John, our patient with metastatic cancer, had three possibilities of treatment: a lethal injection, aggressive treatment to prolong his dying, and allowing him to die peacefully. Ethically speaking, the first option is utterly immoral, and the second is optional but might also be immoral. How about allowing to die? His brother doctor asked John: What do you want? His answer: I want to be relieved of my pain and suffering.
Allowing to die implies palliative care, or comfort care which is currently practiced in many countries of the world. There is a need of more public awareness on palliative care and of more specialized healthcare professionals.
MEANING OF 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).
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 says: 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:
Palliative care –
- Affirms life and regards dying as a normal process.
- Neither hastens nor postpones death.
- Provides relief from pain and other distressing symptoms.
- Integrates the psychological and spiritual aspects of patient care.
- Offers a support system to help patients live as actively as possible until death.
- Offers a support system to help the family cope during the patient illness and in the family 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.â€
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 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.
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 an urgent need to improve palliative medicine. After all medicine 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.
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.
Recently (May 2017), the Korean bishops released some guidelines on end-of-life treatment and palliative care. The bishops teach: “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 underline, 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 recommend 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. Unfortunately, there are cases when the change in the advance directives – done with due knowledge, freedom and responsibility – was not respected by surrogate decision-makers. This lack of due respect is unethical.
Catholics with many other women and men of good will are against assisted suicide. They are also against prolonging dying and for letting die the incurable patient. Taught by their faith and tradition, Christians are with many other men and women of good will for palliative or comfort care, which relieves pain directly, may shorten life indirectly and unintendedly, and provides compassion in solidarity.
Another argument in favor of euthanasia we are told is that pain is against a good quality of life, and therefore it should be eliminated at all costs. In our final piece on the end of life mini-series, we shall converse briefly on the meaning of suffering and death. (Published by O Clarim, June 16, 2017).
FAUSTO GOMEZ OP