for others. When the time is past for one to use one's own organs, what greater evidence of a pro-life stance could one have than offering one's organs to bring life, health and vitality to others either directly for transplantation or indirectly for medical research?

Nevertheless: "Such organs should not be removed until it has been medically determined that the patient has died. In order to prevent any conflict of interest, the physician who determines death should not be a member of the transplant team" (ERD, 64).

Similarly, the donation of tissue or organs from children and even infants is permitted with the informed consent of the parents or guardians (ERD, 65). However, Catholic patients and Catholic institutions should not make use of human tissue obtained from direct abortions, whether for therapeutic or research purposes (ERD, 66).

At this point it is probably important to reiterate that recent magisterial teachings have made it clear that Catholic theology presents no obstacles to the choice of cremation for one's remains. This teaching is echoed on Ash Wednesday when we hear the refrain as we receive our ashes, "Remember, you are dust and unto dust you shall return."

A Catholic understanding of death challenges us to accept bodily death as part of God's vision. Christian hope is the ultimate response in the face of death, whether our own or others. Christian joy transcends the sadness of loss and expresses a faith that looks beyond earthly boundaries. A love for life, a true joie d'vivre, for the authentic Christian would include an openness to death, for death for the Christian is the door to eternal life.

"In death, God calls us to himself. Therefore the Christian can experience a desire for death like St. Paul's: 'My desire is to depart and be with Christ.' He or she can transform their death into an act of obedience and love towards the Father, after the example of Christ" (Catechism of the Catholic Church, n. 1011).

Vincentian Father Richard Benson is academic dean and professor of moral theology at St. John's Seminary, Camarillo. His column appears monthly in The Tidings.