Church and Palliative Care, The

Health Progress, Jan/Feb 2005 by Place, Fr Michael D

I am writing this on a flight home from Rome, where I attended the 19th International Conference of the Pontifical Council for Health Pastoral Care. Before and after the conference, the continental delegates who constitute the board of the International Federation of Catholic Health Associations (AISAC) met. I will begin with a few observations on the AISAC meeting and then turn to the conference's subject: palliative care.

AISAC

A regular component of the AISAC agenda is a report by each delegate on the condition of Catholic health care in his or her part of the world. For me, it is always an opportunity to expand my appreciation of the rich and diverse nature of the ministry across the world. Although these reports are never short on problems, this year's reports were quite sobering. While there was great variety in the specific matters discussed, the general conclusion was that Catholic health care was experiencing a time of significant challenge to its ability to maintain its identity.

As a result of our discussion, it was agreed that two of the delegates will prepare a "basic text" (we Americans would most likely call it a "white paper") that would, first, characterize the themes common to the international experience of the health care ministry and, second, outline some initial opportunities for collaboration. Reflecting on our conversations, I would expect the "basic text" to consider health issues, such as the pandemic of HIV/AIDS; deliver)' issues, such as the cost of pharmaceuticals; economic issues associated with the increasing commodification of health care delivery; public policy issues resulting from the increasing cost of health care and the desire of many governments to realign existing government responsibility for supporting access to health care services; ecclesial issues, such as relations with bishops and episcopal conferences; leadership issues often associated with the changing demographics of religious life; and structural issues concerning the best ways to organize and manage the ministry civilly and ecclesially.

Although it will not be easy to provide coherence to the dimensions of these issues, all of which are held in common, it will be still more difficult to discern the "value added" opportunities for common or shared activities. The possibility of such activity will not be new to Catholic health care in the United States. We are aware of the activities of Catholic Relief Services and the Catholic Medical Mission Board. In addition, within the ministry, there is the Catholic Consortium for International Health Care, a U.S.-based effort to support health care in the Third World. Many institutions and systems also provide opportunities for medical "missions" to various nations. At issue now will be whether, in addition to these activities, there will be other opportunities for international solidarity within the ministry. Stay tuned!

PALLIATIVE CARE

Now to the International Conference: The attendance at this year's meeting was significantly higher than in recent years. There also were more practitioners, particularly nurses, from across the world. Clearly, the topic addressed a very real need.

As I reflect on two and a half days of talks (dialogue was not part of the conference agenda), there are three aspects, among the points of discussion, that I would like to highlight.

Consensus Regarding the Challenge Unlike some international meetings, in which much time can be spent debating definitions and defining the problem, this meeting got quickly down to business. One explanation for this clarity is the significant role the World Health Organization (WHO) plays in much of the world. While we Americans tend to rely on our federal health agencies for expertise and guidance, much of the world-most especially developing nations-rely on WHO. For WHO, increasing access to palliative care is an international priority.

What I found quite interesting was the holistic approach to palliative care taken by WHO and others. Palliative care is commonly understood to include the improvement of quality of life on the part of a patient and family facing life-threatening illness through the relief of suffering by addressing the physical and psychological needs of patient, family, and. caregivers. Palliative care's focus also goes beyond death to include bereavement. Though this expansive definition would not include control of pain not associated with life-threatening illness, conference speakers proposed that tens of millions of persons across the globe would benefit from palliative care. In fact, one speaker argued that few people who need palliative care actually receive it.

As for why this is the case, the international analysis, as summed up by conference speakers, was strikingly similar to what advocates of palliative care in the United States speak of as barriers: lack of political support, social prejudices, the size of the affected population, limited health care resources, deficiencies in the training of health care professionals, and legal and regulatory barriers to providing medications-especially opioids.