BY: MONSIGNOR RENZO PEGORARO and NUNZIATA COMORETTO, MD, PhD
According to the World Health Organization, "Palliative care is an approach that improves the quality of life of patients and their families facing the problem[s] associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual."1
The basic philosophy of palliative care is to achieve the best quality of life for patients suffering from incurable and progressive illness, even when their illness cannot be cured. Palliative care is a health care specialty that is both a philosophy of care and an organized, highly structured system for delivering care. Its services are significant in realizing the most ancient mission of medicine: "to care even when it cannot cure."2
It is worthy to note that palliative care is not just for cancer. Palliative care's approach can be beneficial to patients who bear a heavy symptom burden, such as those with severe pulmonary disease, advanced heart failure, end-stage renal disease and such neurodegenerative diseases as amyotrophic lateral sclerosis, as well as critically ill patients in the intensive care unit. Notwithstanding, all patients deserve the best quality of health care hospitals can provide, at all stages of their illness. There is still much to do so that palliative care becomes a model of good care regardless of the illness.
Palliative care is provided through comprehensive management of the physical, psychological, social and spiritual needs of patients, while remaining sensitive to their personal, cultural and religious values and beliefs. Palliative care puts special attention on the spiritual care of the dying. Spirituality is a fundamental element of human experience. It encompasses the individual's search for meaning and purpose in life and the experience of the transcendent. Spirituality also encompasses the connections one makes with others, nature and the sacred realms inside as well as outside of traditional religion. In patients with advanced disease, spirituality is3 an important component of quality of life and may be a key factor in how people cope with illness. Unfortunately, such dimensions often encounter the indifference of public opinion and a lack of preparation of health care professionals.
Due to such complexity, palliative care services usually are provided through an interdisciplinary team of health care professionals that includes physicians, nurses, psychologists, social workers and chaplains. Their teamwork, which is a core value of palliative care, is an invaluable resource in meeting the complex needs of end-of-life patients. Thanks to a strategy of "inclusive care," the positive outcomes of providing palliative care are not only for patients, but also for their families and their health care providers.
At present, only a few hospitals have palliative care programs well integrated in their service. The lack of palliative care programs is a failure on the part of medicine and society to attend to the needs of advanced and terminal patients, to relieve the pain and suffering. The challenge is not "helping to die," in the perspective of physician-assisted suicide or euthanasia, but helping to live until the end of life, offering care and accompaniment. The holistic approach of palliative care has been demonstrated to be effective in bolstering the dignity of dying patients, addressing their suffering and reducing requests for hastened death.
The Pontifical Academy for Life has been committed to palliative care advocacy for years. It was a partner of the Maruzza Lefebvre D'Ovidio Onlus Foundation in the creation of the "Religions of the World Charter for Children's Palliative Care," by which leaders from several religions, patients and families, palliative care experts and human rights activists advocate for children's palliative care. The "Religions of the World Charter: Palliative Care for Older People," an interfaith charter promoting palliative care for the elderly across the world, was launched in 2017 to support and share the universal right to palliative care as the best solution to guarantee dignity and a better quality of life to older people with advanced chronic conditions or who are approaching the end of life.
The Pontifical Academy for Life has dedicated two General Assemblies to palliative care, "Aging and Disability" in 2014 and "Assisting the Elderly and Palliative Care" in 2015, and is now sponsoring an international project, to be known as PAL-LIFE, to improve clinical and spiritual care for the dying, with particular attention to the development of palliative care. The academy's principal goal through this project is to make ecclesial institutions more aware of the need to develop effective palliative care around the world, together with bringing palliative care to the attention of all social and cultural organizations and promoting dialogue and cooperation in practical initiatives among stakeholders at all levels.
As Pope Francis has said, "Palliative care is an expression of the truly human attitude of taking care of one another, especially of those who suffer. It is a testimony that the human person is always precious, even if marked by illness and old age. Indeed, the person, under any circumstances, is an asset to him/herself and to others and is loved by God. This is why, when their lives become very fragile and the end of their earthly existence approaches, we feel the responsibility to assist and accompany them in the best way."4
MONSIGNOR RENZO PEGORARO is chancellor of the Pontifical Academy for Life in Rome.
NUNZIATA COMORETTO is a researcher in bioethics at the Pontifical Academy for Life in Rome.
NOTES
- World Health Organization, "Definition of Palliative Care," WHO website, www.who.int/cancer/palliative/definition/en/.
- United States Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, 5th ed., Part Five, Introduction.
- Christina Puchalski et al., "Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference," Journal of Palliative Medicine 12, no. 10 (October 2009): 885.
- Francis, "Address to Participants in the Plenary of the Pontifical Academy for Life," March 5, 2015. https://w2.vatican.va/content/francesco/en/speeches/2015/march/documents/papa-francesco_20150305_pontificia-accademia-vita.html.