The Bishops and Palliative Care

Judie Brown
June 22, 2011
Reproduced with Permission

On June 16 of this year, the United States Conference of Catholic Bishops (USCCB) issued a document entitled, "To Live Each Day with Dignity: A Statement on Physician-Assisted Suicide."

The statement is probably long overdue, though it's clear the Church has never condoned direct killing for any reason. However, the statement also contributes to the confusion surrounding what was once known as ethical palliative care versus today's version that places palliative care gone awry at odds with respect for the dignity of the human person.

In the USCCB statement we find these words: "The healing art of medicine is an important part of this assistance. Even when a cure is not possible, medicine plays a critical role in providing 'palliative care' - alleviating pain and other symptoms and meeting basic needs. Such care should combine medical skill with attention to the emotional as well as spiritual needs of those facing the end of life."

The impression is given that there is nothing about the use of palliative care that concerns the bishops, but current details lead to a different conclusion. As you will see, there is plenty to be concerned about. Let's examine the reasons why.

Guidelines for palliative care have been evolving since palliative care leaders from several organizations first met and formed the National Consensus Project (NCP) in 2002. The NCP represents four national palliative care organizations: American Academy of Hospice and Palliative Medicine, Center to Advance Palliative Care (CAPC), Hospice and Palliative Nurses Association, and National Hospice and Palliative Care Organization. Since 2007, the NCP has served as a subcommittee of the Hospice and Palliative Care Coalition.

The project to formulate guidelines (first released in 2004 and revised in 2009) was funded by foundations and organizations which support the euthanasia movement. These National Consensus Project guidelines set the standards for training and certification of palliative care professionals.

As developed by the NCP consortium organizations, palliative care has become a process to encourage patients and families to switch from curative treatment to comfort treatment only. Clearly the line of thinking is that, if palliative care protocol is introduced into a patient's regimen of care closer to the time of diagnosis, the result can be substantial cost savings.

What does this mean? It means the patient would die sooner rather than later.

The Center to Advance Palliative Care (CAPC) guidelines state that non-oral feeding/hydration is considered a medical treatment, not ordinary care, and there is no ethical mandate to provide non-oral hydration and feeding in a patient with advanced dementia and/or in the dying patient when the burden or risk of feeding is greater than the benefit. The guidelines leave interpretation of "benefits" and "burdens" open-ended. It is a proven, and tragic, fact that subjective definitions of such words can lead to early death.

Not only that, but this is the sort of moral relativism that caused Pope John Paul II to make the following statement in 2004: "I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality."

The pope was specifically discussing the patient in a persistent vegetative state, but the principle is the same no matter the condition of the patient - unless his body rejects the sustenance in question.

It must also be noted that, while the CAPC guidelines suggest opposition to assisted suicide, it is obvious that these palliative care guidelines are clearly open to hastening death.

This is why we are profoundly concerned that references to the paradigm shift in how palliative care is being used are absent in the bishops' statement. If only they had seen fit to acknowledge the wisdom of Pope John Paul II. In 2004, when speaking on matters involving the practice of medicine such as questions surrounding organ donation he said, "[T]he Church does not make technical decisions. She limits herself to the Gospel duty of comparing the data offered by medical science with the Christian understanding of the unity of the person, bringing out the similarities and the possible conflicts capable of endangering respect for human dignity." (emphasis added)

The USCCB is to be commended for expressing concern over the juggernaut heading toward those who are born and least capable of defending their lives. However, we find it sad that the USCCB did not emphasize its Gospel duty to make certain that human rights are not violated by any practice - including the abuse of misguided palliative care.

Physician assisted suicide is euthanasia; bringing about the death of a patient by any act of omission or commission is euthanasia; euthanasia is murder.