Katholieke Stichting Medische Ethiek
22 oktober 2021

De goede Samaritaan: zorg voor ernstig en terminaal zieken

De Congregatie voor de Geloofsleer heeft een document gepubliceerd over de zorg voor ernstig en terminaal zieken: Samaritanus bonus.

The human person in the centrality of his integrity

The address of Undersecretary Gambino at the presentation of the Letter on the care of persons in critical and terminal phases of life.

First of all, “the vulnerability of every human being, body and spirit, mysterious marked by the desire for infinite love for which he has been destined from all eternity”; secondly, “the principle that caring for others who are in a state of need is not only a question of the ethics of social solidarity or of beneficence,” but is even more “the recognition of the inestimable value of one’s life as an insurmountable limit in the face of any claim of autonomy”; and last but not least, “the foundation of any juridical order: the worth of every person at any stage of life or condition of existence.”

These are the three cornerstones which the Undersecretary of our Dicastery, Gabriella Gambino, explored in depth this morning in the Sala Stampa, commenting on the Letter “Samaritanus Bonus,” on the care of persons in critical or terminal phases of life, which was edited by the Congregation for the Doctrine of the Faith and presented today at a press conference.

“Care,” explained the Undersecretary, “cannot be reduced to simply attending to the sick from a medical or psychological perspective, but must branch out into a virtuous attitude of devotion and concern for the other, which finds its substance in caring for the whole person, for those who are in a state of need.” It is this caring which, she continued, “supports the encounter between ‘I’ and ‘You,’ thereby calling man out of the state of insignificance and anxiety into which his illness has thrown him, and helping him to rediscover the unity of body and spirit. This aspect,” she clarified, “is full of pastoral and bioethical implications, which should lead us to modify the way the critically and terminally ill are cared for in many contexts.”

Faced with the “complexity of the medical management of sickness and death,” before a “secularized culture and legislation that confounds us on the value of suffering and of our life,” Gambino concluded that with the Letter Samaritanus Bonus “the Church desires to restore the centrality of man in his integrity, a unified totality of body and spirit; and to remind us that we are children of a Father who has loved us to the end, who is the only one who can make sweet the burden of our suffering.”


11-12 december 2019: Religions and Medical Ethics: Palliative Care and Elderly Mental Health

A two-day symposium jointly organized by the World Innovation Summit for Health (Qatar) and the Pontifical Academy for Life (Vatican City)

To be held at the Augustinianum Congress Centre, Via Paolo VI, Rome (adjacent to St. Peter’s Square, Vatican City), 11-12 December, 2019

This special symposium examines the role that religion plays in providing holistic care in the context of medical ethics. By focusing on the intersection of belief-based and evidence-based approaches to care, speakers and participants will have the opportunity to highlight and explore the benefits of interdisciplinary and interfaith approaches to treating the body, mind and soul.

Meer informatie op de website van de Pauselijke Academie voor het Leven


Belgische bisschoppen: geen mens mag aan het eind van zijn leven in de steek worden gelaten

Katholiek Nieuwsblad, 19 juni 2019

Niemand mag aan zijn levenseinde in de steek worden gelaten. Dat schrijven de Belgische bisschoppen in hun nieuwe brochure “Uw hand in mijn hand – pastorale zorg bij het levenseinde“.

Met de brochure willen zij “vanuit het Evangelie oriëntaties aanreiken aan de velen die oude en zieke mensen nabij zijn, in het bijzonder de pastoraal werkenden”. Ze benadrukken hun waardering voor “al wie zieken en stervenden zorgend nabij blijven”.

Het verlangen om menswaardig te kunnen sterven is “een legitiem verlangen”. Over wat dat precies inhoudt, verschillen de meningen echter, vervolgen ze.

“‘Ge zult niet doen’, blijft voor ons – en overigens voor alle grote religieuze tradities – een richtlijn van vitaal belang. We komen op voor de fundamentele waarde van elk menselijk leven, zeker ook het meest broze menselijke leven.”

Een moeilijk spanningsveld

Attente aanwezigheid vormt volgens de bisschoppen de basis van de nabijheid, ook in situaties waarin mensen aangeven te verlangen naar de dood en euthanasie te overwegen. Ook dan “moeten we aanwezig blijven”. Dat “houdt geenszins een goedkeuring van euthanasie in. Voor de pastor kan dit een heel moeilijk spanningsveld betekenen”.

