Research Paper: Hospice Care and Catholic Ethics

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[. . .] Indeed, Gawande admits that -- before surveying hospice care firsthand -- this is the experience that most doctors have of hospice care: when a patient wishes to enter hospice care, the physician must sign an acknowledgement that medical science reasonably believes that the patient in question has no more than six months to live. To this degree, then, the Church recognizes that even medicine will admit to a point at which the diminishing returns on potential avenues for cure might suggest that palliative care is the preferable option -- as long as the palliative care is conducting within church teachings about the dignity of human life, then it is enthusiastically endorsed by the church.

Of course there remains a possibility of a slippery slope within palliative care and indeed within Hospice care, but the Church addresses it directly in the Catechism. Here it is declared that there are ethical strictures on "the use of painkillers to alleviate the sufferings of the dying" (Catechism 2279). In this, the Church advises keeping a strict focus on the actual role played by death -- it cannot be sought, or deliberately hastened, but may be "tolerated as inevitable." To a certain extent, then, what is most important is that the patient maintain -- even in the midst of Hospice care -- a sense of life's sanctity. It is a moral and ethical wrong to desire death for oneself or for any other, according to Church teachings. On the other hand, people continue to die -- although Catholics are confident that they will, through Christ, ultimately enjoy eternal life. For this reason, the sanctity of life is not to be denied on any level: thus Hospice care may be directed toward making the inevitable into something that is not wholly agonizing and wretched, but to guide the inevitable in such a way as to mitigate its most agonizing and wretched aspects. Here, as elsewhere, the basic principles of Catholic bioethics come first, and will seem relatively straightforward when applied to Hospice care. As part of the deference which the church is willing to show toward medical diagnosis overall, according to John Paul II, it is worth noting that the Church defers to medicine in the decision of who is eligible for Hospice care -- but if medicine would suggest it as a possible option, the Church is happy to approve.

In short, Chapple's argument is sound, that Hospice care is ultimately consistent with Catholic bioethics, or it can be. But it is worth noting that Hospice care nevertheless does court some of the paradoxes or difficulties in Catholic bioethics -- particularly the recognition on the Church's part that eligibility for Hospice care is determined by doctors on the basis of whether they believe medicine to have little or no constructive function. But Hospice care is not an abandonment of care -- it is the ethical obligation to provide a special kind of charity for the dying, and it is medical care aimed at being palliative rather than curative. Yet it is not hard to see the ways in which Hospice care courts conceptual controversy within the Catholic bioethic belief system -- to a certain extent, Hospice can be seen as taking a step toward the normalization of assisted suicide by normalizing the idea that in certain cases, medical science has very little concrete to offer a patient. Yet this happens to be a fact: late-stage cancers, for example, do not call forth a range of potential concrete medical treatments. Or in many cases the patient may be persuaded to take part in the medical trial of an experimental drug because there is no otherwise persuasive medical treatment available. But this is where the Church's handy reminder that "extraordinary" medical means are certainly not an obligation in medical ethics -- nobody can be obliged to submit to an untried experimental drug, not even for a fatal illness. As a result Hospice care is the ordinary charity that replaces the extraordinary excesses of medicine, which might well make the patient's few remaining weeks highly unpleasant. The pivotal thing to remember here is that Hospice care is, of necessity, a last resort -- it is by no means an easeful form of slow suicide, but instead a concerted effort to maintain dignity and normality at the end of life. Thus, the ethical obligation to stay alive can, to a certain extent, be passed over in the recognition of death's inevitability -- as long as one is not colluding with death itself in any way, then the permissible moral leeway is granted.

References

Catechism of the Catholic Church. Accessed 18 March 2013 at: http://www.vatican.va/archive/ENG0015/_INDEX.htm

Chapple, HS. "Hospice care." In Furton, EJ Cataldo PJ and Moraczewski AS. Catholic health care ethics: a manual for practitioners. 2nd Edition. Philadelphia: National Catholic Bioethics Center, 2009.

Gawande, A. "Letting Go: What Should Medicine Do When It Can't Save Your Life?" The New Yorker. August 2, 2010. Accessed 18 March 2013 at: http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande#ixzz2Nxoxy3kI

Pope John Paul II. "To Participants in the 19th International Conference of the Pontifical council for Health Pastoral Care." L'Osservatore Romano, English language edition. 24 November 2004. 6. Accessed 18 March 2013 at: https://docs.google.com/viewer?a=v&q=cache:UxsPB9YKUdUJ:www.lifechoicehospice.com/sites/lifechoicehospice.com/files/LCH-028_Catholic_Hosp.pdf+catholic+view+of+hospice+care&hl=en&gl=us&pid=bl&srcid=ADGEESi1P6zIukv2v0SOqYtsbX5GcBTApzyN6GkARX42h1JfgnPoHCG7E1Ohdq9hnEW5P_b6G40sJflNESmCqwEAw8iPqQzM_HoJZPPj5KPH6MRoeXyav_G3Y8kSGm7oR0vCIYewjnKZ&sig=AHIEtbRWuO9dVLtlu9B0sUtukIj_f45dBg [END OF PREVIEW]

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"Hospice Care and Catholic Ethics."  Essaytown.com.  March 19, 2013.  Accessed June 16, 2019.
https://www.essaytown.com/subjects/paper/hospice-care-catholic-ethics/3581923.