Hospice and palliative care: A look at ‘absolutely vital’ end-of-life support

CNA Staff, May 19, 2024 / 05:00 am

As assisted suicide and euthanasia continue to grow more common throughout much of the developed world, services like palliative and hospice care serve as a vital counterweight to those trends, offering what one provider calls care for “the whole person” that’s respectful of both a patient’s life — and death. 

Assisted suicide and euthanasia have been legalized in countries such as Canada, Australia, Spain, Belgium, and in multiple U.S. states, permitting patients to take their own lives or allowing doctors to kill them outright. 

In contrast, services such as palliative care and end-of-life hospice care seek to uphold the dignity of each human life, especially as it nears its end.

What is palliative care? What about hospice?

Dian Backoff told CNA that both palliative and hospice providers are trained to minister to the “psychosocial, spiritual, and financial needs” of patients facing debilitating or terminal illnesses. 

Backoff, the executive director of Catholic Hospice for Catholic Health Services in Fort Lauderdale, Florida, told CNA that palliative care is meant to address “what the whole patient wants during the treatment of an illness,” whether or not the patient is terminally ill or dealing with a long-term affliction. 

Oftentimes a patient suffering from a severe illness has multiple doctors from multiple disciplines, such as neuroscientists and cardiac experts, Backoff pointed out.

“Palliative care has someone bring all that specialty work together so that we don’t forget there’s a person behind the brain, behind the liver, behind the heart,” she said.

Backoff said hospice is a part of palliative care, one that arises at the end of a patient’s life. A significant part of hospice service, she said, involves ensuring that dying patients have medication to alleviate any pain or suffering they may have as death nears. 

But, she noted, “all of the services that are applied to the patient, other than clinical, are also applied to the family.” 

“How are you going to cope with the death? Is there anticipatory grief? Is there complicated grief pending because there are unresolved family issues?” she said.

Hospice workers “make sure coping mechanisms are appropriate” and that family members are “grieving appropriately instead of dealing with something years down the road.”

Hospice ‘absolutely vital,’ in line with Catholic teaching

Joe Zalot, an ethicist and the director of education at the National Catholic Bioethics Center, said that hospice, when done right, is “very, very important” for both dying patients and families.

“Hospice, when done correctly, is proper accompaniment at the end of life,” Zalot said. “It’s palliating symptoms, it’s providing spiritual care, it’s helping people live the most full possible life that they can given the limitations of their illness. It’s helping them and their family prepare well for death.”

“When done well, it’s absolutely vital and very much in line with Catholic teaching,” he said. 

Zalot warned, however, that there are “not-so-good” hospice practices on the market as well. 

“We get calls on our consult line and we hear horror stories, from families and doctors, where people go in and they’re medicated for whatever reason, there’s questions about nutrition and hydration, any number of different things,” he said. 

Zalot said the best hospice workers are those who support the family unobtrusively. “If you don’t know what they did, they probably did their job correctly,” he said. 

Among the best practices of hospice, he said, are symptom management, relief from pain and nausea, and relief from complications that arise from one’s pain, conditions, or treatments.

“Another essential element is to help family members and support them as they journey with their loved ones,” he said. 

“Specifically from a Catholic perspective, a very good-quality hospice is one that provides spiritual care and access to the sacraments, through chaplains,” Zalot noted. 

Backoff said their patients are split between home and hospital settings, with the majority in the former. “We have 750 patients, and all but about 120 are at home,” she said. “The rest are in nursing homes or in our hospice facility.”

“The average length of stay for us is about 70 days,” she said. “That’s average for us, and probably it’s fairly consistent around the country.”

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Zalot said the Church’s opposition to euthanasia and assisted suicide is because those procedures are quite literally homicide. “You’re killing people,” he said. 

“It’s sort of like abortion,” Zalot said. “We have all of these euphemisms — ’reproductive rights,’ et cetera. It’s the same thing with assisted suicide and euthanasia: ‘Death with dignity,’ ‘medical aid in dying.’” 

“Euthanasia and assisted suicide are killing people,” he said. “They are actions that kill people. And the Fifth Commandment says that thou shalt not kill. And that’s the bottom line.”