Caring for Souls at the End of Life: The Limits of Medicine and Hospice Care
Joshua Snyder, Boston College
In responding to this year’s theme of “At the Limits of Medicine: Caring for Body and Soul” this paper argues for the limits of medical intervention at the end of life while expanding access to hospice care. Specifically, this paper will show the need for a complementary understanding of the roles of medicine and religion in order to incorporate holistic care into more clinical settings. Often times the current technocratic paradigm views health care as merely the application of the latest scientific knowledge and technique without concern for the spiritual nature of the human being. In opposition to this current trend, this paper will address how illness, health and healing are religious experiences requiring analysis through a theological-ethical paradigm. Specifically, this paper will highlight the importance of integrating a holistic approach to end of life care that acknowledges the limits of modern medicine.
First, the paper will offer a brief overview of the development of hospice care within the United States health care system. According to the World Health Organization, hospice “care refers to the comprehensive management of the physical, psychological, social, spiritual, and existential needs of the patient.” This type of end of life care affirms life and regards dying as a natural process and a profoundly meaningful experience for the patient and the family. Hospice care challenges our present societal understanding of death as a medical phenomenon to be managed. Death has become one more choice within the context of a “medicalized” view of life. According to the “managed death” paradigm, the values holding pride of place are individual autonomy, independence and personal rights. This perspective is problematic in that it is a highly individualized conception of the human person that does not take into account the interconnectedness of human life and the holistic needs of the dying patient.
The second part of the paper focuses on the ethical obligation to expand access to holistic care at the end of life. While hospice care offers a viable alternative to the managed death paradigm, not all forms of care are equal. The statistics are alarmingly clear that nearly eighty percent of hospice recipients are white males dying of cancer. Those underserved by hospice care “include people of color; non-English-speaking people; those who reside in inner cities or in isolated rural areas; those who are living with advanced pulmonary disease, liver disease, heart failure, or dementia; and those with dual diagnosis that include addictions, developmental disability or serious mental illness.” As a matter of justice, underrepresented communities have a right to demand hospice care. Quality end of life care needs to be community-based and integrated into a continuum of care the meets both the patient and community needs and values.
First, the paper will offer a brief overview of the development of hospice care within the United States health care system. According to the World Health Organization, hospice “care refers to the comprehensive management of the physical, psychological, social, spiritual, and existential needs of the patient.” This type of end of life care affirms life and regards dying as a natural process and a profoundly meaningful experience for the patient and the family. Hospice care challenges our present societal understanding of death as a medical phenomenon to be managed. Death has become one more choice within the context of a “medicalized” view of life. According to the “managed death” paradigm, the values holding pride of place are individual autonomy, independence and personal rights. This perspective is problematic in that it is a highly individualized conception of the human person that does not take into account the interconnectedness of human life and the holistic needs of the dying patient.
The second part of the paper focuses on the ethical obligation to expand access to holistic care at the end of life. While hospice care offers a viable alternative to the managed death paradigm, not all forms of care are equal. The statistics are alarmingly clear that nearly eighty percent of hospice recipients are white males dying of cancer. Those underserved by hospice care “include people of color; non-English-speaking people; those who reside in inner cities or in isolated rural areas; those who are living with advanced pulmonary disease, liver disease, heart failure, or dementia; and those with dual diagnosis that include addictions, developmental disability or serious mental illness.” As a matter of justice, underrepresented communities have a right to demand hospice care. Quality end of life care needs to be community-based and integrated into a continuum of care the meets both the patient and community needs and values.