THE ASSOCIATION OF CATHOLIC NURSES | Archdiocese of Birmingham

CATHOLIC TODAY OCTOBER 2007

I am a qualified nurse (RGN) and want to specialize in the care of the dying . The Joffe Assisted Dying for the Terminally Ill Bill , although blocked by the House of Lords , is often discussed by my nursing colleagues . I want to care for the terminally ill but I want also to be able to follow my conscience which is informed by my Catholic Faith. Can you give me or advise me on this issue both regarding current thinking and any new developments?

Ethical debates about what is morally or spiritually acceptable in medical or nursing practice are not new. The principle of the duty of primum non nocere or non maleficence was inscribed into the Hippocratic Oath around 425 BC ‘I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art.’( Maryvale, 2004 ) Such issues remain debated because as practices in society change old debates do take on new concepts and meanings.

Jim Dobbin (2007) and Baroness Finlay (2006/07) have both presented private members Palliative Care Bills that have moved quickly through three successful readings in the House of Lords campaigning for a necessary government funded expansion of treatment and care services for the terminally ill and the controversial Joffe Assisted Dying for the Terminally Ill Bill (HMSO,2004) to legalize assisted dying for the terminally ill, blocked on its third attempt by the House of Lords May 2006 still hangs around waiting for a further submission. Voluntary euthanasia or assisted dying requested by the patient, non-voluntary euthanasia of a person who lacks capacity and involuntary euthanasia or taking of a life against the wishes of the patient all become legal possibilities if the Joffe Bill becomes passed. The Mental Capacity Act (HMSO,2005) to be introduced in two stages April and October 2007 states ‘A person must be assumed to have capacity unless it is established that he lacks capacity’ and ‘is not to be treated as unable to make a decision merely because he makes an unwise decision’ prohibits judgements of a person’s capacity by ‘a person’s age or appearance’ or ‘ an aspect of his behaviour which might lead others to make unjustified assumptions about his capacity’ . The Mental Capacity Act relates to persons over 16 years (children under 16 can still claim capacity under the Children Act (HMSO,1989), persons must be over 18 years for some decision making processes and the act empowers professionals carers and family and friends to make best interest decisions about health and property for persons who they deem to lack capacity. Whilst ill treatment and negligence by a carer can incur a criminal liability to prosecution the possibility of legalized euthanasia opens new concerns about what is in the best interest of the patient if care places too many demands on carers or earlier gain from inheritance of money or property influences decisions of carers. If a person is deemed to have capacity but makes an unreasonable decision are all the possible situational variables such as poor diet or medication or violence or intimidation from relatives fully considered when such an unreasonable decision is made. The Department of Health document Human Rights in Healthcare (DH,2007) provides a guide to local NHS Trusts and makes some attempt to protect basic rights within healthcare including the right to dignity and to religious belief that are at risk of being overlooked as local strategies become shaped by national economic constraints.

The Professional regulatory bodies of nursing and medicine do provide guidance and conscience clause exits where there is ethical conflict with personal belief but may also suspend a doctor or nurse deemed unfit to practice within a particular work practice area. Doctors and nurses divert more easily ,once trained, into areas that produce less ethical conflict with personal beliefs but will rarely ,if ever, be completely able to avoid all ethical dilemmas .The Royal College of Psychiatrists (2007)acknowledges ‘the problem of good and evil and a wide range of specific experiences invested with spiritual meaning’ occurring around birth ,death and other life experiences that should be acknowledged in healthcare delivery.. Some information on the diverse nature of spirituality usually exists within palliative care because of the holistic nature of terminal care when dealing with death. Searches for such information in other areas of health delivery can be somewhat heuristic because there is often little or no reference to spirituality in professional journals or website content of professional organizations Teaching on the spiritual dimensions of healthcare practice and specifically Christian or Catholic resources for studying spirituality within health are usually those that are provided by the Churches. The authoritative magisterial teachings of the Vatican documents such as Evangelium Vitae (Pope John Paul II,1995) presented more pragmatically for everyday practice by documents produced by the Bishops’ Conference of England and Wales such as Cherishing Life (2004)or Care not Killing Resource Materials (2006) can provide valuable material for individual study or lectures, discussion and debate on a range of contemporary ethical concerns

Access to more information on Vatican and UK documents and recent UK legislation listed above and to the Royal College of Psychiatrists website is available on our national and archdiocesan websites www.catholicnurses.org.uk and www.catholicnursesbham.co.uk .

