Palliative care as a Christian response to suffering at the end of life

Nedenstående artikel er et supplement til artiklen af John Wyatt om eutanasi, som blev bragt i årsskriftet Serpens Aeneus 2018 (læs denne artikel her).

By John Wyatt

Perhaps the most influential individual in the development of modern palliative care was the Christian physician Cicely Saunders. She pioneered a new way of caring for dying people that went round the world, and her remarkable initiative still reverberates today.

One of her most profound insights was the concept of “total pain”. An elderly person was dying of cancer. There was gnawing and continuous physical pain because the cancer cells had invaded the bone. But there was also mental or psychological pain, anxiety about what each day might bring. Perhaps there was despair and a sense of hopelessness at the recognition that life was coming to an end. Then there was relational pain, concerns about the effect of the cancer on a spouse or child.

And finally there was spiritual pain, maybe from feelings of guilt from past events, or a sense of the meaninglessness of existence. Cicely realised that each form of pain had to be addressed in order to maximise the well-being of the patient, and where possible the family and relatives too, over the critical hours and days as death approached.

Not just physical pain but all unpleasant symptoms, nausea, itching, cough, dry mouth and so on, were to be addressed in painstaking detail with skilled nursing care. Psychological pain was tackled with human contact, friendship, music, humour, encouragement of hobbies and interests, as well as professional counselling and support when necessary. Relational pain was approached by supporting and encouraging family members to be present and encouraging openness and honest communication.

And spiritual pain was addressed by placing prayer and worship at the centre of the community she was forming, inviting patients to celebrate communion (often in beds and wheelchairs) in the Chapel which was placed symbolically at the centre of St Christopher’s, a purpose-built hospice that she designed and led.

Cicely pioneered an approach which put the dying individual at the centre of care. There is endless meticulous attention to mouth care, bathing sore eyes, putting cream on itchy skin, placing cushions between aching knees. But above all Cicely and her colleagues discovered that it is not primarily about doing things to patients – it is about “being there” for each individual.

“Suffering is not a question which demands an answer, it’s not a problem which demands a solution, it’s a mystery that demands a presence”.

Through a number of intense and personal experiences of caring she learnt that “it was possible to live a lifetime in a few weeks; that time is a matter of depth, not length; that in the right atmosphere and with pain controlled so that the patient is free to be herself, the last days can be the richest, they can be a time of reconciliation that makes the dying peaceful and the mourning bearable.”

One of the best known of her sayings is: “You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.” “To live until you die” became one of the slogans of a new kind of caring and the foundation of the medical specialty of palliative care.

På Kristelig Lægeforenings årsmøde i Svendborg den 5.-8. oktober 2018 holder John Wyatt blandt andet en tale med overskriften "Suffering - a mystery which needs a presence". Se programmet for årsmødet her.