“Scruple,” as defined by the Catholic Encyclopedia, is an unfounded apprehension and consequently unwarranted fear that something is a sin which, as a matter of fact, is not. St. Alphonsus Liguori, who suffered from it, describes it as a condition in which one, influenced by trifling reasons and without any solid foundation, is often afraid that there is sin where there really is not.
The scrupulous is tormented in every action, even the most harmless, with the thought that he may be committing a sin. He then does his best to recover divine grace, achieves momentary peace, but unrest comes again upon him, suggesting that his decision was wrong. He ponders over the circumstances of an act which have simply no relation to its morality. Never at peace, he compulsively reexamines and reevaluates every aspect of the matter upon which his scruples center—and even each one of his past confessions. In his calmer moments, he knows that all these fears are groundless, yet he falls back into this sad state. Although his anxiety is unfounded, his suffering is very real.
This habitual state of unreasonable doubt filled with anxiety—scrupulosity—must not be confused with what moralists call a “delicate conscience.” The delicate conscience loves God ardently and, in order to please Him, wants to avoid the least fault or imperfection; it has a horror of sin, and knowing its own weakness, has a rational but quiet fear of displeasing God. At the same time, it knows how to distinguish between moral and venial sin, between imperfections and temptations, and submits willingly to the judgment of the spiritual director. The scrupulous conscience, on the other hand, is led on by a certain self-centeredness which causes an inordinate eagerness for absolute certainty of one’s state of grace; it has unfounded, vain fears of sinning in every circumstance.
Scruples may have their origin in the natural temperament of a person or in his physical state at the moment, rendering the person nervous, dejected and easily frightened, or clouding his judgment, and thus strengthening the confusion and fears that may arise when one has doubts of conscience. God may permit scruples, in view of a greater spiritual good; but He cannot be supposed to wish this state to persist if it leads to despair, neglect of prayer, or worldly concerns. Satan, man’s enemy, is frequently the cause of scruples that lead to disquiet, despair and moral disorder.
The scrupulous’ fears usually arise regarding past confessions, or the possibility of having consented to sinful thoughts in the past, or the threats that he sees lurking even in the most harmless action of ordinary life.
Spiritual authors and moralists have offered a variety of remedies which should be effective. Unfortunately, the difficulty lies in getting the scrupulous to avail himself of those remedies, particularly of the fundamental one: obedience—full and absolute obedience to an enlightened spiritual director. But by sad experience, confessors know that often under an appearance of docility, they will find obstinate resistance to their advice: doubts, suspicion, and even open hostility.
Nonetheless, these remedies exist and should be applied as soon as there is the slightest indication of the advent of scruples.
First of all, the penitent must be convinced that he is really scrupulous and that his judgment on those particular matters is not reliable. Therefore, he must follow the direction of one good confessor—not many!—in all humility and obedience. He must be convinced that even if the confessor were to be wrong in his judgment, God will not hold the penitent responsible. He should be humble, resigned to God’s will, making frequent acts of confidence and love.
His examinations of conscience must be brief; he should never seek peace of mind by giving way and acting as his scruples dictate. The hope of finding peace in that way is bound ultimately to prove illusory, and the scrupulous condition would only be aggravated by yielding to it and so lead to greater anxiety in the future. He should act as he sees other people act, without constantly prying into his own motives.
He must disregard all doubts, being convinced that he cannot commit a sin, either mortal or venial, unless he is absolutely certain that the action is forbidden under pain of sin and fully aware of this fact—without paying any attention to probabilities. He must act without question upon the confessor’s judgment that a doubtful sin was not certain sin, and that he need not confess doubts but only certainties. If disturbed about the possibility of having consented to evil thoughts, he must assume that there was no consent; if troubled about his past confessions, he must assume that they were good.
As scruples produce a mental obsession, a disease of the will, recent moralists point out that, in certain cases, they could be a manifestation of an obsessive-compulsive disorder, a mental illness that will require clinical assistance, as it exceeds the competence of the confessor or spiritual director, who will nonetheless continue offering the proper spiritual support.
Life and health are gifts from God, which we have the duty to preserve, which implies the consequent duty to avoid and to fight what detracts from them: illness, pain, suffering.
Nonetheless, life and health are temporal, limited goods. They are relative, to be affirmed and preserved as gifts from God, yet not in themselves and absolutely, but in the manner in which, and for the end for which, He has given them. Spiritual goods are higher in the scale of values. Therefore, we may accept the evil of physical suffering for a greater, spiritual good.
The Catholic faith looks upon suffering in two different ways: (1) As an evil, the result of sin; forerunner of death by the judgment of God and as man’s merited punishment because of his sin. But the command of God (that man must will to live and not die; to be healthy and not sick) is not withdrawn, not revoked, not even for sinful man forfeited to the judgment of God. (2) As an occasion for spiritual growth, if the proper dispositions are present. It is an evil out of which God can bring good.