Ook in dergelijke situaties kan, zo stellen de bisschoppen, altijd voor en indien mogelijk samen met de betrokken persoon worden gebeden. Want “hoe groot onze menselijke onmacht ook is, altijd vertrouwen we onze medemens toe aan Hem die de bron is van alle leven en wiens barmhartigheid geen grenzen kent”.

Kanttekening bij ‘ondraaglijk lijden’

Bij het vaak aangevoerde “ondraaglijk lijden” kunnen volgens de bisschoppen wel kanttekeningen worden gezet. Zo kan de vraag gesteld worden of kwetsbare mensen wel voldoende aandacht krijgen, zo schrijven ze.

Ze doen een oproep aan pastores en vrijwilligers om hier alert op te zijn en nieuwe wegen te vinden om de betrokken personen nabij te zijn en te steunen.

God is bondgenoot van broze mensen

Volgens de bisschoppen helpt christelijk geïnspireerde zorg mensen ook om aan het eind van hun leven te kunnen loslaten, de balans op te maken en tegemoet te komen aan de nood aan verzoening en heling.

Wie stervenden begeleidt, moet proberen verbindend te werken, stellen ze: naar de naasten van de betrokkene, en als die ervoor open staat ook naar God “die de Bondgenoot is van broze mensen, ook al blijft Hij in de beleving vaak een ondoorgrondelijk Mysterie”.

De ziekenzalving

Ze benadrukken de rol van rituelen, die het onzegbare uitdrukken. Pastores moeten inspelen op de nood daaraan, zonder de sacramenten en typisch katholieke rituelen hun eigenheid te doen verliezen.

Ook vragen ze om het sacrament van de ziekenzalving niet pas aan het einde van iemands leven toe te dienen. “Het is een sacrament voor zwaar zieke of verzwakte oudere mensen. Zo heet het ook ziekenzalving, niet het sacrament van stervenden.”

Het verrijzenisgeloof

In het laatste deel gaan de bisschoppen in op het geloof in de verrijzenis. “Sterven als christen is je één mogen weten met Christus in zijn sterven én verrijzen.” Dat verrijzenisgeloof is echter “nooit een evidentie” en “ontkent alleszins de ernst van de dood niet”.

In de laatste levensfase wisselen veel verschillende emoties elkaar af, schrijven ze: “angst, protest, macheteloosheid, verdriet, maar ook genegenheid, hoop, dankbaarheid, aanvaarding… Dit alles kan ook in de godsrelatie tot uiting komen.”

De woorden die Christus op het kruis sprak kunnen dan “inspiratie bieden een heel herkenbaar worden. Gelovig sterven is je uiteindelijk aan Gods handen durven toevertrouwen”.

Overgenomen met toestemming van Katholiek Nieuwsblad.


Mgr. V. Paglia: Einde van het leven en palliatieve zorg

Abp. Paglia in Moscow talks about end of life and Palliative Care

Pauselijke Academie voor het Leven, 12 februari 2019

“A globalization devoid of Christian inspiration is poor in love and prey to conflicts; and the task of the Christian world is to re-center relations between people: Care means taking care of others, as the Gospel teaches. The parable of the Good Samaritan takes on a new dimension in the technological and hyper connected society whose implications are people “increasingly withdrawn into their own enclosures,” reiterated Abp. Vincenzo Paglia, President of the Pontifical Academy for Life.

Abp. Paglia was speaking in Moscow on Tuesday 12 February, as part of the annual “Colloquium” between the Catholic Church and the Patriarchate of Moscow to commemorate the Cuba meeting between Pope Francis and Patriarch Kirill, which took place in 2016. This year the Colloquium was dedicated to “end of life”.

Addressing the theme “At the service of human dignity, called to life” in light of Humana Communitas, the Holy Father’s Letter to the Pontifical Academy for Life, Abp. Paglia stressed that in “taking care”, “we must take care of human life in the sense of the human quality of the choices that guard and reaffirm the ultimate destiny of life” while at the same time caring for the environment. “We are called to rediscover tour connection to and relationship with the places that host our lives”.

