Palliative Care and Catholic Health Care

There are two major types of writing about theological bioethics: the first uses Scripture, ecclesial pronouncements, and/or theological reflection in to formulate an answer to a specific bioethical quandary rooted in Christian tradition. The second type concerns the lives of patients and health care practitioners and the spiritual and institutional practices necessary to sustain what Christians consider ethical in the face of illness or health care pressures and the lives of health care practitioners.

In Palliative Care and Catholic Health Care, Peter J. Cataldo and Dan O’Brien edit a theologically informative and practically relevant collection that includes both types of bioethics writing. They examine the practical implications for the care of the sick based on Scripture, church history, and Roman Catholic magisterial documents. But they also include case studies on how Christian practitioners and Catholic hospitals can and have shaped their institutional care practices in ways that align care goals with theological teachings.

The book’s first section on “Catholic Theological and Moral Tradition and Teaching on Palliative Care” connects contemporary palliative care practices in Catholic contexts with Christian and Catholic care for the suffering and ill. In contemporary contexts, palliative care is an interdisciplinary effort. But it also has connections to the earlier Christian Ars Moriendi (the Art of Dying) tradition of dying well, popularized during the bubonic plague in the Western Christian tradition. This historical context helps show the differing roots of Catholic palliative care, rooted in the example of Jesus, and secular efforts at palliative care that see it as facilitating an autonomous individual right to be free from suffering.

Furthermore, Christian practices of care for the sick arise from the Christian Scriptures, where Jesus shows a clear, and profound concern for the sick and suffering. It is interesting, and unfortunate, that in a collection of essays tied to the Catholic magisterium there is not a substantive discussion in the volume of John Paul II’s pastoral letter Salvifici Doloris (on the meaning of human suffering). This is a key text in Catholic thinking about pain and suffering. There was a clear need to put it in dialogue with the teaching of medical ethics, and this collection’s failure to do so is disappointing.

Ron Hamel’s essay asserts a  claim made often but one that is rarely backed up by surveys or studies when made, that excellence in palliative care is a defense against patient requests for physician assisted suicide, a practice rejected by Roman Catholic moral teaching.  There is debate over this claim, which is often made by opponents of physician assisted suicide.  Some individuals fear a loss of function and control is almost as great as their fear of pain.

The second section turns from history and authoritative teachings to issues of “Body, Mind, and Spirit.” These essays explore Catholic teachings on pain and symptom management and the role spiritual care can play in improving patient’s quality of life on physical, spiritual, and emotional levels, since all of these dimensions are connected. It also notes the challenge that practitioners confront when patients ask them to help them hasten death. This is something forbidden in Catholic teaching except in cases where there is a relationship of “double effect.” The teaching of double effect holds that one may pursue an action with one intention, even though an agent may know it may cause another. In end of life circumstances this means that a physician may prescribe a high does of pain medication, in order to relieve a patient’s pain, even as they know that doing so will shorten a patient’s life.

The book’s final section explores how different Catholic health systems have implemented practices of palliative care that are in line with the Catholic tradition on an institutional level. This section explores the role that spirituality plays in national guidelines in palliative care, including the National Consensus Project and the National Quality Forum. In addition to the larger secular efforts, Tina Picci’s essay also outlines the ways in which the Supportive Care Coalition can assist Roman Catholic hospitals in their efforts to develop excellent palliative care. There is also a good chapter on how to do Advanced Directive planning within the bounds of magisterial teaching. The volume closes with a helpful appendix that gathers magisterial documents that pertain to palliative care and end of life issues that may not necessarily be easy to find for clinical readers not familiar with theological databases.

This thoughtful volume contributes to Roman Catholic bioethics in its focus on palliative care, rather than simply on decisions about the discontinuation of treatments and provision of care to patients in compromised states. In this way, it sets out a holistic picture of the Roman Catholic tradition on care of the sick, which can too easily be reduced via polemic to parroting certain positions. Its accessible chapters on Christian care for the sick are informative and accessible, avoiding simple narration of debates over historiography that concern theologians more than practitioners. In addition, it gives a portrait of the innovative ways Catholic health care institutions are dealing with palliative care. The book’s focus on the relationships between Roman Catholic teaching and the broader practice of palliative care is an important contribution.

Aaron Klink is chaplain of Pruitt Health Hospice of Rocky Mount, North Carolina.

Aaron Klink

Date Of Review:

July 31, 2020