Palliative care: A special form of disinterested charity

A POST TO CELEBRATE WORLD DAY OF THE SICK – SATURDAY, 11 FEBRUARY 2017

Ahead of tomorrow’s World Day of the Sick, Dr Katherine Pettus, Advocacy and Human Rights Officer, International Association for Hospice and Palliative Care (IAHPC), explains the background to a concept note that has just been published by the IAHPC.

Dr Katherine Pettus

Dr Katherine Pettus

When I was visiting Papal Nuncio Bishop Michael Blume, in Kampala, Uganda with Dr Anne Merriman, a few years ago, he surprised me by saying that the Catechism of the Catholic Church calls palliative care: “a special form of disinterested charity.” [1] I have since learned that at least four popes have made statements on palliative care and the rational use of pain medicines, and that there is a vibrant body of teaching on the topic. These are available in the IAHPC Concept Paper on World Day of the Sick (WDS) published on our website.

Pope Benedict XVI made the case for palliative care on WDS 20 in 2007: 

The Church wishes to support the incurably and terminally ill by calling for just social policies which can help to eliminate the causes of many diseases and by urging improved care for the dying and those for whom no medical remedy is available. There is a need to promote policies, which create conditions where human beings can bear even incurable illnesses and death in a dignified manner. Here it is necessary to stress once again the need for more palliative care centres, which provide integral care, offering the sick the human assistance and spiritual accompaniment they need. This is a right belonging to every human being, one which we must all be committed to defend. [2]

Hospice has always been faith based.[3] Its medieval roots lie in the religious orders that cared for the seriously ill and dying before the Reformation, bearing fruit in modern times in St Christopher’s Hospice, London, the institutional (Anglican) inspiration of the modern movement. In some parts of the world, hospice has taken on the secular identity of the wider society, with non-denominational palliative care teams who support people of all faiths (or no faith) in their final journeys. Some of these hospices are functioning as a for-profit enterprise.

Yet, hospice and palliative care services are still only available to less than 20 per cent of the world’s patients who desperately need them, despite the fact that the Roman Catholic Church is the largest global non-governmental provider of healthcare services. It manages 26 per cent of the world’s healthcare facilities, 65 per cent of which are located in developing countries. If every Catholic healthcare institution had a palliative care team, the world would be well along the way to integrated coverage and to reducing the “pain divide” [4] that separates the lower- and middle-income countries from their upper-income counterparts.

The World Day of the Sick (WDS) 2017 is a good opportunity to encourage faith-based healthcare organisations to promote and, wherever possible, develop palliative care through their healthcare networks. Advocates can remind policymakers and administrators about the canonical teachings on the rational use of painkillers [5] to support appropriate training of providers, and to overcome endemic ‘opiophobia’.

As part of our campaign to increase global palliative care literacy, IAHPC wishes to encourage our partners to learn more about faith-based teachings on palliative care. Increasing public and faith-based palliative care literacy can undermine erroneous assumptions that palliative care is the same as euthanasia, or may lead to euthanasia or physician-assisted suicide. We have even seen it called ‘stealth euthanasia’.[6]

In some instances, this confusion and misinformation has led to the deletion of palliative care language in the text of international agreements, or made it impossible for representatives to reach a consensus. It is important to clarify this misinformation with clear information about the clinical remit of palliative care, such as the recently published IAHPC statement on Physician-Assisted Suicide and Euthanasia, as well as authoritative ethical teachings of the major faiths.

Main Points about World Day of the Sick

  • The involvement of palliative care organisations in WDS2017 will emphasise that palliative care is pro-life until natural death.[7]
  • Pope Francis’ message for the WDS 2017 states that:

“Every person is, and always remains, a human being, and is to be treated as such. The sick and those who are disabled, even severely, have their own inalienable dignity and mission in life.” [8]

  •  Palliative care values, and its respect for human dignity until the end of life, are consistent with this message.

Link to the full concept note with a table of authorities and annotated statements by four popes is here.

References

  1. Catechism of the Catholic Church 2279.
  2. http://w2.vatican.va/content/benedict-xvi/en/messages/sick/documents/hf_ben-xvi_mes_20061208_world-day-of-the-sick-2007.html
  3. The origin of hospices/hospitals William E. Phipps, Death Studies Vol. 12 , Iss. 2,1988
  4. Knaul, F. M., et al. “Closing the pain divide: the quest for effective universal health coverage.” The Lancet Global Health 3 (2015): S35.
  5.  “The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable.” Catechism of the Catholic Church 2279.
  6. https://www.chausa.org/publications/health-progress/article/january-february-2014/ethics—palliative-care—stealth-euthanasia
  7. World Health Organization Definition of Palliative Care affirms life and regards dying as a normal process, and intends neither to hasten nor postpone death.
  8. http://en.radiovaticana.va/news/2016/12/15/pope_francis_releases_message_for_2017_world_day_of_sick/1279194
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