References

Bishops Conference of England and Wales (2004) Cherishing Life ,London ,CTS Available online http://www.catholic-ew.org.uk/cherishinglife/contents.htm

Bishops Conference of England and Wales (2006) Care not Killing Resource Materials, London, St Mary’s College. Available online http://www.catholic-ew.org.uk/cnk/briefmaterial.pdf

DH (2007) Human Rights in Healthcare, London, Department of Health Available online http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073473

Dobbin,J (2007) Provision of Palliative Care Bill 2007, London ,HMSO

Available online http://www.publications.parliament.uk/pa/cm200607/cmbills/040/2007040.pdf

Finlay,J Baroness (2006/07) Palliative Care Bill, London,HMSO

Available online http://www.publications.parliament.uk/pa/ld200607/ldbills/004/2007004.pdf

HMSO (1989) The Children Act,London,HMSO Available online http://www.opsi.gov.uk/acts/acts1989/Ukpga_19890041_en_1.htm

HMSO (2004)Assisted Dying for the Terminally Ill Bill,London,HMSO Available online

http://www.publications.parliament.uk/pa/ld200304/ldbills/017/2004017.htm

HMSO (2005) The Mental Capacity Act , London,HMSO Available online http://www.opsi.gov.uk/acts/acts2005/20050009.htm

Maryvale Institute (2004) Fundamental Themes in Christian Ethics, Birmingham,Maryvale Institute

Pope John Paul II (1995) Evangelium Vitae ,London,CTS available online http://www.vatican.va/edocs/ENG0141/_INDEX.HTM

Royal College of Psychiatrists (2007) Spirituality and Psychiatry Special Interest Group available online http://www.rcpsych.ac.uk/college/specialinterestgroups/spirituality.aspx

Mary Farnan

Association of Catholic Nurses

Archdiocese of Birmingham

Article abridged for submission

CATHOLIC TODAY FEBRUARY 2007

WORLD DAY OF THE SICK

Article by Mary Farnan

Sunday 11^th February 2007 ,the liturgical feast day of Our Lady of Lourdes will also be the fifteenth World Day of the Sick of the Catholic Church. Each year, since the institution of the World Day of the Sick by Pope John Paul II in 1992 , a papal message has been delivered and a country and an appropriate theme has been selected to host the event for the universal Catholic Church internationally. In 2007 the World Day of the Sick will be hosted by Seoul, Korea focusing on ‘The Spiritual and Pastoral Care of the Patients with Incurable Illnesses’.The World Day of the Sick recognizes that we are physical, psychological, emotional and spiritual beings and that our spirituality is of significant importance to our whole being or state of health. .A definition of Spirituality by the Royal College of Psychiatrists states:'

In healthcare ,spirituality is identified with experiencing a deep seated sense of meaning and purpose in life,together with a sense of belonging.It is about acceptance,integration and wholeness'

'According to one definition "The spiritual dimension tries to be in harmony with the universe,strives for answers about the infinite, and comes especially into focus in times of emotional stress, physical and mental illness, loss, bereavement and death" This desire for wholeness of being is not an intellectual attainment ,for it is no less present in people with learning disability, but lies in the essence of what it means to be human .'

From the spiritual perspective, a distinction can be made between cure, or relief of symptoms, and healing of the whole person. Life is a perpetual journey of discovery and development, during which maturity is often gained through adversity.The relief of suffering remains a primary aim of health care,but it is by no means the whole story'

(http://www.rcpsych.ac.uk)

Anyone who has been to Lourdes must have some appreciation that illness is not just a physical event –that physical illness in fact also affects us psychologically, emotionally and spiritually. Mental Illness likewise can psychosomatically produce signs and symptoms of physical ill health –the body , mind and soul in fact function as one. To be at Lourdes is to recognize that people of many languages, colours and cultural backgrounds can be united in a singular belief in the existence of God and the power of Our Lady to care and intervene where human suffering exists. Miracles may be performed or there may be an inner conversion to accept what cannot be changed or as St Augustine of Hippo is quoted to have said ’Thou has made us for Thyself’ to learn to recognize the existence of God and to come face to face with one’s own spirituality at a deeper level. The manifestation of faith at Lourdes reflects spiritual belief of the global Church body of people and supports recognition that St Augustine’s belief in the innateness of spiritual belief has not been not erased by the scientific enlightenment of recent centuries or contemporary existentialism or post modern destructuralism. The 20^th century molecular geneticist Dean Hamer in ‘The God Gene:How Faith is Hardwired into our Genes’ 2005 states confidently that ‘spirituality is one of our basic human inheritances’.

