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                              Revision of Critiques about Palliative Care and Approval of Hospice Care

In the original post on this Blog of my article, “If I had to choose between Hospice Care and Palliative Care, I would choose Hospice Care,” I presented my reasons for having reservations about palliative care.  After submitting that article, I have continued my research on this subject and have come to the conclusion that Hospice Care is also to be held suspect with regard to stealth euthanasia.  At the end of the day, it all boils down to how a particular palliative or hospice team practices the theory of comfort care that is always good and ethical.  My critique of the palliative care agenda was, as I stated clearly at the beginning of my article, based on my daily exposure to one particular palliative team, in my year of working with them as a chaplain on their interdisciplinary team.

My critique of palliative care was valid and legitimate, as substantiated by Dr. Ralph Capone in his June 2013 Ethics & Medics article, “The Rise of Stealth Euthanasia.”  In that article, Dr. Capone states:  “Thus, many hospice and palliative care physicians are urging, and actually performing, euthanasia by stealth.”  Ms. Julie Grimstad states that, while my critique of palliative care was with good intentions, it was nonetheless “potentially harmful and misleading.”  However, in re-reading my critique of palliative care, I find in my first paragraph I made the disclosure that my expertise and exposure to palliative care is limited to only one very intensive year of work with one palliative interdisciplinary team.   Ms. Grimstad says in her own words:  “Admittedly, there are abuses in palliative care as there are abuses in hospice care. This is all the more reason for vigilance in choosing those hospices and palliative care programs that are sensitive to and respect the value of life and the culture of life.”

On the one hand Ms. Grimstad seems to take me to task for being very suspicious of palliative care, and on the other hand both she and Dr. Ralph Capone go even further than the cautions which I recommended in the article.  After reading Ms. Grimstad’s critique of my critique of palliative care, I will admit that my advice may have been altogether too categorical and sweeping with negative conclusions.  In an ideal world, Ms. Grimstad’s advice is totally on target:  “I would advise people to investigate the practices of any hospice or palliative care program before enrolling in it in order to assess whether it adheres to a ‘quality of life’ or a ‘sanctity of life’ ethic.”  In the real world, however, when people are vulnerable and desperate, not feeling empowered or able to voice their preferences, patients get transitioned into hospice or palliative care whether they like it or not.  Yes, those entrusted with medical power of attorney make those final legal approvals for palliative or hospice treatment, but most of the time these people who give approval feel very coerced into going the palliative or hospice route, without recourse for something else.

– Father Angelo

Ergo, I came up with my conclusion, which was and still is to avoid palliative care.  I revise my conclusion to include the avoidance of hospice care if possible.  Once upon a time when there was no “palliative care” or “hospice care,” the primary doctor made arrangements for end of life issues and comfort treatment.  This traditional option is less and less viable for most of the U.S.A. at the beginning of the 21st century, and I am suspicious of medical teams that are over-invested and over-preoccupied with medicine which is primarily focused on death.  I am sure there are true palliative care and hospice care teams out there, which are “true” to the good ethical theories, but I am too suspicious of how this theory is practiced, given the money agenda side of end of life medical care.

Fr. Angelo