ONCE MORE: YES, TO PALLIATIVE CARE
Basic teaching from our Christian faith: “Every human life, from the moment of conception until death, is sacred because the human person has been willed for its own sake in the image and likeness of the living and holy God” (Catechism of the Catholic Church, CCC, 2319); “Those whose lives are diminished or weakened deserve special respect. Sick or handicapped persons should be helped to lead lives as normal as possible” (CCC, 2276).
PALLIATIVECARE
Palliative care refers to holistic care of incurable and terminal patients. It comprises medical, psychological, social, and spiritual dimensions of care. Holistic care focuses on the patient as a human person, not on the symptoms of his or her illness. Pope Francis sayd: “Palliative care means support for the elderly (and patients) in the last stages of illness. Palliative care recognizes something equally important: recognizing the value of the person.” While healthcare professionals take care especially of physical and psychological suffering, significant others, of the social and spiritual dimensions of palliative care for patient and family. The World Health Organization (WHO) describes palliative care as follows:
o Affirms life and regards dying as a normal process.
o Neither hastens nor postpones death.
o Provides relief from pain and other distressing symptoms.
o Integrates the psychological and spiritual aspects of patient care.
o Offers a support system to help patients live as actively as possible until death.
o Offers a support system to help the family cope during the patient’s illness and in the family’s bereavement
(World Health organization (WHO), Cancer: Pain Relief and Palliative Care).
Cardinal Thomas Collins, archbishop of Toronto writes: “We need to make available for all Canadians (not just 30% of us) real medical assistance in dying: palliative care, where people who are dying are surrounded with love, and where any pain they experience is countered with the most advanced medical care available.” This wonderful! Hw about the reality? Unfortunately, “some are more equal than others.” – worldwide.
Currently, hospice care is generally considered an outstanding model of palliative care. It may be provided at home, in the hospital or in a nursing home. Echoing Christian tradition, the Catechism of the Catholic Church encourages palliative care, and calls it “a form of disinterested charity” (CCC, 2279). It is important to note that the spiritual aspect, which includes pastoral care, should not be treated as an added footnote, or an accidental aspect, but as what it is: an essential dimension of holistic care of the terminally ill persons.
PAIN RELIEF
According to some, there is among a good number of doctors a certain “opiophobia,” or reluctance to prescribe opioids analgesics to alleviate pain. In a study done in France some time ago, only three per cent of internists and seven per cent of specialists prescribed an adequate dosage of morphine. It is widely accepted that today there is still a need to improve palliative medicine. After all medicine’s goal is to care always and to cure when possible. Caring implies palliative or comfort care.
In Christian perspective, Pius XII was the first Pope to articulate concrete ethical guidelines on pain relief. In Evangelium Vitae, John Paul II presents the main points of this traditional teaching.
Pius XII affirmed that it is licit to relieve pain by narcotics, even when the result is decreased consciousness and a shortening of life, “if no other means exists, and if, in the given circumstances, this does not prevent the carrying out of other religious and moral duties.” In such a case, death is not willed or sought, even though for reasonable motives one runs the risk of it. There is simply a desire to ease pain effectively by using analgesics which medicine provides. Pope Pius XII adds: “It is not right to deprive the dying person of consciousness without a serious reason.” As they approach death, people ought to be able to satisfy their moral and family duties, and above all they ought to be able to prepare in a fully conscious way for their definitive meeting with God (St. John Paul II).
If a capable patient, a Christian decides to reject treatment with painkillers in order to offer his suffering to Christ, his free and responsible decision ought to be respected. A surrogate, however, may not decide in a similar manner, for this would be against the best interest of incapable patients.
LIVING WILL
Connected with orthothanasia or allowing to die and palliative care are the so-called “living wills,” or “anticipated wills,” or “advanced directives.” A living will is described thus: “A signed, witnessed or notarized document that allows a patient to direct that specified life-sustaining treatments be withheld or withdrawn if the patient is in a terminal condition and unable to make healthcare decisions” (William May). Actually, many hospitals offer their patients a “living will” form that the patient freely may or may not sign. Likewise, some local Conferences of Bishops of the Catholic Church have also proposed forms for an “advanced will.” These statements usually request doctors to remove or not to start unduly aggressive treatment, and to provide instead terminal or palliative sedation with the direct intention of relieving pain.
In this context, in May 2017, the Korean bishops released some guidelines on end-of-life treatment and palliative care. They wrote: "Catholics should make the declaration as part of their will to implement Catholic teaching that life should be cherished up to the last moment." They underlined, furthermore, that “the supply of nutrition and water is an essential part of humane treatment and does not count as a medical intervention.” The bishops recommended to Catholics to express their intention to have spiritual care as well as medical care. They added: "Hospice and palliative care is an effective way to help patients spend their last days with dignity. At the same time, when they prepare for death, they need to reflect on their lives and reconcile with God."
The living will that a free and responsible patient signs is only a temporary statement in the sense that it can be re-affirmed or changed during his or her stay in the hospital, or later. This change of will does happen some times, and is usually respected – as it should be.
Taught by their faith and tradition, Catholics are, with many other men and women of good will, for palliative or comfort care, which relieves pain directly, and may shorten life indirectly and unintendedly, and provide compassion in solidarity.
And to close, we repeat: life is a great gift, and should be cherished up to the last moment. ### (F. GÓMEZ BERLANA OP)