After having framed the challenges posed by the specific theme of the “end of life”, Abp. Paglia focused on how the Pontifical Academy has inserted as one of the qualifying points of its commitment as Palliative Care.

Palliative Care accompanies people in the transition to death. It does not abandon the sick person, as is sometimes the case when it is deemed that there “is nothing left to do neither is it directed towards a “therapeutic obstinacy”.

Palliative Care teaches us that “we have no patients; we have people, with all their physical, psychological, cultural and spiritual baggage”. It recognizes “the presence of family members and of those who work for their health” alongside the sick.

Palliative Care “re-locates the suffering person, even those preparing for the passage of death, within his or her fundamental, familial and social relational dynamic. You cannot die alone! Experience has shown that the demand for euthanasia or assisted suicide is in almost all cases the result of the social and therapeutic abandonment of the patient. On the contrary, once a valid multidisciplinary acceptance of the patient has been put in place and the network of affective and professional relationships is positively involved, it is very rare to find a request for death “.

“Dear friends – concluded Msgr. Paglia – our discipleship of the Lord Jesus, healer of bodies and souls, entrusts us with responsibility for the lives of men and women, especially the youngest and poorest, of today and of future generations. It is a great challenge, due to the complexity of the world in which we live and the vastness of its horizon. Of course it cannot be reduced to a simple technological question. In this age of ours, Christianity can truly help the whole of humanity to grasp the challenges of life in an essential and elemental humanistic and spiritual dimension “.

Finally, Msgr. Paglia gifted the Moscow Patriarchate and the local Catholic Church a Russian translation of the Letter Humana Communitas.


Dienstbaar aan de waardigheid van de mens en geroepen tot het leven

Serving the dignity of man, and called to life

Address of His Excellency, the Most Reverend Vincenzo Paglia, president of the Pontifical Academy for Life

Moscow – February 12, 2019

Your Eminences, Most Reverend Prelates, Dear Professors,

I am pleased and honored to have this opportunity to speak on such an important occasion whose purpose is to bring about deeper understanding and fuller cooperation between the Catholic Church and the Patriarchate of Moscow and of the entire Russian Orthodox Church. During their meeting in Cuba three years ago, Pope Francis and Patriarch Kirill emphasized the importance of the Gospel and of the Christian faith in the construction of a more just and peaceful society, one that promotes “respect for the dignity of man, called to life.” It is important that we recognize this responsibility and take it on as a shared commitment.

I interpret as a providential sign the fact that I just returned from a stay in Cuba, where I attended the fourth International Conference for World Balance in Havana. It dealt with the question of a more human and more fair coexistence in our now globalized planet. I spoke to the participants about the meeting in Cuba between Pope Francis and Patriarch Kirill, as well as about this conference, which takes its inspiration from the Joint Declaration that the Pope and the Patriarch signed.

We find ourselves now at a moment in history that requires greater unity among Christians because globalization without Christian inspiration is lacking in love and is prey to conflict. And unfortunately, that is what we often see today. The moment in history that we are passing through is characterized by people retreating into their own closed circles. We see everywhere an increased danger of an individualism that weakens both society and religions themselves. It is urgent for ChristiansCin a globalized worldCto offer everyone that vision of the unity of humanity that permeates the Gospel.

 

The collapse of “us”

In fact, at the beginning of the 21st century, society is characterized by some of the negative results produced by modern Western culture and imposed by it on the rest of the world. These results are now centered on a contradiction that undermines the hopes for Christian humanism. While on the one hand, recent centuries have seen increased attention to the person, and the person’s irreplaceable and priceless uniqueness and desire for a well-lived life, on the other hand we see an explosion of individualism that leads to loneliness, self-referentiality, and embitterment against society. Some philosophers such as, for example, Gilles Lipovetsky, speak of a “second individualist revolution” marked by the worship of hedonism and of psychology, by the privatization of life and by the triumph of autonomy over collective institutions. Zygmunt Bauman, one of the most careful students of social phenomena, spoke recently of a “fluid society,” a society with no fixed values.

Contemporary man, obsessively concerned with his personal destiny, is at risk of such an overwhelming narcissism that he is insensitive to those around him and no longer has the inner strength to commit himself to building a shared human community. The passion for humanity’s condition and “common destiny,” which nourishes an aspiration for “universal brotherhood,” has weakened and became uncertain. We could speak of what I call “the collapse of ‘us,’” that is, the loss of a common dream, of common vision.

