GROWING THE CULTURE | Catholic health care has role to play in acceptance of end-of-life care

Printer-friendly versionSend to friend

BETHESDA, Md. -- Dr. Ira Byock, a pioneer in palliative and hospice care, believes Catholic health care has a unique role to play as the nation's understanding and acceptance of end-of-life care begins to turn a corner.

"Catholic health care has a lot to contribute to helping our culture grow the rest of the way up," the director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., told Catholic News Service Aug. 10. The goal, he said, is "integrating the fact of mortality into full and healthy living."

Byock calls palliative care -- which involves management of pain as well as care for the physical, emotional and spiritual needs of the patient and his or her loved ones -- "ardently life-affirming," adding, "If you are committed to affirming life, you have to affirm all of life, including that part we call dying."

He spoke with Catholic News Service the evening before addressing a summit in Bethesda on "The Science of Compassion: Future Directions in End-of-Life and Palliative Care." Sponsored by the National Institute of Nursing Research and other agencies of the National Institutes of Health, the summit, held in August, included a town hall meeting on "The Ethics of Science at the End of Life."

Involved in the movement to improve end-of-life care since 1978, Byock said, "we are swimming downstream now" in the attitudes of physicians, other health care professionals, patients and families toward palliative and hospice care.

"We are wonderfully struggling to keep up with the demand" at Dartmouth-Hitchcock, where about 600 new hospital patients and 520 new outpatients received palliative care last year, he said.

Byock, who also is a professor of anesthesiology and community and family medicine at Dartmouth-Hitchcock, said that "until recently, many doctors assumed there was no value in the time of life we call dying" and that their only role was to keep the patient alive at all costs.

But he said there has been an increasing awareness, "even among nonpalliative care docs, that there is something really precious happening during this last time of life."

Once familiar only to oncologists, who treat cancer patients, palliative care is now being suggested by physicians who work in intensive care, transplant surgeries, cardiac care, neurology and other specialties, Byock said.

"After seeing us in action a few times, doctors want that for their other patients," he said. "Patients and families are benefiting, and physicians and nurses are more satisfied with their ability to care for those they treat."

During the town hall meeting, Marie T. Hilliard, director of bioethics and public policy at the National Catholic Bioethics Center in Philadelphia, said the need for palliative care has been heightened by the fact that "fewer resources of a nonmedical nature, resources of faith and family" are available these days to patients with life-limiting illnesses.

"Death is less of a private matter than it once was," said Hilliard, who served as mistress of ceremonies for the discussion.

She cited a need to "discuss, debate and define whether the ethics of end-of-life research are different" than the ethics of other research. For example, patients who are dying might have "misplaced motivations for participation in research" that muddle the question of their informed consent to the research, she said.

Dr. Joseph J. Fins, professor of medical ethics at Weill Cornell Medical College in New York, said some of the ethical problems that arise in medicine come from "the power of the technological imperative that is still out there."

He said technological advances allow "people who used to be dead" to remain alive on a machine "without a heartbeat."

Karla FC Holloway, a professor of English and law at Duke University in Durham, N.C., said the dying process must be seen as "a sacred transition" and called for moves to "restore the privacy to death" that used to surround it when most people died quietly at home.

She said research on the dying should be guided by the legal principle of "strict scrutiny" and conducted only when there is "a compelling and overwhelming interest in our need to know" something related to the research.

Nancy Berlinger, deputy director and research scholar at the Hastings Center in Garrison, N.Y., cautioned against the use of "code words" like "vulnerable population" that can lead to incorrect assumptions about patients.