Montag 20. November 2017
#189 - January 2016

A European framework for Palliative Care

A growing need for palliative care requires a better understanding of its ethical intricacies

In a recent 2015 Ageing Report issued by the European Commission, a projection is made that, by 2060, in the EU28, those aged 80 and over will rise from 5% to 12% of the population, while those aged 15-64 will become a substantially smaller share of the population, declining from 66% to 57%. In this scenario, a growing demand for palliative care should be accompanied by an increase of quality supply of such services supported by better, trained and specialized human resources. General public awareness about its availability is also paramount.

 

What is palliative care ?

Palliative care is defined by the World Health Organization as an approach that improves the quality of life of patients and their families facing the problem 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. It is important to note the reference to this latter element.

 

The Church is particularly attentive to the importance of this issue. Addressing the participants in the Plenary of the Pontifical Academy for Life, in March 2015, devoted to the Assistance to the elderly and palliative Care, Pope Francis declared that “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.

 

The theme of palliative care is also gaining momentum broadly at the European Union level, with the EU Commission working in a European framework that will take into account demands coming from its working groups on cancer, dementias and rare diseases as well as conclusions of different research projects, including a collaborative project on defining best practices in palliative care in Europe that is being supported under the EU Health Programme (cf. EuropaLL).

 

On September 2014, an informal meeting of the Council of European Health Ministries during the Italian Presidency addressed the issue of pain therapy and palliative care (cf. related documents) and, before that, a parliamentary a study was issued on this subject (Palliative care in the European Union); furthermore, a number of ‘questions for written answer to the Commission’ have been put forward recently at the European Parliament as well.  

 

Inquire into the meaning of human suffering  

Palliative care raises important questions of an ethical order. The very definition of the concept is problematic and the same is true of ist components. A distinction needs tob e drawn between pallliative care and other end-of-life issues, such as euthanasia. Concern may arise from the fact that some official European documents in the ambit of palliative care make indeed reference to euthanasia.

 

Other relevant issues related to palliative care include the assessment of the clinical situations and the adequate time for its introduction; proportionality and treatment limits; palliative sedation; the inequalities in access to quality care; and the role of the family, to name just a few. Yet, maybe the most important and primary question is of an anthropological nature and is related to the very meaning of human suffering.

 

The Christian reflection on these issues within the magisterium of the Church is vast and extremely rich. For instance in parragraph 222 of the Compendium of the Social Doctrine of the Church one can read that if the elderly are in situations where they experience suffering and dependence, not only do they need health care services and appropriate assistance, but — and above all — they need to be treated with love.

 

The Church can also bring to the European debate a long and impressive experience in caring for the ill and the suffering, for example, through the work of the Hospitaller Order of St. John of God and many nursing orders of religious sisters such as the Irish Sisters of Charity and the Bon Secours Sisters.

 

COMECE’s Working Group on Ethics in Research and Healthcare held a meeting in October last where palliative care was analysed in depth. An Opinion on this topic is now being drafted.

 

It is to be hoped that the process currently being initiated by the European Commission, with the foreseen launch of a public consultation by the beginning of 2016, will culminate with a design of a European framework for palliative care that be scientific-based, socially impactful and ethically sound.

José Ramos-Ascensão

COMECE

 

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