The men and women of today are more connected, but not for that are they more brothers and sisters. If on the one hand technology and the economy have more or less bureaucratically unified societies, they have on the other hand disrupted them emotionally: pressure for functional efficiency kills relationships. We are looking at plan for the cultural and social “creation” of the individual as an end in himself, disconnected from any individual uniqueness and any possible separate “empowerment.” In the search for autonomy, the contemporary individual removes, day after day, the memory of the roots and bonds that generated and constructed him as a human person. Some speak of a new religion, “egolatry,” the cult of the ego, on whose altar the most sacred affections are sacrificed. The deterioration of social bonds, in all their aspects – family, work, culture, politics – is one of the most critical effects of the global diffusion of this individualism that has no others and no history.

 

Humana Communitas

Pope Francis, on the recent celebration of the 25th Anniversary of the creation of the Pontifical Academy for Life, wrote us a letter entitled Humana Communitas. We have translated it into Russian and want to give it to Patriarch Kirill and to all of you. In the letter, the Holy Father asks questions about the life of man and points out the (theological) roots that can serve as reference points when addressing the questions and difficulties that confront life itself. He explicitly and clearly points to the human community as the most complete and genuine locus for the free and conscious development of every man and woman. This is what the Pope writes: The human community is Gods dream even from before the creation of the world (cf. Eph 1:3-14). In it, the eternal Son begotten of God the Father has taken flesh and blood, heart and emotions. Through the mystery of giving life, the great family of humanity is enabled to discover its true meaning. (HC1). This dream …is what Jesus has entrusted to the Church and has placed in the heart of every person: the whole human family has a common origin and a common destiny. In a globalized world, the unity of the human family is the horizon that must involve all peoples. It is crucial to rediscover brotherhood, which unfortunately has not yet been achieved. Life is not an abstract universal; life is each person from his conception until the moment of death. Life is the whole human family all over the world. This is life, an historical reality.

And further on the Pope says: Indeed, the many extraordinary resources made available to human beings by scientific and technological research could overshadow the joy of fraternal sharing and the beauty of common undertakings, unless they find their meaning in advancing that joy and beauty. We should keep in mind that fraternity remains the unkept promise of modernity. The universal spirit of fraternity that grows by mutual trust B within modern civil society and between peoples and nations B appears much weakened. (HC13)

In the web of relationships that are part of the life of contemporary individuals, the fundamental questions that fill their hearts, their minds, even their bodies, and that are otherwise incapable of being answered exhaustively, must be included. Even the pressing question of rights, in order that it not become simply a declaration of intent, needs to be raised, justified, communicated and implemented, not with reference to an unconnected “I” but rather with broader reference to a human “us.” Without a harmonious correlation, without shared rights and duties, the proper protection of the person and his inherent dignity is not guaranteed, and the life of the community is not more human. One example: too often we witness the reduction of the great theme of humanity’s aspiration to happiness to the search for psycho-physical gratification, which becomes the sole criterion for and measure of everyday “quality of life.” In fact, to think about it, true well-being is what wells up from mutual love, from being well-loved, that is, loved and able to love, welcomed and welcoming, mercied” (as Pope Francis likes to say) and merciful.

The challenge that the lives of the more than seven billion people alive today offers us is that of the “us”: that is, rethinking ourselves within a web of relationships that certainly marks, limits, and imposes itself, but precisely for this reason does not abandon the other, that continues to reproduce, remains in solidarity, and hopes for a salvation that can reconcile us, all together, in shared and hopeful life.

There are two initiatives that I believe are fundamental in this area. The first deals with relocating the questions that must be asked about human life into the broader global perspective that is obligatory today. It is objectively illogical and unproductive to deal with the analysis of individual questions without first placing them into a framework within which, as far as possible, the complexity of the current situation can be taken into account. Today, in respect for, in defense of, and in the promotion of human life, everything is under consideration: local symptoms cannot be treated if global causes are not taken into account. Global bioethics is the current vehicle for examining the human quality of the choices intended to protect and reaffirm the ultimate destiny of life: resistance to addressing the radical understanding of this activity would be a serious misunderstanding of the responsibility that faith has today.

