The Vatican has reaffirmed its stance that euthanasia and assisted suicide are "intrinsically evil", and told priests they should minister to those contemplating such deaths to try to change their minds, but should not be present at the end if they do not.
The Vatican's doctrine office, the Congregation for the Doctrine of the Faith, issued a lengthy new document on end-of-life care for the terminally ill on Tuesday.
It takes into account medical advances, the advent of "do not resuscitate" orders and legal approval for assisted suicide, as well as new Vatican perspectives on palliative care, including for children.
Catholic teaching holds that life must be defended from conception until its natural death. It insists that chronically ill patients, including those in vegetative states, must receive "ordinary" care such as hydration and nutrition, but that "extraordinary" or disproportionate care can be suspended if it is no longer beneficial or is only prolonging a precarious and painful life.
The Vatican stressed in the new document that the renunciation of extraordinary care cannot mean a request for assisted suicide or euthanasia, which it called "a crime against human life".
"The judgment that an illness is incurable cannot mean that care has come at an end," it said. "Euthanasia, therefore, is an intrinsically evil act, in every situation or circumstance."
It said those who participate in it, including medical personnel, are committing "homicide" and that legislators who approve it "become accomplices of a grave sin".
Pope Francis has described euthanasia and abortion as evidence of a "throwaway culture" in which the sick, elderly and disabled are considered unworthy of life.
In the text, the Vatican told priests they should provide spiritual accompaniment to those who have expressed a desire to end their lives through assisted suicide or euthanasia, but can only offer the sacraments of confession or anointing of the sick if the patients truly repent and change their minds.
"To delay absolution is a medicinal act of the church, intended not to condemn, but to lead the sinner to conversion," it said.
It told priests that if such patients do not change their minds, the priests should not be present at the time of death since "that could be interpreted as approval of this action".
The Vatican backed the use of hospice centres and palliative care, including deep sedation to reduce pain, but said such medication must never be used with the intent of hastening death.
It called for the expansion of "prenatal hospice centres" to provide medical, psychological and spiritual care to parents and children suffering prenatal pathologies that are "inconsistent with life".
Rather than resorting to abortion, the Vatican said, providing this assistance "helps the parents to handle their grief and to regard this experience not just as a loss, but as a moment in the journey of love which they have travelled together with their child".