I’ve recently had a dialogue with a reader regarding a recent post. My friend is a Christian Scientist, while I, obviously, am not. The discussion centred somewhat around end-of-life issues, and it’s prompted me to think about this rather uncomfortable subject.
My friend pointed out some rather tragic instances in her own family where certain forms of medical care were imposed on people apparently against their wishes (in at least one case), and in both cases where the treatment offered little to no hope of a successful outcome. I will say this as straight to the point as I can: any sort of treatment imposed on a person against their stated or known wishes is, in my opinion, immoral, unethical, and completely unconscionable. If a Christian Scientist explicitly states that they do not wish to have medical treatment, painful as it may be to those who disagree, I believe those wishes must be respected. If someone has cancer, and treatment is hopeless for a successful outcome, and the patient expresses a desire to cease treatment, nobody should force them to undergo treatment. Period. There, I think I’ve made my point, and in that respect, my friend and I are in agreement. However, I think many, both Christian Scientists/ex-Christian Scientists, and some of the general public, don’t fully understand some key terms that are often thrown about in the debate over end-of-life issues.
Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.1
(World Health Organization)
Additionally, palliative care:
- provides relief from pain and other distressing symptoms;
- affirms life and regards dying as a normal process;
- intends neither to hasten or postpone death;
- integrates the psychological and spiritual aspects of patient care;
- offers a support system to help patients live as actively as possible until death;
- offers a support system to help the family cope during the patients illness and in their own bereavement;
- uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
- will enhance quality of life, and may also positively influence the course of illness;
- is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.2
So, as you can see, palliative care is a holistic approach to helping those facing serious illness, or terminal illness, and their families. It is now recognized in the United States as a specialty in internal medicine. It is different from curative care. Generally, palliative care and medication is administered to alleviate symptoms, relieve pain, or reduce discomfort; it is not administered for a curative purpose. Palliative care also extends beyond medical care to mental health, emotional, and spiritual needs.
Curative Care & Preventive Care
Curative care differs from palliative care. It seeks to cure or treat disease, not to just alleviate symptoms or pain, although those would be effects of successful curative treatment. It differs from preventive care, which focuses on preventing the appearance of disease through preventive measures such as immunization, exercises, diet, and/or other lifestyle changes.3 These are the most common forms of care people think of when generally considering medical care.
All too often, curative care is imposed on a seriously or terminally ill person in opposition to the person’s stated wishes, or they are coerced into it by family members.
Concluding Thoughts & Advice
Everyone should have the right and access to good palliative care in the face of serious or terminal illness, according to their wishes. I don’t think the care received in Christian Science nursing facilities constitutes palliative care. Little to nothing is done to relieve symptoms or pain. I’m sorry, but prayer alone does nothing to relieve either, and propping up pillows and changing one’s body position doesn’t do much. At most, prayer has a meditative effect and could possibly calm a person’s mental state, possibly providing some distraction, however if excruciating pain is ripping through your body, I don’t see how one could even begin to achieve a meditative state. When dealing with what I believe were kidney stones, I tried to pray about it in Christian Science, but the pain was so extreme, I could think of nothing else but finding relief, which I found via a hot shower. Ultimately, a naturopathic solution brought me a cure and the stones passed. However, if a person explicitly wishes to have Christian Science care exclusively, then those wishes must be respected. If a person elects not to seek curative treatment for a disease, and just palliative care, those wishes must be respected.
A concluding thought I will leave you all, dear readers, is this: get a living will and/or put in place an advance directive. These documents allow others you trust to make decisions for you if you become unable to, and/or outline your instructions in such an instance. However, it is vitally important that you consult a lawyer who is familiar with the laws in your area. Laws regarding living wills and/or advance directives differ from country to country, state to state, and province to province. Not all jurisdictions use or legally recognize either or both documents.
Of equal importance, is to discuss your intentions with those who would potentially be making decisions on your behalf and ensure that they fully understand your wishes, and will carry them out no matter what. While neither of my parents had living wills, and living wills are not used where they lived, they both had been verbally explicit to me over the years about how they wanted to be cared for if they faced serious illness. In my father’s case, he ultimately was rendered unable to make or articulate his own decisions after he was admitted to the hospital, so I acted on his behalf according to his wishes as I had come to understand them over many conversations over several years. In the face of a diagnosis that offered no hope of a successful curative outcome, I requested palliative care for him only.
Thinking about end-of-life, and potential serious illness is an uncomfortable topic, but it is one that shouldn’t be ignored. If your intentions and desires are not clearly spelled out and understood by those close to you, you could be subjected to treatment you do not want, or no treatment at all when you desire otherwise. As the Boy Scouts say, be prepared. I for one, am going to take care of this for myself now.
1 “WHO Definition of Palliative Care.” World Health Organization. World Health Organization. n.d. Web. 24 September 2014. <http://www.who.int/cancer/palliative/definition/en/>
3 “Curative care.” Wikipedia. Wikimedia Foundation, Inc. 24 December 2012. Web. 24 September 2014. <http://en.wikipedia.org/wiki/Curative_care>