The second initiative is instead an extension of that theme. In recent decades, quite rightly, attention has been given to conditions on our planet and to the consequences of human activity on the environment. Today, it is time to widen this attention, to turn from a consideration of our common home to concern for its inhabitants. Precisely because the habitability of the planet is put into crisis by the reckless and selfish actions of its inhabitants, the time has come to concern ourselves seriously with this behavior. We are called to rediscover the connection between the relationships among us on the one hand and our relationships with the places in which we live on the other.

Accompany in the passage of death

In the context of our discussions, a unifying social understanding of death is particularly important. What troubles me deeply about the demand for approval of the various modalities of euthanasia is not simply the fact that there is a desire to pervert the practice of medicine, which should be entirely dedicated to the patient’s life and not to his death, but rather the fact that a person who, at a particularly serious and difficult time in life, asks to die.

The task of accompanying those who approach the sensitive passage from earthly life to a definitive encounter with Heavenly Father has an importance that is not limited to those immediately involved, but rather has much broader implications. It is the expression of a caring that finds the proper balance between the use of available medical resources and the search for the integral good of the person, in his familial and social context. In fact, the progress of science in the biomedical field risks making healing almost the main, if not the exclusive, purpose of contemporary clinical practice. This evolution brings with it the risk of focusing on the fight against disease and neglecting (or eliminating) the patient. At that point, we forget that the deepest meaning of therapeutic efforts (curing) is found in a relationship centered on taking care of the patient (caring). The tendency, especially in strongly technological contexts, is to look at the elimination of disease as the only objective to be pursued.

This attitude, in its turn, has two consequences. First, there is the risk of being unreasonable in the use of medical treatments, in order to obtain a healing that “must” be achieved at all costs, because in any failure to heal is seen as a defeat for medicine. Doing this, however, opens the way to the stubbornly unreasonable adoption of excessive measures. We can end up inflicting suffering on the patient by using means that are invasive and losing sight of the integral good of the person. Doing everything possible (if this is understood as always using all available means) can mean doing too much (that is, an excess that damages the patient).

The second risk is abandonment of the patient when a cure is no longer possible. Once that happens, the relationship between the doctor and the patient ends, and medicine (society) no longer has anything to do for him. This is an unacceptable course of action. If we cannot heal, we can still relieve pain and suffering and continue to take care of that person. The incurable patient is never to be left uncared for. This total commitment to care springs from a conviction that every person is endowed with absolute dignity at every stage of his life. We cannot speak seriously about the humanization of medicine unless we have an effective understanding of the dignity of every unique human person, even when seriously ill or near death. The risk that the incurable patient runs today is the risk of abandonment due to the idea that “Oh well, there is nothing left to do” or that “It’s not worth the effort.” Another risk that is the other side of the coin is euthanasia, based on the idea that if there is nothing that can be done, we might as well “get it over with.”

The firm refusal to adopt such courses of action finds a strong ally in palliative care. Recently, the international scientific community has approved (and the Academy for Life has been among the supporters of this development) a new definition of palliative care. It begins by stating that: “Palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illnesses, and especially of those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers.

Two aspects of this definition seem particularly significant: the first is the holistic approach that palliative care offers, which is the exact opposite of a medical reduction in care. We don’t have patients, we have people, with all their physical, psychological, cultural and spiritual baggage. It is only within a framework that takes into account the whole of the human person, that technology, which is particularly efficient today, finds its true effectiveness, expresses its true strength.

The second aspect presented by the new definition of palliative care is that it recognizes, not only the person being treated but also family members and healthcare professionals, with the interesting proviso that they are not simply agents in the treatment of the person who is ill, they themselves are recipients of specific and caring attention. This formulation is crucial precisely because it keeps the suffering person, even one who is approaching death, within the circle of his fundamental family and social relationships. It is unthinkable to die alone! Experience has shown that the request for euthanasia or assisted suicide is in almost all cases the result of the patient being abandoned by society or the medical profession. To the contrary, once a true multi- disciplinary treatment protocol has been put in place and a network of affective and professional relationships created, it is very rare to encounter a death request.

