Pathways to Convergence Report
Religion plays a key role in addressing the spiritual, emotional, and psychological concerns that many patients and families hold regarding dying and the kinds of care they value near the end of life. For many people, their faith provides an important perspective on how to address concerns around end-of life care, including the use of palliative care and advance care planning. Yet most religious communities are far from monolithic in how they view the questions that people must grapple with when facing serious illness. Among Catholics, differences exist in the understanding and application of Church teachings within Catholic health care and in the public square.
The Center for Practical Bioethics with the support of Pew Charitable Trusts engaged a small group of Catholic leaders from clinical, clerical, ethical, and theological perspectives in an extended discussion to explore areas of convergence and divergence around palliative care and advance care planning in American society. This steering group independently designed and directed the effort. That initial group also identified an additional two dozen Catholic leaders from diverse professional perspectives, educational backgrounds, and geographic regions to join in the discussion. Working groups were established to focus on three areas: the social responsibility of Catholics with regard to public policy and law, the covenant and contract of the provider-patient relationship, and shared decision making and the Church teachings that inform its process. This report, Pathways to Convergence, reflects the robust conversation at a meeting in which participants engaged in a wide-ranging conversation about many key issues:
• There was broad concern over the emphasis in popular culture on ideas of individual autonomy and personal choice at the expense of Catholic concerns about “the sanctity of life.” The group felt that secular priorities ran counter to Catholic concerns about the value of a person’s life, no matter how incapacitated.
• The group strongly reaffirmed the significance of advance care planning that respects the values and preferences of the patient and other stakeholders as well, while providing support and care every step of the journey. It was important, the group noted, to promote a model of shared decision-making that respected the proper boundaries of the patient, their family and the provider while promoting the virtues of counsel and prudence. State-based Physicians Orders for Life Sustaining Treatment (POLST) were identified as a tool to achieve that end by adopting physician orders reflecting those preferences, but there were concerns about variation in how they are used and whether they could reliably communicate patient wishes in all cases.
• Participants reaffirmed the importance of palliative care and noted Pope Francis’ description of it as “an expression of the truly human attitude of taking care of one another, especially of those who suffer.” While the group embraced the idea that palliative care should begin at first medical encounter with serious illness, some felt that a distinctive Catholic approach would include the intentional creation of community around a plan of compassionate care. This view of palliative care embodies a pastoral theology in which clinicians and others in the health system should accompany the patient and their family through the course of illness.
• The duty of the Church and individual Catholics to promote a clear vision of palliative care and end-of-life care through further dialogue not only within the Church but also, the entire society, including caregivers. This includes speaking out on the comfort and meaning that palliative care can provide to people with serious illness and their families, at Catholic schools of medicine, with workers in Catholic health systems and in secular forums.
Pew and the Center are optimistic that this report may serve as catalyst for continued thoughtful dialogue and collaboration within the Catholic community about ways to improve care and health outcomes for those at the end of life.
Collision of Religion and Pain Treatment MP3
Dr. Richard Randolph, former associate professor of bioethics at the Kansas City University of Medicine and Biosciences, explores three questions about religion that often collide with the medical ethics of treating pain: In what ways may patients draw resources from their religious faith as a form of managing or coping with chronic pain? In what ways may patients incorporate their religious faith to make sense of chronic pain? In what ways or why do patients refuse opioids and other pain management resources for religious reasons?
VIEW: Collision of Religion and Pain Treatment MP3
Balancing Faith and Politics MP3
Episcopal priest and retired Missouri U.S Senator and attorney general John Danforth presented the keynote address at the Center’s 25th Anniversary Annual Dinner in 2009. In his book, he devoted a chapter to the Terri Schiavo case. In this interview, he explains why he views the case as an “outrageous and extreme use of government” that was overly politicized and inconsistent with Republican principles of small government.
VIEW: Balancing Faith and Politics MP3
Spirituality, Race and End of Life Care
What does spirituality and race have to do with end of life care? Terry Rosell, Rosemary Flanigan Chair, and Richard Payne, MD, professor at Duke University and John B. Francis Chair at the Center, discuss disparities in healthcare in African American populations and how they impact care at the end of life prior to presenting a program on the same subject to African American faith leaders in Topeka on July 27, 2011.
VIEW: Spirituality, Race and End of Life Care MP3
Religion. Healthcare Policy. Do the Twain Meet? MP3
Rosemary Flanigan discusses what it means to have a “religious consciousness” and how having such a consciousness affects our thinking as we deal with life and death issues as well as a host of bioethical issues facing us today.
VIEW: Religion. Healthcare Policy. Do the Twain Meet? MP3
Should Religion Play a Role in the Practice of Medicine?
Dr. Barr Curlin, assistant professor of medicine, and John Lantos, both University of Chicago, address the question: Should religion play a role in the practice of medicine?
VIEW: Should Religion Play a Role in the Practice of Medicine? MP3
A Muslim in America Practicing Medicine
Dr. Rauf Mir discusses what’s it like to be a Muslim practicing medicine in the United States.
VIEW: A Muslim in America Practicing Medicine MP3
Psychospiritual Care: A Shared Journey Embracing Life and Wholeness
By Margaret Burkhardt and Mary Gail Nagai-Jacobsen VIEW
By Rosemary Flanigan VIEW
By Myra J. Christopher VIEW
A Cartography of Spirituality in End-of-Life Care
By Timothy P. Daaleman VIEW
Psychospiritual Elements of Illness: Beyond Biomedicine
By Clifford C. Kuhn VIEW
The Spiritual Side of Dying
By Laurence K. O’Connell VIEW
Reflecting on the Death of A Friend
By Jane Pitz VIEW
Spirituality, Religion, and the Physician: New Ethical Challenges in Patient Care
By Gregory A. Plotnikoff VIEW
Dying in America: Contexts and Problems
By Thomas A. Shannon VIEW
Ensuring a Good Death
By David C. Thomasma VIEW
An African American Looks at Death
By Marian Gray Secundy VIEW
Compassion Sabbath—Engaging Clergy and Faith Communities in Improving Spiritual Care of the Dying
By JoEllen Wurth and M.C. Sullivan VIEW