Pope John Paul stated in his first message for the World Day of the Sick hosted at the shrine of Our Lady in Lourdes ‘The Christian community has always paid particular attention to the sick and the world of suffering in its multiple manifestations.. This day, which, beginning in February 1993, will be celebrated every year on the commemoration of Our Lady of Lourdes, for all believers .’.to be ‘a special time of prayer and sharing, .....On the commemoration of Our Lady of Lourdes, ….in spiritual communion with the whole Church’ Pope John Pauls inaugural letter for the First World Day of the Sick reached out to those afflicted or suffering ill health ,to health care workers and chaplains of spiritual care to the sick::

‘To you, dear sick people all over the world, the main actors of this World Day, may this event bring the announcement of the living and comforting presence of the Lord. Your sufferings, accepted and borne with unshakeable faith, when joined to those of Christ take on extraordinary value for the life of the Church and the good of humanity.

For you, health-care workers called to the highest, most meritorious and exemplary testimony of justice and love, may this Day be a renewed spur to continue in your delicate service with generous openness to the profound values of the person, to respect for human dignity, and to defence of life, from its beginning to its natural close.

For you, Pastors of the Christian people, and to all the different members of the Church community, for volunteers, and particularly for those engaged in the health-care ministry, may this World Day of the Sick offer stimulus and encouragement to go forward with fresh dedication on the way of service to tried, suffering humanity.’

Subsequent World Days of the Sick have been hosted in 1994 Czestochowa, Poland, 1995 Cote D’Ivoire Africa, 1996 Mexico City, Mexico, 1997 Fatima ,Portugal, 1998 Loreto, Italy, 1999 Beirut, Lebanon, 2000 Rome, Italy, 2001Sydney ,Australia, 2002VailanKanny, India , 2003Washington DC,USA, 2004 Lourdes,France 2005 Yaounde, Cameroon,Africa, and 2006 Adelaide Australia.

Pope Benedict XVI has continued the World Day of the Sick established by his predecessor and in his message for the World Day of the Sick 2006 in Adelaide focusing on ‘Mental health and human dignity ‘states ‘ I would here like to address myself to you, dear brothers and sisters burdened by illness, so as to invite you to offer your condition of suffering, together with Christ, to the Father, certain that every ordeal received with resignation is meritorious and draws the benevolence of God upon the whole of mankind. I express my appreciation to those who help and care for you in residential centres, day hospitals and wards providing diagnosis and treatment, and I exhort them to strive to ensure that medical, social and pastoral assistance for those in need which respects the dignity specific to every human being is never absent. The Church, in particular through the work of chaplains, will not fail to offer you her own help, being well aware that she is called to express the love and care of Christ for those who suffer and for those who look after them. I commend pastoral workers and voluntary associations and organisations to support – in practical forms and through practical initiatives’.

Much contemporary nursing and medicine is historically rooted in the corporal works of mercy administered by religious institutions to those in need .Scientific advances improve the quality of life and life expectancy but do so in a move to more secularised healthcare care within a fragmented individualistic society where religious belief still exists but is often ignored.If healthcare delivery is not responsive to spiritual needs the service provided will never recognize or completely heal the holistic needs of the person.. Pope John Paul’s final World Day of the Sick Message in 2005 stated the ‘"World Day of the Sick aims to stimulate reflection on the subject of health". This message is still relevant if we are to influence the type of health care we practice or expect to receive-The World Day of the Sick is not only for those working in healthcare ministries –it is relevant to all Catholics.

CATHOLIC TODAY DECEMBER 2006

SPENDING CHRISTMAS IN HOSPITAL

Article by Mary Farnan

CATHOLIC TODAY OCTOBER 2006

Article by Chris Barber who writes on behalf of The Association of Catholic Nurses organization which exists to spiritually support nurses and health care assistants in their vocation