Medicine must recognize the value of its fundamental vocation to “take care” and breathe new life into that vocation. We need to overcome the misunderstanding that equates “palliative” with “useless” or ineffective. This confusion explains some of the resistance that hinders the practice and acceptance of palliative care, even when its importance is recognized in principle.

Among the different levels and participants involved in a “taking care” that is reintroduced in a specific case, thanks in some way to palliative care, special attention is to be given to spiritual and religious questions and the persons (chaplains, spiritual counselors) who deal with them. For the believer, death always takes the form of a radical surrender to the mystery of God who does not abandon His children to the grave; moreover, the last days of the earthly life of every human person are a precious and irreplaceable opportunity to take stock of their existence and speak words of reconciliation and forgiveness. To assist and accompany a dying person (and that person’s family!) in this twofold transition is a precious gesture that gives added value to even the final moments of a person’s life.

Dear friends, following the Lord Jesus, healer of bodies and souls, confers on us the responsibility for the lives of men and women of today, especially the youngest and poorest, and of future generations. This is a great challenge because the world we live in is complex and its horizons are vast. This responsibility cannot be reduced to a simple technological process, but I can assure you that Christianity can really, in our time and within a humanistic and spiritual framework that is essential and inescapable, help the whole of humanity to answer the challenges of life. And this is one or the reasons we are here today. Together.

Thank you.


Pauselijke Academie voor het Leven: palliatieve zorg is een mensenrecht

Monsignor Paglia’s Address at a Conference in Qatar

“Palliative care is a human right,” affirmed Monsignor Vincenzo Paglia, President of the Pontifical Academy for Life. “Different international programs are implementing it, but the true human right is to continue to be recognized and welcomed as a member of society, being part of a community,” he stressed.

Monsignor Paglia made these comments on opening the works of the Conference entitled “Muslim and Christian Perspectives on Palliative Care and the End of Life,” which began on January 22, 2019, at Doha, in Qatar, reported “Vatican News” in Italian. The two days of study, organized by Georgetown University and the WISH program of the Qatar Foundation, began with the signing at Qatar of a Joint Declaration on the End of Life and Palliative Care, by the World Innovation Summit for Health (WISH) and the Pontifical Academy for Life.

Palliative care is a reaction to the “throw-away culture,” which renders normal euthanasia and indifference to others, said Monsignor Paglia, stressing its importance today when one witnesses “the marginalization, discrimination and elimination of the most fragile human beings, such as those that suffer serious, disabling or incurable illnesses.”

“I consider it urgent to intensify the reflection to address more solidly the great anthropological questions and the immense ethical challenges that present themselves to us with the questions that concern the end of life,” continued Monsignor Paglia.

Recalling the contribution of religions ”to give concrete impulse to this was the form of accompaniment of sick or dying persons,” Monsignor Paglia stressed  “the capacity of religions themselves to reach humanity’s peripheries,” but also the essence itself of religions, described as being part of “veritable forces of palliative care.”

“Palliative care embodies a vision of man of which their great religious traditions are the guardians and promoters: that is the most profound and incisive contribution that they can make in terms of motivation and inspiration,” added Monsignor Paglia.

The President of the Pontifical Academy for Life recalled “the specific mandate that Pope Francis gave to the Pontifical Academy for Life on the occasion of the 25thanniversary of its institution. “ The Holy Father called to “reinvent a new fraternity,” he said, “such is the anthropological and social challenge of our time.”

By way of conclusion, Monsignor Paglia said that the palliative care community witnesses in a new way a living together that puts the person and his good at the center. In this community, the good of each is pursued as being a good for all.


Mgr. V. Paglia: Palliatieve zorg is een basaal mensenrecht

Address of mgr. Vincenzo Paglia to the conference “Muslim and Christian Perspectives on Palliative Care and End of Life”,  organized by the Pontifical Academy for Life and Georgetown University in Qatar Doha

January 22-23, 2019

I would like to join in the greeting offered by Dean Dallal and welcome you, both for myself and on behalf of the Pontifical Academy for Life, to our Conference dealing with “Muslim and Christian Perspectives on Palliative Care and the End of Life.” This conference is part of the Academy’s wider PAL-LIFE project that is dedicated to the increased acceptance and full implementation of palliative care around the world. I first of all thank Georgetown University in Washington DC, represented here by Doctor John Borelli, then Georgetown University in Qatar, represented by Dean Ahmad Dallal, and I thank Sultana Afdhal, Chief Executive Officer of the World Innovation Summit for Health (WISH) Community sponsored Qatar Foundation. Their contributions to the scientific and organizational aspects of this event have been invaluable. It is an honor to collaborate with such prestigious and culturally committed institutions.