These two notions are not contradictory, but complementary. We should care for those who suffer, but we should not imagine that suffering can be eliminated from human life or that it can have no point or purpose in our lives. Nor should we suppose that suffering must be eliminated by any means available to us, for a good end does not justify any and all means. Seeking medical help does not necessarily demonstrate lack of trust or faith on our part. Rather, it indicates that we trust God to care for us through the means He provides us—through doctors, medical treatment, medicines. But we cannot expect more from medicine than it can offer. The healing of an illness may increase our sense of invulnerability, an exhilaration that may lead us away from God —a physical healing disastrous for our spiritual health. On the other hand, the inability to heal our illness may be for us an occasion of drawing closer to God, by accepting suffering and dependence, in conformity with the example of Our Lord, in submission to the will of the Father.
In principle, it is permissible to avoid physical pain. Far too often, physical pain becomes the occasion of other sins: impatience, anger, lack of charity regarding those who surround us, rebellion against God’s will, despair, etc. But it may be reasonably accepted because of motives of abnegation and internal purification, to tend to a greater perfection, in imitation of Christ and His saints. But no decisions on this regard should be taken without having sought beforehand the advice of a prudent priest.
Nonetheless, the Church has always been wary of the motives of those too eager to suffer. In the early centuries, the Church refused to consider as martyrs those who rushed to offer themselves to the persecutors to be put to death, because of their presumption that God would give them the graces needed to endure what a man cannot normally endure by his own natural forces. She judged that such people were, in fact, trying to oblige God to comply with their own will to suffer, rather than submitting themselves to the dictates of His will.
In the end, it is a question of a prudential judgment, of balancing the duty to preserve life and health by undergoing medical treatments, taking medications, etc., with a counsel of perfection by enduring physical pain and suffering with patience and confidence, as coming from the hand of God. If pain and disability persist in spite of our efforts to regain health, then it becomes perfectly clear that God’s will is that we have to continue suffering. In these circumstances, acceptance of pain and disability is perfect submission to God’s will, a more perfect conformity to the example of Our Lord.
In recent decades, side by side with the advances in medical technology and treatment options, there has also developed the question on the morality of using or withholding the use of such advances—in particular, a reflection on the moral possibility of refusing extraordinary means to preserve one’s life and health, and, conversely, a concern about assuring the continuance of the available ordinary means to the same end. As a result of the concern for the proper stewardship of the gifts received from God—life and health—many Catholics in recent years have been led to consider the possibility of availing themselves of the so-called “advance directives” for health care.
The “advance directives” are documents stating our personal health-care choices. The most common types are: (1) a “living will,” directing the physician to withhold or withdraw certain life-sustaining procedures if we are in a terminal condition and unable to decide for ourselves; (2) a “durable power of attorney for health care,” which is a document by which we appoint a particular person to make health care decisions on our behalf if we are unable to make them ourselves; and (3) a “do-not-resuscitate directive” forbidding cardio-pulmonary resuscitation and other life-sustaining procedures.
In deciding whether to use one of these documents, we should not forget that they originated in various organizations that were in favor of euthanasia. Their original intent was to favor the termination of life. They were—and, in fact, they still are—slanted towards the termination rather than the preservation of life. Their promoters usually tied them to the notion of “quality of life,” leading to the refusal of medical interventions if a certain level of activity and self-sufficiency could not be preserved. Crafted by non-Catholics, such documents were an assertion of independence, a final act of autonomy: to die in accord with one’s own wishes, refusing to acknowledge that whether we live or die, we belong to God, thus denying the supreme dominion of God over life and death. They were also seen as promoting “death with dignity,” which usually meant the avoidance of pain and of the spectacle of death for relatives and friends, thus in practice denying the redeeming value of pain, the possibility of atonement for past sins, and depriving others of a salutary reminder so that, subject to a common fate, we may begin our preparation to come, one day, face to face with God.
This should make a Catholic think twice before rushing to make a “living will,” which is the most usual kind of directive. Moreover, we must keep in mind that the existence of an “advance directive” does not by itself solve the problems that may arise regarding medical treatment. Legally speaking, medical providers cannot act against a patient’s clear directives or against the patient’s authorized proxy, but concrete factors complicate the situation… For instance, the health provider may not know about existence of an “advance directive” and therefore not follow it. Also, very often people do not express their wishes very clearly or precisely—general language like refusing “heroic measures” does not give much guidance to the doctor; therefore, problems of interpretation arise. But a more careful wording means going down to the description of concrete treatments, which cannot be foreseen before the actual illness or accident.
Thus, on the purely practical level, it would be safer not to use any kind of “advance directives.” If, however, one were to insist on having some kind of legal protection against what one perceives as the excesses or shortcomings of the “medical machinery,” the “durable power of attorney” would be the safest choice—without forgetting that, in any case, it is not strictly necessary, as health care decisions can be made on our behalf even without any such document by our relatives in consultation with the physician, and always requiring the moral guidance of a Catholic priest.
But we must also look above the purely practical and natural level. On the spiritual level, it would be far more perfect not to try to second-guess the designs of divine Providence and to reach the end of our lives in total submission to God’s will—whatever that will may be.