More than twenty years ago, the United States Conference of Catholic Bishops (USCCB) recognized that healthcare is the central issue of importance to all citizens of the world:
“Complex in their ramifications and universal in their relevance, these issues are of concern to us all – rich and poor, young and old.”
A Pastoral Letter of the American Catholic Bishops, November 19, 1981
This pastoral letter acknowledged that in the face of advancing medical technologies, unique ethical and religious issues would arise as a result of those advancements. The Bishops emphasized that works of mercy and works of justice are inseparable, and that it is the moral and religious obligation of all Christians to “engage themselves in direct efforts to alleviate the misery of the afflicted”. The Bishops further perceived that the U.S. Healthcare industry would require changes to the cost structure in order to allow for the care of the poor and uninsured whose numbers were increasing.
On November 17, 2009 the USCCB released a fifth edition of their position on healthcare: Ethical and Religious Directives for Catholic Health Care Services (ERDS). These 72 directives provide guidance for religious institutions and medical professionals by which to practice medicine in the face of rapidly changing legal, ethical, and medical environments.
The issues of caring for the seriously ill and dying were addressed in Directives 5566 of the ERDS. The bishops had two main areas of concern: 1) euthanasia, by any means, and 2) obligations that health care providers have in alleviating the suffering of the sick.
Divine Mercy Supportive Care, in response to the USCCB Directives on Healthcare, has developed Catholic Standards of Care™ for Catholic medical practitioners and care providers to be used as guidelines when caring for patients who have been medically identified as approaching the end of their lives. We strive to embody the values and virtues expressed in these Standards as the core of our ministry of care.
In developing the Catholic Standards of Care™ for Hospice and Palliative Care, Divine Mercy Supportive Care has referenced the following:
- The Code of Canon Law;
- The U.S. Conference of Catholic Bishops (USCCB)1981 pastoral letter on Health and Healthcare;
- The USCCB 2009 directives on Ethical and Religious Directives (“ERDs”) For Catholic Health Care Services;
- The statements and findings of The National Catholic Bioethics Center;
- NHPCO Standards of Practice for Hospice Programs;
- The National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care;
- The Eden Alternative; and
- Colorado Revised Statutes.
The Catholic Standards of Care™ for Hospice and Palliative Care Patients
These standards are presented as a guide for Catholic practitioners to use in caring for patients and their families facing end of life challenges.
- Compassionate Environment: We will foster an atmosphere of respect, love and support to patients and their families as they face the reality of an illness that will carry them home to the Father. Through PatientCentric Care, we will address the needs of the whole person, including the physical, emotional, spiritual, social, and financial factors impacting their lives and those of their families. Every effort will be made to maintain the dignity of the patient through “Intensive Caring” of their mind, body and spirit. Using evidencebased modalities, we will utilize all ethical means to alleviate pain and suffering without intentionally hastening death. Patients and families will also be provided spiritual support as well as an opportunity to receive the Sacraments, especially the Anointing of the Sick, to comfort the existential suffering they may experience, as they cope with a debilitating illness or prepare for death.
- Access: A special effort will be made for our services to be available for any person or family who wishes to receive them, regardless of economic status, insurability, national origin, race, ethnicity, religion, gender, disability, age, disease, or other factors. We hope that our services will provide care not only for the imminently dying, but be initiated earlier in the continuum of their disease through active Palliative care programs.
- Advanced Care Planning: Patients and their families will be provided education, support, and resources to prepare them for the impact their illness will have on their lives and those around them. We will afford them the opportunity to discuss their situation with healthcare providers, clergy, religious and others, so that ethically appropriate advance planning can be developed. They will also be provided appropriate medical information in order to make morally legitimate choices available to them, helping to distinguish between beneficial and burdensome care. From these indepth interactions with a multidisciplinary team, patients should have completed their Advanced Medical Directive, ideally outside of a critical event.
- Life Sustaining Procedures: Assisted Suicide and euthanasia are never morally acceptable options, and our care is oriented toward eliminating the demand for these acts that often stem from unrelieved suffering and misguided compassion. Under ordinary circumstances, we are obligated to provide food and water, including medically assisted nutrition and hydration (MANH), until such time as the patient cannot reasonably expect to prolong his or her life through these means. If MANH cannot be assimilated, causes significant physical discomfort or generally becomes unduly burdensome, then it may be declined. However, every effort should be made to safely offer food and liquids that can provide comforting tastes and moisture to the mouth, even if they cannot be fully ingested. While we have a duty to preserve life and use it for the glory of God, at the request of the patient or patient’s appointed guardian, we may reject life prolonging procedures that are insufficiently beneficial or excessively burdensome.
- Clinical Excellence and Safety: Ensuring clinical excellence and promoting safety through standards of practice are conducted without exception. These principles apply to every provider in the care and operation process including, but not limited to, patients, employees, volunteers, agents, partnerships, and other.
- Ethical Behavior and Consumer Rights: Our standards of ethical conduct stem from the teachings of the Catholic Church. Catholic health care defends the rights of individual conscience that may refuse to participate in actions or medical procedures that are judged morally wrong by the teaching authority of the Church. We will accommodate patient/family requests whenever possible or arrange for families to obtain alternative providers to achieve their desired objectives, provided such actions do not entail wrongful complicity with an immoral act.
- Organizational Excellence: We are committed to establishing and maintaining a culture of openness, quality and accountability within our organization that values collaboration and communication and also ensures ethical business practices at every level of care and operations and in all dealings within our community.
- Workforce Excellence: We are committed to fostering a collaborative, interdisciplinary environment that promotes inclusion, individual accountability and workforce excellence. Professional development, training, and support will be provided for each member of our staff and our volunteers and we will promote an open environment based on loving care, honesty, reliability and compassion.
- Compliance with Laws and Regulations: We are committed to ensuring compliance with applicable laws, regulations, and professional standards of practice, implementing systems and processes that prevent fraud, abuse and other unethical behaviors. We will maintain a review process to assure appropriate compliance and foster quality assessment and performance improvement in all areas of care and services.
- Stewardship and Leadership: We are committed to developing a qualified and diverse governance structure and senior leadership who share the responsibilities of fiscal and managerial oversight as well as ensuring that standards of care are adhered to at all levels of operations.