"DAY FOR LIFE"
2002
"End of Life Care - Ethical and Pastoral Issues"
Irish Bishops' Committee for Bioethics
SUMMARY
Palliative Care avoids two extremesAdvances in medicine and in technology mean that the taking of decisions about appropriate care for peoplewho have advanced and progressive illness have become more complex.
The document says that, in caringfor people who are dying, there are two extremes to be avoided:
a. Trying to keep people alive at all costs, even when it is clear that death is imminent
b. Deciding to end the life of a person on the basis that his or her life no longer worth living. (pp. 5-6)
Palliative care avoids both of these extremes "in that it upholds absolute respect for human life, and acknowledges human mortality and the dominion we have over life" It is about "maximising the quality oflife remaining, while enabling patients to 'live until they die.' (p. 7)
Euthanasia is not acceptable
Euthanasia is any action or omission, which is deliberately calculated to end the life of another human being,with or without that person's consent, on so-called health grounds. (pp 7-8).
Euthanasia is morally unacceptable not only because it "would mean the introduction of a qualitative judgement on what is determined to be a worthwhile life or existence," but also because it "would have an enormous effect on theethos of healthcare provision." (p. 12)
"The Catholic Church absolutely rejects Euthanasia as a response to chronic or serious illness. This rejection is rooted in an understanding of the human person as someone who is called into life by God, and the ultimate meaning of whose life is to be found in relationship with God. " (p. 19)
The Rights and Responsibilities of Healthcare Professionals
The document points out that healthcare professionals, although they act on behalf of the patient, are not just functionaries who are required to do whatever they are asked to do. They have a right and a duty to choosewhat is good, and to reject any course of action which conflicts with an informed judgement of conscience, even if this is requested by the patient or by the family." (p. 13)
Appropriate Pain Relief is not Euthanasia
The document uses the traditional Principle of Double Effect to explain that necessary pain relief, even if itsometimes results in an unintended and unavoidable reduction in the length of life is not euthanasia. Thedegree to which life is shortened must not be out of proportionate to the benefits which come to the patientthrough pain relief.(p. 9)
Euthanasia is not Necessary
The document points out that requests for euthanasia frequently coincide with a bad period of symptom control, even a clinically treatable depression.(p 10) The solution, in part, is to improve pain control. In the vast majority of cases unbearable pain can be avoided. Some distress is not directly related to physical pain, but has its roots in issues such as "fear, anxiety, loss ofcontrol and loss of independence. "
Good counselling, which is an integral part of palliative care "allows thepatient, the family, and others who are closely involved to discuss these fears. " (p. 15) Sedation maysometimes be required to deal with high levels of anxiety, but it should not be a first resort. While it cancertainly help to reduce the experience of emotional stress, it also reduces the capacity of the patient torespond freely and deliberately to what is happening in his/her life." (p. 15)
(Sedation is not the same as physical pain-relief; sedation deals with emotional distress).
The Provision of Resources
The document makes a very strong case for the provision of adequate resources for palliative care,not only in hospices, but in general hospitals and in the community."The inadequacy of such resources impinges directly on the quality of care that can be provided to those who are dying, and may be a contributory factor in the level of demand for euthanasia. (p. 16)
Spiritual and Sacramental Ministry
The document points out that "a comprehensive approach to healthcare must take account of the spiritualneeds of the patient. " (p 20) All the key moments of life, including sickness and death, have the capacity tobring our relationship with God into sharper focus. Poor communication is an obstacle to spiritual care,because patients are often discouraged from even mentioning the possibility of death.
By contrast, the ethos of sensitive but honest communication that is part of palliative care greatly facilitates the spiritual and sacramental care of those who are dying; the patient's questions are welcomed and answered appropriately.Talk of death and dying is not taboo. This means that if people pray with the patient, they can pray more honestly too.” (p.21)
