Messages from the Bishop

End of Life Issues and Palliative Care

Written by Bishop Henry on Tuesday, 01 September 2015

In a recent homily, following the proclamation of the Gospel story of Jesus, Jairus and his little twelve year old daughter, and the woman who had been suffering from haemorrhages for twelve years, I told the following story:

A friend was visiting the chaplain of a hospice. In the course of the conversation, the chaplain said that on the past weekend eight, of the hospice's 30 patients had died. The visitor asked about the effect of so many deaths on the staff. The chaplain explained that it was tough, and shared one particular story from the weekend.

On Saturday, a woman who had been at the hospice for a couple of months had a visit from her teenage son. It was a great visit, filled with laughs and fun and hugs. At noon the boy told his mother that he was going to have lunch with his friends but that he would be back later in the afternoon.

Shortly after the son left, the mother called the nurse on duty, a wonderful young woman who was the patient's favourite nurse. She said, "I think this is it. I may be dying," The nurse checked her vital signs and replied honestly, "it's possible that you are."

The patient then asked the nurse, "Will you hold me? I think if you hold me I can do this well." The young nurse did not hesitate, she reached across the bed and began to cradle the emaciated body of the woman in her arms, and held her into eternity.

The visitor then asked the chaplain, "What about the nurse? What did it do to her?" And the chaplain replied that the nurse had taken four days off to go to the mountains to think, and feel, and decide whether to come back to work again.

"Do you think she'll be back?" the chaplain was asked. "She'll be back. You learn in a place like this that caring hurts - but when you really care, you offer something special - and become special yourself."

We are all going to die. The number of people requiring end of life care is growing as the population grows and the baby boomers reach an age where terminal illness and age increase the number of patients entering the health care system. The health care system is geared to healing not dying. Often, patients and their families are unable to manage pain and symptoms at home and, often, unnecessary tests and treatments are prescribed to dying patients, leading to unnecessary and unwanted hospital stays and undue complications. We need more palliative care.

Palliative care involves a comprehensive plan for serving the needs of persons who are ill, who usually are living with a terminal illness or chronic diagnosis for which care can be provided but for which a cure is not anticipated.

The World Health Organization calls palliative care an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psycho social and spiritual.

Quality-of-life considerations are a relevant aspect of moral reflection when considering whether a patient may abandon a particular treatment. For example, a patient who is already suffering multiple complications, such as congestive heart failure, stroke, and persistent bed sores, will not be a good candidate for a risky course of surgery. Even if the patient survived the surgery, the prospects for a reasonable quality of life are so greatly diminished by the complicating factors that the surgery would be inadvisable. The potential benefits simply do not outweigh the burdens.

This is very different from saying that those who are seriously disabled do not have lives worth living. Talk about quality of life should never suggest that the life of any patient has no value. Life itself is an intrinsic good and so always possesses value. What is at issue is the condition of the patient, the state of disease, and the resources that are available to combat it, or if necessary, continue to live with it. If we distinguish between the good of life that always belongs to the patient, and the condition of life that the patient currently experiences, it is possible to make a quality-of-life assessment without denigrating the person.

The problem arises when the value of the person is called into question by those who would say that life becomes "worthless" when it is not of a sufficient quality, usually meaning that the patient has lost some or all higher cognitive abilities. We cannot associate loss of consciousness with the loss of value.

Another difficult area for judgment concerns patients whose lives can be saved after a traumatic event but who are not likely to return to a meaningful level of recovery. Here again it would seem unnecessarily rigorous to hold that measures must always be taken so long as there is any possibility of continued life.

If the means to preserve the life of the patient require minimal effort, then these means must be employed. But it is also reasonable to hold that if the patient cannot hope for a meaningful level of recovery, then the measure of an ordinary course of treatment diminishes considerably. Although a permanent loss of consciousness is not a reason to diminish the value of a person, the decision to restrict care to comfort measures can be an appropriate and justifiable response to this diminished quality of life. Cognitive powers are vital to our personal identity; their loss cannot help but affect an assessment of what treatment options should be pursued.

Returning to my opening story, I can?t help but wonder if the woman prayed for a happy death. Part of my upbringing was the prayer to St. Joseph:

O Glorious St. Joseph, behold I choose thee today for my special patron in life and at the hour of my death. Preserve and increase in me the spirit of prayer and fervor in the service of God. Remove far from me every kind of sin; obtain for me that my death may not come upon me unawares, but that I may have time to confess my sins sacramentally and to bewail them with a most perfect understanding and a most sincere and perfect contrition, in order that I may breathe forth my soul into the hands of Jesus and Mary. Amen.


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