Catholic Bioethics
PALLIATIVE CARE
 

  Aticella,


THE term palliative care describes the treatment of symptoms, usually pain and psychological distress associated with illness, rather than an attempt to cure the underlying illness.  Here we will primarily focus on palliative care at the end of life  - or hospice as it is usually called.  However, it is important to note that palliative medicine will play an increasingly-important role in the practice of medicine in all stages of life as advances are made in methods of controlling pain and alleviating symptoms of chronic and incurable diseases.  We will note, in particular, that the Catholic Church encourages and commends palliative care as an important and unselfish kind of love, a special form of disinterested charity (Catechism §2279: formam constituunt excellentem caritatis gratuitae).


15.1. Bl. Pope John Paul II on Palliative Care

15.2. Palliative Care in Documents of the Magisterium
Catechism 2279  1994;  John Paul II, Evangelium Vitae, 1995;  Address of Benedict XVI to Ambassadors of Belgium to the Holy See;  USCCB Physician-Assisted Suicide - Threat to Improved Palliative Care 2012.

15.3. Palliative Care, Palliative Sedation and Opioids (Walsh, ch. 21), “Four Assumptions

15.4. Perinatal Hospice


READING:

1. Pope John Paul II on Palliative Care

2. Additional Documents of the Magisterium on Palliative Care (Catechism § 2279, 1994;  John Paul II, Evangelium Vitae, 1985;  Addresses of Benedict XVI 2006 & 2007;  USCCB Physician-Assisted Suicide - Threat to Improved Palliative Care 2011).

2. Broeckaert, Bert, Euthanasia and Physician-Assisted Suicide in Walsh, Palliative Medicine, 1st ed., ch 21  (2008 Saunders/Elsevier).

3. Z. Zylicz, “Palliative Care and Euthanasia in the Netherlands: Observations of a Dutch Physician,” in K. Foley and H. Hendin, The Case Against Assisted Suicide: For the Right to End-of-Life Care (Johns Hopkins University Press 2002), 122-43.

4. USCCB, “Life Matters - to the End of Our Days”.

5. [Encouraging hope at the end of life:] Biomedicine and Beatitude, Austriaco, ch.5 Bioethics at the End of Life (pp. 135-169, esp. pp. 167-169, Highlighting the Role of Virtue in Bioethics,


LIMITATIONS and AVAILABILITY of PALLIATIVE and HOSPICE CARE

 


 

 


 

 



1b PALLIATIVE CARE


 


PALLIATIVE
CARE

 

 


   Pope St John Paul II on Palliative Care (2004);      END of LIFE CARE (L.A. Archdiocese)
 Interviewing a Hospice Agency (LA Archdiocese:) [local]


PALLIATIVE CARE describes the treatment of symptoms, usually pain and psychological distress associated with illness, rather than an attempt to cure the underlying illness.  At the end of life palliative care is generally called “HOSPICE”; however palliative medicine will play an increasingly-important role in the practice of medicine in all stages of life as advances are made in methods of controlling pain and alleviating symptoms of chronic and incurable diseases. 


THE Catholic Church encourages and recommends palliative care as an important and unselfish kind of love, “a special form of gracious [disinterested] charity” (Catechism §2279: formam constituunt excellentem caritatis gratuitae).  Pope St. John Paul II echoed this in a 2004 address on Palliative Care.

The Dicastery for the Doctrine of the Faith encourages palliative care (Samaritanus Bonus V.4) and has clarified that is morally acceptable for persons facing the end of life to obtain treatment that renders them unconscious (“deep palliative sedation in the terminal stage”): Samaritanus Bonus V.7.   

 


 

 


 

 

 

 

 

 

 

 

 


LIMITATIONS and AVAILABILITY of PALLIATIVE and HOSPICE CARE

 


 


AVAILABILITY and LIMITATIONS
of
PALLIATIVE and HOSPICE CARE
 

 


The following summary was kindly provided by a physician who specializes in palliative care and practices in Southern California


PATIENTS and families are often surprised that hospice and home-based palliative care do NOT provide 24/7 care for anyone.

 

Routine hospice care may include a couple of half days a week for a bath aide plus skilled nursing visits (typically in 2 hour increments at least once weekly) for medication management, wound care, catheter management, etc.

The most that HOSPICE can provide is “continuous care” at home in 4 hour increments [and  renewable in 4 hour increments] for patients in crisis.

There is an in-patient hospice benefit that can keep a patient in a facility for a few days (typically during a crisis or at the very end of life)

There is also a RESPITE benefit of a few days of facility-based caregiving

There are VOLUNTEER companions that may be available to sit with patients for a few hours while family is away or resting

There are community-based residential non-profits (many originating from the AIDS crisis of the 80s and 90’s) that provide no-cost or sliding-scale care for weeks or months at the end of life [e.g.: the Zen Hospice in San Francisco.]

Hospice and Palliative Care in the United States is mostly FOR-PROFIT and provide charity care as a community service subsidized by their paying patients [note that LIVINGSTON MEMORIAL VNA and HOSPICE in Ventura County is a non-profit operation

 

When an uninsured patient shows up [typically in the ER setting with catastrophic illness] it is hospital case management that gets involved. The hospital assumes the cost of unreimbursed care. Sometimes, emergency Medi-Cal can be obtained to cover the cost of (some) services. Nursing facilities and Residential facilities will not accept these patients without a payment source and they end up staying in the hospital, being transferred to a county hospital, or returning home and cycling in and out of the ER. Non-hospital care is provided for the uninsured by a network of free clinics that are funded by state, local and private grants.

Home-based caregiving is not a covered benefit for anyone in this country except for persons who purchased a long-term care insurance policy. Even for those patients, criteria to activate the benefit is highly restrictive and there is typically a “waiting period” of 100 days before the benefit begins to pay out. Home health nursing benefits provide intermittent/episodic care to meet defined medical needs and do not provide caregiving as part of their services.

The counties in California have an In-home Supportive Services [IHSS] benefit that pays for a limited amount of care for patients on Medi-Cal. Application and activation of benefits can take up to 6-8 weeks. Typical awards are for less than 100 hours a month.

There is also a limited State benefit for employees needing time off to assist in the care of a qualifying family member. Information at https://edd.ca.gov — search term paid family leave for caregivers


 

 


 

 

 

 

 

 

 


This Webpage was created for a workshop held at Saint Andrew's Abbey, Valyermo, California in 2002....x....   “”.