By Judie Brown
This past weekend, the National Hospice and Palliative Care Organization joined with thousands from 80 countries to focus attention on making end-of-life care a public health priority. The occasion was this year’s World Hospice and Palliative Care Day, and its theme was “My Care, My Right.” Its goal was to communicate that palliative care can be demanded by the public and that, together, every person impacted by a life-limiting illness can influence their policy makers to prioritize palliative care financing under Universal Health Coverage.
In other words, personal autonomy trumps everything, including fundamental healthcare ethics. Or, in the absence of God, anything goes. Such a temporal worldview ignores any mention of the Christ-centered meaning of suffering and avoids reference to the truth that every one of us has an obligation to respect life—our own and the lives of others. The truth that each of our lives is an unrepeatable gift from God becomes an inconvenient truth.
The delusion of autonomy rejects truth. St. John Paul II wrote about this, saying: “Since the created world is not self-sufficient, every illusion of autonomy which would deny the essential dependence on God of every creature—the human being included—leads to dramatic situations which subvert the rational search for the harmony and the meaning of human life.”
This is why discussions and decisions about how to care for people and how to minister to the suffering are askew. The alleged autonomy of the individual trumps the truth, and respect for life becomes a question of cost savings and personal preferences. For example, according to a recent report, Congress repealed the part of Obamacare that “called for the government to set up a board of experts that would find ways to slow the growth in Medicare spending.” We remember that as “death panels.”
But now that the Trump administration is leaning toward the appointment of Brad Smith, chief executive officer of Aspire, the same concerns have cropped up again. According to the Wall Street Journal, Aspire came to the public’s attention a few years ago because it uses what is called a death-predicting algorithm that “sorts through medical claims, looking for diagnoses such as congestive heart failure or late-stage cancer or for a pattern of frequent hospitalizations. Its clinicians also consult with patients’ primary care physicians to see if palliative care would be appropriate.” The algorithm that Aspire uses will “identify patients with serious medical conditions, many of whom have only a year to live, and helps those who don’t want intensive medical care to get palliative care, which helps people relieve suffering at home until they die or recover.”
In case this is not evident to you, the bottom line is saving cash, not respecting lives and providing Christ-like nurturing care until God calls the patient home. Rushing things along appears to be the cost-efficient way to go.
The threat of using palliative care to ease patients out of life appears again and again. We see it in the news report that tells us that “ICU Nurses’ Moral Distress Levels Differ Based on Perceived Use of Palliative Care.” The sentence that screams at me in this article is this: “The failure to relieve patients’ suffering and feeling forced to provide aggressive interventions perceived as inappropriate or futile can trigger moral distress.”
What? Since when is estimated futility of treatment or quality of life more important than making sure the patient is spiritually ready when death comes? What sort of moral distress is alleviated by hastening death by the use of pain relief or terminal sedation?
It seems to me that when medical ethics is equated with killing the mentally ill or putting the dying down like a dog, something is wrong.
St. John Paul II saw this clearly, writing: “While it is true that the taking of life not yet born or in its final stages is sometimes marked by a mistaken sense of altruism and human compassion, it cannot be denied that such a culture of death, taken as a whole, betrays a completely individualistic concept of freedom, which ends up by becoming the freedom of ‘the strong’ against the weak who have no choice but to submit.”
What we need in this time of cruel compassion is a real sense of solidarity with our brothers and sisters—both born and preborn. It is not all about “my care, my right,” it is about serving the will of God.