Historically, the palliative care movement was born at the middle of the last century to give specific medical and social attention to incurable cancer patients and relieve the complex of symptoms that accompany the most advanced stages of the disease until death.

From the beginning, palliative care includes not only the management of symptoms and care for the needs of the patient, but also preparation for death, in the realization that it is not only inevitable for all, but that it must be dealt with in particular ways when a disease is incurable and the progression to death is unstoppable. Palliative care also includes the patient’s family, or those others who are closest, as beneficiaries of accompaniment.

We are aware of the importance that palliative care can assume, inside and outside medicine, in times like ours where we witness marginalization, discrimination, and the elimination of the weakest of human beings, such as those suffering from a serious, disabling or incurable disease. We want to oppose the “throw-away culture”— and we know how pervasive it is in most of contemporary society— by promoting a “palliative care culture,” that overcomes the attraction of euthanasia and assisted suicide, and that leads to the greatest possible acceptance of a culture of care that enables us to accompany the dying with love until the end.

To accomplishing this, I think we must reflect as deeply as possible about the great anthropological questions and enormous ethical challenges we face in dealing with the end of earthly life. For this reason, our efforts in this Conference will be directed to exploring what palliative care can offer to those human needs that arise from the power of the human spirit. We will take consider not only clinical experience, but also the contributions that science and the deathless truths that religions preach about mystery of humanity.

Today the palliative care scientific community recognizes the important role that religions play in advancing this form of accompaniment of the sick or dying, given the ability of religions to reach the peripheries of humanity, those who in every community are in some way most in need. While this is certainly true, religions are and do much more. Religions are not only able to facilitate a greater presence of palliative care where it is needed, but they are one of the true component forces of palliative care itself. Total attention to the person is made much more difficult by economic hegemonies that colonize contemporary cultures and societies. The result of this situation can be only a culture, or rather anti-culture, of wastefulness. An understanding of human existence and of reality that values religious experience allows us to see and affirm a good that surpasses and is not limited by economic calculus. Recognition of the integral openness of the person to transcendence makes it possible to state that in human life, even when it is fragile and seems to be defeated by illness, there is inalienable value. Palliative care represents a vision of man that is preached and protected by the great religious traditions. In terms of motivation and inspiration, this is the most profound and trenchant contribution palliative care can receive.

Palliative care today represents for all of us a concrete initiative within a climate of vanishing love for humanity and a crisis of social ties that beginning with a generic disengagement is now reaching a real social disintegration that involves all social structures, beginning with the family. Societas as a communion of persons, no matter what form it takes, is necessary for self-realization of the individual. While the individual is not the servant of society, society is not merely an instrument for the self-realization of the individual. It is rather a condition that allows for the such realization. It is difficult to make what is human develop in a society where relationships are mummified. The ego, as it is more and more conceived of by postmodernity, becomes an force for dissolution, not for bonding; exclusion, not inclusion; fluidity, not consolidation. It is therefore essential to foster not only problem-solving, which can be superficial, but also the lasting dream of a new humanism for all, and of universal brotherhood. Reinventing a new brotherhood is the anthropological and social challenge of our day and is the specific charge that Pope Francis gave to the Pontifical Academy for Life on the occasion of the twenty-fifth anniversary of its creation, which will be celebrated on February eleventh. The text of the Holy Father’s letter is in your folders. Here too, religions have a very special word to say.

Dependency—a human condition that is a focus of religions and palliative care—is indeed human and should be appreciated, when freely chosen, as an inalienable human value. The ego finds its fulfillment in relationship, in the “we.” The “we” is no less innate in us than the “I.” It is clear that our existence is marked by a permanent movement from the “I” to the “we.” Humanism must necessarily be marked by solidarity. The task of “caring for” the other, and for creation, is very different from the false, predatory and destructive attitude so often adopted by man—not only towards nature and the earth, but also against brothers, especially when they are perceived as obstacles or no longer useful. The palliative care community bears witness to a new way of living that focuses on the person and his good, to which not only the individual but the whole community tends. In this community the good of each person is pursued as a good that benefits everyone. Palliative care is a human right, and various international programs are working to implement it; but the basic human right is to continue to be recognized and accepted as a member of society, as part of a community.

