Catholic Medical Quarterly Volume 65(4) November 2015
European Federation of Catholic Medical Associations (FEAMC). Paris, April 2015
Dr Ian Jessiman
No one who has been to Paris can have failed to notice the Basilica of the Sacré Coeur towering over the city from its hill of Montmartre. Less well known is that there is a pilgrim hospice there run by Benedictine Sisters, chiefly to accommodate those who come the spend the night, or some part of it, in the perpetual adoration of the Blessed Sacrament. They also cater for others who come for religious meetings or conferences, and so the European Federation of Catholic Doctors came for their spring bureau (council meeting). Accommodation was simple but entirely acceptable and meals provided were of a high standard.
The basilica itself, an art nouveau structure, had been paid for by public subscription, following a vow, and was finished in 1914. The chapel of St Luke, SS Cosmas and Damian (the Chapel of the Doctors) was paid for by the then two French Catholic Doctors Guilds, making it a particularly appropriate place for FEAMC to meet! In the chapel is a statue of St Rita, patroness of impossible cases (canonised in 1900),
Most of the delegates arrived on the Thursday afternoon allowing time to explore some of Paris, although there was a more formal tour of the Sainte Chapelle and Notre Dame on Friday morning.
Friday afternoon was given over to a meeting, attended also by members of the French Catholic doctors’ association, to discuss ‘End of Life in Europe’. We learned that in France lawyers are opposed to any ‘conscience clauses’ in legislation and their supreme court limits their application as much as possible. The French mindset is that insuperable suffering has to be relieved so the use of deep sedation and ‘living wills’ is recognised. The unfortunate and loaded term ‘useless’ is often used in regard to end of life situations.
The Council of Europe, notably in the Oviedo Convention, emphasises autonomy and endorses beneficence and non-malevolence. Advance directives are upheld by the convention, but must be updated no less than three yearly. There are mediation committees for these in USA whilst in Europe such matters commonly come before the courts, leading to ‘collective decisions’. For us hydration and nutrition are not options but essential measures.
In Germany there has been intense debate. From being largely opposed to euthanasia (for historical reasons) ‘popular opinion’ now seems to be in favour, whilst doctors and legislators remain opposed. There is no active euthanasia and assisted suicide is not permitted. Therapy, however, is seen to be to relieve pain and suffering, not specifically to sustain life.
Terminal sedation is used in palliative care centres in France, but the definition depends on the length of the period for which it is applied. Palliative care physicians need to be clear what they are doing. Some 3-5% of patients may need continuous sedation towards the end of life, and properly used (with occasional intervals) this is not euthanasia, nor is it intended to be. In competent and organised hands it is not a disguised response to a request to bring life to an end.
The question of alimentation and hydration was discussed. Is this care or therapy? Treatment is in the hope of recovery, not merely to prolong life. The CDF have said that alimentation and hydration are ‘ordinary measures’ and ‘proportionate means’. Whenever possible oral measures are to be chosen.
Patients and doctors may judge when treatments have become inappropriate. If the doctors has managed it all well, there should be no call for euthanasia. But primary care has changed and health services are no longer from cradle to grave – there is no longer the continuity. Having fewer priests also affects the provision of spiritual care. In Holland there is now an end of life clinic in the Hague, which can end a patient’s life in spite of his being already under the care of another doctor. In any event we must assure the patient of our continuing care.
Dr Sonkin, a Paediatrician from Moscow, explained that in Russia life-sustaining treatment cannot be withdrawn. Although, in theory, a patient can refuse inappropriate or burdensome treatment, the obligation to provide it remains with the doctor or hospital, so he will receive it nevertheless. No resuscitation, however, is given to those with an incurable disease. In Russia euthanasia is defined as hastening death by act or omission or by discontinuation of life sustaining treatment. There is no professional self regulation. There is no palliative care, virtually no opiates, and treatment is often done without consultation (with the family, etc.) Vitalism (sustaining life at all costs) is the prevailing Russian outlook and the Orthodox Church seems happy to accept this.
Each evening, after supper, there was compline at 9.30 and Mass at 10pm. There was no choir but the singing at mass was clearly and very beautifully led by one of nuns. After this mass each night the watching (perpetual adoration) follows.
The Saturday was taken up with the board meeting. One statute was altered to fit in with the FIAMC statutes as approved by Rome. In the evening we enjoyed dinner at Chez Eugene in the Place du Tertre, a very pleasant affair, and finished in time to get to the 10pm Mass (for the Sunday)! On the Sunday we were free to leave, be shown around Montmartre, or explore Paris again on our way home.