Friday, October 9, 2009

The Contested Hospice.

When told that her kidney cancer had spread to her liver, Dorothy Eisele and her husband, Owen, a retired doctor, decided to forgo other treatments and signed on with hospice. The Messenger, the newspaper of the Diocese of Belleville, Illinois, has a story on the couple who have been married for nearly 70 years.

The article, written by and for a Catholic publication, clearly supports personal choice in treatment and Dorothy's decision. But it is written to recommend hospice as an answer to asssisted suicide or euthanasia. "Any thoughts of euthanasia, the hastening or causing a death, never entered their minds," the article states.

Father Dennis Voss, a local pastor, is quoted:

Dying can be “a very holy experience,” Father Voss said. When family and friends gather with the dying person, good-byes can be said, and love is palpable in the room.”

The problem, Father Voss said, is “most people don’t want to talk about death; they do everything possible to avoid death. We are in a death denying culture.”

Some people might say we are also afraid of the pain of death. That could lead some people to consider euthanasia or assisted suicide. Hospice assists in managing pain so that pain does not become a focal point of the dying process.
The Church speaks forcefully against both euthanasia and assisted suicide.

“As Catholic leaders and moral teachers, we believe that life is the most basic gift of a loving God — a gift over which we have stewardship but not absolute dominion. Our tradition, declaring a moral obligation to care for our own life and health and to seek such care from others, recognizes that we are not morally obligated to use all available medical procedures in every set of circumstances. But that tradition clearly and strongly affirms that as a responsible steward of life one must never directly intend to cause one’s own death, or the death of an innocent victim, by action or omission.” (Administrative Committee National Conference of Catholic Bishops Sept. 12, 1991) Hospice of Southern Illinois does not believe in either euthanasia or assisted suicide.

The modern hospice movement was founded by the Anglican nurse, writer and physician Cicely Saunders. A student of the Christian writer C.S. Lewis, Saunders established the first hospice in Britain in 1967 as a “powerful force for undercutting the movement for active euthanasia.”

She fell in love with a string of terminally ill Poles, experienced a religious conversion after the deaths of family and lovers, and spent 11 years planning St. Christopher's, the hospice she ultimately founded. She was a pioneer of palliative medicine, the treatment of pain in the ill and dying.

Saunders claimed that after 11 years of thinking about the project, she had drawn up a comprehensive blueprint and sought finance after reading Psalm 37: "Commit thy way unto the Lord; trust also in him; and he shall bring it to pass."

Saunder's work has been rightly commended over the last half century and the subsequent emphasis on hospice and palliative care is, however slow to proliferate, revolutionary to end of life care.

While hospice and palliative care can alleviate pain among approximately 9 out of 10 dying patients, it does not moot the demands for death with dignity, seen as a right by aid in dying advocates.

Yet, "pro-life" organizations still look at hospice as a service which disregards God's jurisdiction over death. SouthernIllinoisCatholic harshly criticizes the article in the Messenger as promoting a service that was proven ineffective in saving the life of Terri Schiavo:

I relate this to Terri Schiavo case because she was placed in a hospice facility, but she wasnt' dying, just not recovering--in part, arguably because she wasn't receiving therapies that could ameliorate her condition.

I have suspicions toward hospice as a result of the Schiavo case. That hospice organization sounded like it was tilted toward hastening death, or letting people wither and die. Some euthanasia advocates were affiliated with that hospice group, I recall.

Those staunchly opposed to hospice, despite it's strongly-stated anti-assisted suicide founding and stance, and opposed to end of life planning, advance directives and other services and tools that help the terminally ill, disabled, aged and suffering claim an absolutist position. (To clarify, Schiavo's autopsy shows that she would never recover but recent studies show that some persistent vegetative patients can perhaps be taught to eat and drink on their own.)

"But death comes in God's time, not ours," they say, "All our planning can be turned on its head with God's timing and plans."

Regarding hospice, they are in part correct. Recent studies show that continuous deep sedation (CDS) is commonly practiced in the world's hospitals and hospice facilities. The practice of sedating a suffering patient until they die in order to relieve their pain is not prosecutable under what is called the "double effect" because death is only a double or secondary result.

I suspect that Saunder's concept of hospice care did not include CDS, but I have yet to confirm that. (She died at St. Christopher's in 2005.) However, the institution of which she is considered the founder has learned that the use of modern medicine, sedating drugs, eases the suffering of the terminally ill into death.

Those who advocate for Death with Dignity only wish to provide the terminally ill with another choice.

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