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The article How should a Catholic hospice respond to patients who choose to voluntarily stop eating and drinking in order to hasten death? (2014) discusses the difficulty between meeting the spiritual and palliative need of the dying, when a person is entering hospice for the sole purpose of prematurely ending their life. The issues of sanctity of life, dignity of life, and choice in life, is not simply black and white. Cavanagh (2014) points out the difference in perspectives between the religious view on life and organizations that are alerting and encouraging people to peruse the idea of voluntarily stopping eating and drinking, referred to as VSED. Cavanagh (2014) goes on to address how Catholic hospice should begin to address this issue. This paper will express the struggle of providing quality spiritual, psychological, and palliative care that is provided in Catholic hospice when the patient’s reason for entering hospice is contrary to the faith of the hospice program.
Keywords: Catholic hospice, voluntarily stop eating and drinking
The Line Between Faith, Hospice, and Choice
The idea of having the right to choose death complicates the role of Catholic hospice, a program that operates from the view that only God is in control of life and death, not the individual person. The strongly held belief that life has value and meaning from beginning to end, makes it much less clear, as to how to provide palliative and spiritual support to those who are choosing to voluntarily stop eating and drinking (VSED). Cavanagh (2014) states “Hospice programs, in particular Catholic hospice programs, must remain steadfast in the philosophy that they do not hasten death by any method including VSED (p. 280). There is acknowledgement that at the end of life, people who are very close to death, may not be interested in eating and drinking. This, however, is not viewed the same as those patients, whom Cavanagh (2014) states, are not in the dying process, yet choose VSED and plan to use the hospice service to alleviate any adverse symptoms associated with their choice.
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Organizations like Compassion and Choices have been growing in their determination to make people aware that VSED is an option for expediting the end of their life. Groups that aid in people’s choice to die, suggest that they contact hospice because of the depth of knowledge and experience hospice services have in managing symptoms and pain associated with the dying process (Cavanagh, 2014). From the perspective of Compassion and Choices, hospice is viewed as a means of augmenting a person’s choice to end their life prematurely, nevertheless, it does not take into consideration the moral dilemma imposed upon religious hospice organizations. These referrals to hospice, however, afford these programs a unique juncture to offer continued life until natural death. Through open communication Catholic hospice can share the philosophy of their faith-based program, as well as, encourage the patients that their physical and psychological needs can be met in a dignifying way (Cavanagh, 2014). Even a proponent of the right to choose, Ganzini (2010, p.3) admits that, “hospice is the single most effective means of allowing patients to reconsider physician assisted death, not by taking the issue head on, but by slowly chipping away at the patient’s fears of dependence and care” (Cavanagh, 2014 p. 284).
In the discussion about VSED, the controversial issue is whether it is seen as suicide. While some argue that it is the right of a competent adult to choose VSED, others contend that doing so constitutes suicide. From a legal standpoint Cavanagh (2014) stated that the legal system is unlikely to force a patient to take in food and fluids. Another concern is for any person intimately involved in the care of the patient. Some areas of the country have laws surrounding assisting in an activity that results in a person dying. If VSED is considered suicide then there is the potential for legal repercussion against those who assisted with the VSED process (Cavanagh, 2014).
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The fact that there is not a standard agreement on the definition of voluntary stopping eating and drinking, adds to the depth of the moral and ethical dilemma imposed on those in Catholic hospice. Cavanagh (2014) reports that the only common language between definitions is “the notion of intentionally hastening death” (p.281). If it is seen as suicide, then does providing Catholic hospice infer that the program is condoning the patient’s choice to end their life early? Cavanagh (2014) notes one perspective is this, the individual person has the right to choose, while another adds if there is irretractable suffering choosing VSED should be an option. This then requires a method of defining terms such as unrelenting and irretractable pain. From an ethical perspective who is responsible for determining what qualifies as such, when each individual person approaches life differently.
The key distinction surrounding hospice patients is, those who are in the process of dying and those who are not. Cavanagh (2014) states that everyone wishing to enter hospice should be made aware that Catholic hospice will in no way participate in hastening a person’s death. Following careful intake questioning regarding any mental health concerns, pain, and other related symptoms Cavanagh (2014) notes that Catholic hospice should refrain from entering into any agreement with persons wishing to utilize their services for the purpose of ending their life.
In the end Catholic hospice programs must stand strong in their deeply held religious believe that God is the creator of life. Religious organization who proved hospice services, therefore, have an obligation to help maintain the dignity of each life brought into their service until God calls the patient home. This message needs to be clearly conveyed to potential hospice recipients at the very beginning. Communication will be key in formulating an understanding of the services provided by religious hospice. This will help diminish the potential that a hospice patient would feel abandoned during an already difficult time.
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