Right Now It Is Access To Contraception, What Happens When They Find Out About Hospice?

The Doctrine of Double Effect; How Will The GOP Deal With Moral Questions That Surround Hospice?

For the past few weeks, the political debate has centered around access to contraception. What is going to happen when social conservatives find out the truth about hospice care? Hospice is designed to care for people at the end of life; to help people die with dignity and as pain free as possible. The "pain free as possible" part of hospice care must certainly enter into our conversation of moral absolutes as we travel back in time. How can those so caught up in the pro-life issue that they seek to rid this country of contraception because it is, in their minds killing, ignore the very premise of hospice?

Believe it or not, palliative care is that which specializes in the treatment of pain and in so many cases, that treatment to relieve pain, hastens death. Where do social conservatives and pro-lifers stand when they come to realize that those increasing doses of morphine depress the respiratory system, and as the dosage keeps increasing, the respiratory system becomes more and more compromised. We all know, or should know what happens then. People die...

Doctors know it, nurses know it, social workers know it. It is the unspoken fact that surrounds hospice care, and at this point in the devolution of social conversation and religious intervention in health care, why hasn't hospice care also come front and center?

The Doctrine Of Double Effect

Are people dying sooner because their pain is being treated? The answer, quite simply, is yes. Doesn't this fact alone make hospice a realistic target for all conscientious believers and advocates for life? Shouldn't hospice then, in addition to contraception, be inaccessible in this country? As such a 'Christian' and moral country, how can we stand by and allow hospice care to continue? One would think that anyone who assists in hastening death is doing something wrong. Come on, all of you evangelicals! Speak up and be counted for life! Add hospice care to the list of choices you want to ban...

Hospice care is governed by what is called "The Doctrine of Double Effect". Never heard of it? Those involved with hospice usually have and interestingly enough, it is a doctrine that was developed by the Roman Catholic Church. Put simply, this theory lays out the argument in this manner:

Our motives are to do something good (controlling pain), but by doing this good thing, chances are that the good thing will cause something bad (the patient's death). This, of course, is the simplest of explanations of the doctrine. For those who have a mind that requires details, here goes:

The New Catholic Encyclopedia provides four conditions for the application of the principle of double effect:

  1. The act itself must be morally good or at least indifferent.
  2. The agent may not positively will the bad effect but may permit it. If he could attain the good effect without the bad effect he should do so. The bad effect is sometimes said to be indirectly voluntary.
  3. The good effect must flow from the action at least as immediately (in the order of causality, though not necessarily in the order of time) as the bad effect. In other words the good effect must be produced directly by the action, not by the bad effect. Otherwise the agent would be using a bad means to a good end, which is never allowed.
  4. The good effect must be sufficiently desirable to compensate for the allowing of the bad effect.

This is the doctrine that has guided much of hospice care. St. Thomas Aquinas is said to have formulated the doctrine and it is used to guide ethicists in many situations, not just hospice. It is probable that the dispensing of larger and larger doses of morphine never entered Aquinas' mind when he conceived of this idea.



Will Hospice Care Become A Target Of The GOP?

I support hospice. I believe that people who are terminally ill, in pain and suffering, should be kept as pain free and comfortable as possible. I do NOT believe that people who are at or near the end of their lives should be killed or euthanized.

This article is an attempt to start a conversation. I fear that once started, in this present climate of politically-motivated culture wars, the battle lines will be drawn. I want to know what the candidates think, or if they have even thought about hospice.

Try as I might, I am unable to find accurate statistics in regards to hospice population; it is estimated that over one million patients a year utilize the services of hospice, whether at home or in facilities.

Quite frankly, with an ever increasing senior population that have hospice benefits with their Medicare, I am surprised there are not more statistics readily available.

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Comments 7 comments

Brenda Durham 4 years ago

Although you make some good points here, there does remain some differences in the two issues. Hospice patients are usually adults, not helpless babies. And even more usually, they've had a living will drawn up. Their own personal choice about themselves, not about some other person's life.

Actually, your comparison would've made more sense if you compared abortion to hospice care anyway (even though it still would be different!) Because the contraception issue wasn't really even about basic contraception; it was about Obama trying to force the Catholic Church to incorporate contraceptives and the the responsibility for PAYMENT of contraceptives into their Church.


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Jillian Barclay 4 years ago from California, USA Author

Dear Brenda,

I was going to leave it up to the politicians to make the comparisons, but you make a good point!


Brenda Durham 4 years ago

I should say, though, that this subject is valid. It's a tough one too. And actually becomes tougher as the medical field gains more knowledge and more life-saving devices. Strange how a good thing like medical knowledge can cause greater dilemma about other situations.


HSchneider 4 years ago from Parsippany, New Jersey

Why are you trying to rile up the Far Right more? Don't they oppose and hate enough? You make great points about hospice care. Giving the dying a respite from pain is most certainly worth the shortening of life effects. That is, of course, if they give permission. It is humane and proper in my opinion. Great informational Hub as always, Jillian.


Jillian Barclay profile image

Jillian Barclay 4 years ago from California, USA Author

Dear H,

I want the GOP spread so thin and to go so far right that thinking people will know that a vote for any Republican is a vote for extremism in every area...


AKA Winston 4 years ago

You are mistaken about pain control causing death. Opiods may supress respirations, but only in those who are sedated or who receive too high of initial dose. Unlike some other drugs, morphine has no upper limit and sometimes it takes huge amounts to control pain.


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Jillian Barclay 4 years ago from California, USA Author

Dear AKA Winston,

I have not said that pain control causes death, but that adequate pain control hastens death in many situations. My statements are backed by dozens of studies. One such study, featured in The Journal of Hospice and Palliative Nursing:

The Rule of Double Effect and Its Role in Facilitating Good: How Nurses Apply the RDE to End-of-Life Decision Making, points out,

When experienced hospice or palliative care nurses speak about titrating morphine to manage dying patients' symptoms of pain or suffering, most readily acknowledge the possibility of secondarily hastening death. Several oncology nurses wrote about instances of opiate-related hastened death on questionnaires they completed about their EOL nursing practices. "I do not know of any nursing colleagues who have not increased a morphine drip to increase comfort, and most likely hastened death..."

I am not suggesting that clinicians seek to kill people. They seek to control pain and the provision of effective pain control has an outcome which comes as no surprise to most medical professionals.

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