The Conference which we are about to begin will open with the signing, by me and Sultana Afdhal, of a Joint Declaration on the End of Life and Palliative Care, issued by WISH and the Pontifical Academy for Life, two institutions of different faiths, but sharing the task of study, scientific advancement and cultural development; two academic institutions that specifically in palliative care find a fruitful ground for encounter and cooperation in order to reach a new humanism for the benefit of all persons and all peoples. In this context I would like to express my appreciation for the scientific and cultural contribution that WISH has offered to the international community through its activities, not least for the work of the group on “Islamic Ethics and Palliative Care” led by Dr. Mohammed Ghaly, who presented its results during the Summit celebrated here in Doha last November. This was a valuable starting point for our work.

I hope that these two days can make an effective contribution to making palliative care—which is called on every day to face great challenges in accompanying the dying—more well-known and fully accepted by public opinion, and can give rise to a fruitful new humanism for the benefit of all. I am sure that we can work together effectively and learn much from each other. I wish everyone a very profitable two days.


Joint declaration on End of life and Palliative care

While we applaud medical science for advances to prevent and cure disease, we recognize that every life will ultimately end in death. For many, however, death is not considered as an unrewarding journey; it is the passing through a door that opens to eternal life in the hereafter.

The Promotion of Palliative Care

We encourage palliative care to support and provide companionship during illness and at the end of life. The basic philosophy of palliative care is to achieve the best quality of life for patients suffering incurable, progressive illness even when their illness cannot be cured. Palliative care is a health care specialty that is both a philosophy of care and an organized, highly structured system for delivering care. Palliative care services are critical for realizing the most ancient mission of medicine “to care even when it cannot cure.” Palliative care is an expression of the truly human devotion to taking care of one another, especially of those who suffer. We should encourage professionals and students to specialize in this type of assistance which is no less valuable though it may not be considered “life-saving.” Palliative care accomplishes something vitally important: it values the person.

Noting that the scriptures of faith traditions emphasize divine purpose for all persons, regardless of health, we proclaim that:

  • We reject any form of pressure upon the dying to end their lives.
  • We encourage and support the concept of palliative care in all places and for everyone.
  • We affirm laws and policies that protect the rights and dignity of the dying.
  • Even when staving off death seems futile or unreasonably burdensome to continue, we must seek to offer comfort care: effective pain relief, companionship, and support the patient in the hard and sacred work of preparing for death.
  • We as a society must assure that patients’ desire not to be a burden does not tempt them to choose death rather than receiving the care and support that could enable them to live out their remaining time in comfort and peace.
  • We believe that all health care workers are bound to create the conditions by which religious assistance is assured to anyone who asks for it, either expressly or implicitly – We commit to using our knowledge and research to shape policies that encompass social, physical and spiritual care to provide more informed care for those facing grave illness and death.
  • We commit to engaging the community regarding the issues of bioethics as well as the techniques of compassionate companionship for those who are suffering and dying.
  • We commit to raise public awareness about palliative care through teaching resources and adult programs to consider treatments for the suffering and the dying in the context of religious affirmations of God’s providence and hope.
  • We commit to providing succor to the family and loved ones of the dying

Doha, January 22 2019


Pauselijke Academie voor het Leven publiceert Witboek over Palliatieve Zorg

Pontifical Academy for Life, Palliative Care Working Group

The Pontifical Academy for Life has published a white book on palliative care. The White Book was developed by the Vatican-based Pontifical Academy for Life (PAV) and describes the broad-based, expert-led effort to develop recommendations for improving global palliative care. Advances in palliative care are needed to aid the more than 25 million people who die each year with serious health-related suffering, as the current supply of palliative care cannot meet the growing demand. The White Book is a product of the work by a group of experts in palliative care advocacy who represent different faiths and were invited by the PAV to develop strategic recommendations to advance global palliative care. The expert group identified 43 recommendations and 13 stakeholder groups, targeting the most important recommendations for each stakeholder group. The English version of the White Book was presented in the Vatican in September 2018.