Canadian bishops: Keep palliative care distinct from assisted suicide

Ottawa, Canada, Aug 11, 2018 / 15:35 pm

In the age of legal assisted suicide and euthanasia, palliative care must remain as a distinct form of care that attends to the needs and dignity of the whole person at the natural end of their life, the Catholic bishops of Canada have said.

The bishops gave their recommendations in a submission for a national public consultation, in response to the passing of a new bill on the development of palliative care in the country.

The bishops' document focused on numerous questions and suggestions for healthcare providers, and was developed with the assistance of the Catholic Health Alliance of Canada, the Canadian Catholic Bioethics Institute, and multiple other resources.

"The investment of the Catholic community in healthcare is inspired by Christ," Bishop Lionel Gendron of Saint-Jean-Longueuil, president of the Canadian Conference of Catholic Bishops, said in the bishops' submission. "It is a response by Christians to be healing hands for the sick; to provide compassionate care for those in need; to accompany the dying with self sacrifice, and to bear witness to the inviolable dignity of the human person and our common responsibility to love our neighbour and to serve and protect human life at every stage."

He also noted that despite the legalization of euthanasia and assisted suicide in Canada, the Catholic Church remains "strongly opposed" to the practices.

Assisted suicide and euthanasia were legalized by the Canadian Senate 44-28 in June 2016. However, the move was met with pushback from some lawmakers, who underscored their concerns over euthanasia for minors and additionally said the legislation would conflict with conscious protections for medical institutions.

Some of these concerns were raised again in the recent case of a Canadian man, Roger Foley, who suffers from an incurable disease and claims that despite asking for home care, the medical team at an Ontario hospital would only offer him medically assisted suicide.

Foley has filed a lawsuit and provided Canada's CTV News with two separate audio recordings, in which medical personnel appear to offer him assisted suicide.

Due to the opportunity for coercion, the bishops in their statement noted multiple times that it is imperative that assisted suicide and euthanasia are not included as part of palliative care programs.

"While euthanasia and assisted suicide are also referred to as Medical Assistance in Dying (MAiD), these are not to be admitted within the definition and practice of palliative care," Gendron noted, a stance which is in keeping with the World Health Organization's definition of palliative care, along with that of many other secular providers.

Palliative care providers must also be careful not to reduce their practice strictly to science, Gendron said, and must take into account not only the physical but also the emotional, psychological and spiritual needs of people at the end of their lives.

In an interfaith statement signed by the Catholic bishops of Canada, palliative care is defined in this way: "As a comprehensive approach to end-of-life challenges, palliative care combines pain management with efforts to attend to a patient's psychological, emotional, social, and spiritual needs, as well as caregiver support. We affirm the World Health Organization's definition of palliative care, as well as the official positions of the Canadian Society of Palliative Care Physicians, the Canadian Hospice Palliative Care Association, and the Canadian Medical Association that the practice of palliative care does not include interventions which intentionally cause the death of the patient. This has been central to the philosophy of palliative care and is a fundamental distinction that must be maintained."

However, while the Catholic Church recognizes life as a good, the bishops' statement also included a definition of palliative care which clarified that patients and doctors are not required to do everything possible to avoid death if a life has reached its natural conclusion and medical intervention would not be beneficial.

"So while life is a penultimate good, requiring us to take reasonable care of our lives, we are not morally obligated to seek or undergo burdensome therapies 'at all costs' that provide no benefit. Nor at the same time are clinicians morally obligated to 'do everything possible' if life has reached its natural conclusion and it is no longer medically appropriate. Such a stance is known as vitalism and is rejected by the Catholic moral tradition," according to Covenant Health's definition of palliative care included in the bishops' statement.

A Catholic approach to palliative care is a "person-centered approach," the bishops said, "which draws deeply from the scriptural understanding of healing, compassion and love."

This approach takes account of a patient's "body, mind and spirit" and tries to relieve human suffering while also attending to "the transcendent needs of the dying person and his/her loved ones, with special solicitude for the poor and disadvantaged."

There also needs to be more and better information available about palliative care resources for patients and their families in Canada, the bishops said. They advocated for public awareness campaigns about palliative care implemented in the country's health care systems, including resources that would take into account the needs of different cultures or of disadvantaged and vulnerable groups.

Furthermore, they advocated for the continued development of palliative care as a branch of medicine, one that would be of the highest quality and equally accessible by all Canadians, and which receives sufficient government funding.

In a person-centered approach to palliative care, people must never be reduced to statistics, and patients must never be made to feel that they are a burden on themselves or others, the bishops noted. They also advocated for better sick care leave so that patient-identified caregivers may better accompany their friends and loved ones at the end of their life.

The bishops also announced that they will be partnering with several other organizations in order to develop educational material and to promote palliative care within parishes and within their own health care system.

"For Catholics, the parish is a primary place where questions about life and suffering – both their meaning and purpose – are explored in silent prayer as well as in dialogue with others," the bishops said. "For this reason, the Canadian Conference of Catholic Bishops, in partnership with Pallium Canada, Dominican University College, the Catholic Health Alliance of Canada, and the Catholic Organization for Life and Family (COLF), has adopted the parish as a locus for canvassing and raising awareness about palliative care." They also emphasized the need to offer care to family members and caregivers, even after a patient's death.

"Those in the palliative care delivery team often extend their contact with the patient's self-identified caregivers beyond the patient's death," the bishops noted. "In doing so, the members of the palliative care delivery team can offer the bereaved support and serve as a catalyst for the bereaved person's healing and forgiveness. Such final reconciliation can help a person achieve a sense of closure and peace."

The bishops' document was submitted to the "Let's Talk Palliative Care" and "The End of Life Care Team" at the conclusion of the consultation.