The British Medical Association (BMA) has published a report on end of life care, which is summarised for us here by the Guardian, where it makes sobering reading. There is also some sensible commentary in the same newspaper by Archie Bland, which can be read here.
Years ago, I remember shouting at the television in disbelief, on hearing a BBC correspondent in Italy telling us, with regard to the case of “right to die” activist Piergiorgio Welby, that “the Catholic Church believes that life is to be preserved at all costs.” Actually, this is not and has never been the teaching of the Catholic Church. It is perfectly legitimate for a patient who judges reasonably that he or she has come to the end of life to refuse further treatment. It is perfectly legitimate for doctors to decide that, given the state a patient is in, that further intervention would bear little fruit or indeed be counterproductive. It is perfectly legitimate for doctors and nurses to let nature take its course, and let people die in peace, when death cannot be put off further.
At the same time, it is never legitimate, indeed it is a great moral evil, actively to kill a patient, or to fail to intervene in such a way as to save a patient’s life when that can be done. The Church is opposed to euthanasia, which is the equivalent of murder, but this must not be taken to mean that we support medical interventions that have no therapeutic purpose.
A traditional formulation of the Church’s teaching is as follows: “Thou shalt not kill, but needst not officiously strive to keep alive.” Needless to say, one cannot discuss this at the length it deserves in a short article.
The BMA report seems to suggest that some doctors would do well to bear the above saying in mind and act on it. I myself have seen cases where this has not happened, where bad decisions have been made with regard to patients who are at the end of life. For example, I have known patients, who are clearly at the end of life, being transferred from one hospital to another, and then being sent back to the original hospital on arrival, on the grounds that they are too ill to be admitted, who have then died on their return, no doubt exhausted by the fruitless journeys by ambulance.
I have known of residents in nursing homes sent to hospital a few hours before death, for no good medical reason that I can think of. And I have seen very old people with dementia in hospital wards that are concerned with curing people, when such patients really need to be an environment where care and management of what ails them should be the aim.
On a brighter note, I have also visited hospices and been impressed with the excellent care and calm atmosphere of such places. Sadly, I have also known patients who have been told that they are too ill to go to the hospice, and some who are told they are not ill enough, who have died a few days later. We need more hospice places – let us be clear about that.
What the BMA report seems to suggest (I have not read it, but am going by the summary) is that modern medicine needs to abandon the idea that the goal is cure and that death represents a failure. Death can’t be a failure, as it is a natural process, but if it were, it means we are all going to fail one day. We need to recognise this, and prepare ourselves, and our doctors should see themselves as those who not only cure us when they can, but help us to prepare for death as well.
The last worrying thing I note from the report is that so many doctors do not seem comfortable or capable when it comes to discussing death with patients and their relatives. The avoidance of the subject can hardly be a help in facing it. We all need to talk about death, and this perhaps is where the clergy can help. Some patients have a hearty dislike of hospital chaplains, as do some doctors and nurses, as they associate the clergy with death; if one can shun the clergy, one can perhaps put off the grim reaper too. But death is not just a grim reaper: death can be a comfort and a friend as well. Nowadays the real fear should be of living too long, not the dying when our time has come. There can be a good death, as the BMA report recognises; it should not be out of the reach of so many of us, as it is at present.