Concept statement of the Synodal Department for Charity and Social Ministry of the Ukrainian Orthodox Church

The number of such people in our society constantly grows today. Apart from purely physical negative manifestations of illnesses, the final days of the earthy life of many patients are accompanied by distress of soul, fear of death, feeling of personal helplessness, absolute loneliness, isolation, anxiety over the fate of their relatives and dear ones. At the same time, the effective measures and means of assistance to such patients and their families are non-developed or absent in our society.

The so-called palliative assistance can facilitate solving the problems that the incurable patients are faced; in its modern meaning it is considered as a complex system of social, medical, spiritual and psychological measures, aimed at full-scale support of a patient in case of incurable diseases.

Unlike specialized medical assistance, oriented at healing a disease, palliative assistance is primarily concerned with easement of the physical condition of a patient – pain relief and removal of other negative manifestations of a disease (symptomatic treatment), facilitation of his/her spiritual and emotional state, it also attempts to improve existence conditions of a patient and his/her encirclement.

Among the problems emerging in Ukraine in connection with the introduction and implementation of the system of palliative assistance, there are problems of ideological, axiological and spiritual character, the problems concerning conceptualization of palliative assistance as such, its place and role in modern medicine and society on the whole, its content and actual ways of organization of palliative assistance, and the society’s attitude to incurable patients.

That is why the Ukrainian Orthodox Church finds it necessary to declare her attitude towards and her position concerning the problems mentioned, and possible ways of their solution.

1. Conceptualization of palliative assistance from the perspective of the Orthodox doctrine

1.1 The Orthodox Church, proceeding from her doctrine, considers the last days of human life as the time preceding direct encounter with God, which has to be filled with special spiritual content, worthy of man as the image and likeness of God.

The Church emphasizes that death, being a tragic consequence of man’s secession from God, at the same time is the doors to the future life of man, his second birth, sacrament, in which the way to the new life and the succeeding renewal of man in perfection of his nature due to the salutary sacrifice of Christ.

According to the doctrine of the Holy Fathers, the primary organization of man’s nature supposed hierarchical subordination of the body to the soul and of the soul to the spirit, and of the spirit – to God, with whom man was supposed to be in continuous connection as the source of his own being.

The original sin – the self-will of man towards the God-given commandment – broke the communion of man and God and transformed the very nature of man, which began its autonomous existence under conditions of surrounding physical reality. At the same time the nature of the surrounding world – the earth – becomes the main source of existence of man, subjecting him to its laws. The original order of organization of the human nature changes for diverse: the spirit starts feeding from the soul, the soul – from the body, the body – from the material world. The soul obeys the needs and whims of the body, becomes its hostage. The spirit comes under command of the passions – sufferings of the soul. Physical abilities of man become principally finite, and the death he can experience – inevitable.

Restoring communion of man and God, Christ the Savior restores the very nature of man, releasing him from the power of sin and death through His free-will sufferings, death on the Cross and Resurrection. Indivisible and unconfused union of the divine and human natures in Christ makes mutual communion of God and man possible, both in the plane of the sufferings and death and of the resurrection and eternal life. From now on the pre-mortal sufferings and death unites man with the death and sufferings of the Savior, and the free and conscious union with Christ in the Sacraments of the Church enables each man reunite with God and inherit the Kingdom of Heavens and the life of the age to come.

1.2 The ideological stance of the Church, which immediately ensues from the Orthodox Christian doctrine, is that whatever level of development the science might reach, it would never be able to overcome diseases and death.

That is why the Church believes that the aims, declared by the modern medical biological science as for the final victory over death and the unlimited continuation of human life are not absolute, and achievement of these goals for any price is not acceptable either from a religious or socio-historical viewpoint.

At the same time, it should be noted that the quality of life as a purpose, declared by the modern secular medicine, cannot be self-sufficient and complete, since it can serve both spiritual development of man as well as his degradation.

The objectives of medicine, concerning both healing diseases and alleviation of physical condition of a patient by medical means, should be set in order to create such living conditions for man to enable him fulfill his life mission and to grow spiritually in his own dignity.

The essence of medicine should be closely connected to the essence of human existence, and its tasks and objectives should be subordinate to this essence and its discovery by every individual. Confrontation with disease is a struggle for the sense of existence of a human being, for his/her personality, ability to concentrate their spiritual resources and to focus them at the benefit of the soul.

For that reason the medical care can be naturally combined with the spiritual care, it requires cooperation with a patient, it becomes active when it takes into account his/her personality and his/her essence, significance and value are not diminished even when physical abilities of his/her organism are exhausted.

In this case, in combination with spiritual care and various means of support of a patient, the medicine still answers its purpose, working for discovery and comprehension by a patient of his spiritual essence in the first place.

Therein lays the assistance to an incurable patient, only in this meaning the palliative assistance may be considered, only in this perspective the Church may view palliative assistance as an object of her care and attention.

2. Forms and essence of palliative assistance organization

2.1 The Christian Orthodox doctrine considers man as a unique entity, in which the spiritual and physical principles are united. Their close connection is manifested in the fact that physical disorders and pain the body suffers affect the state of mind of human, and at the same time the psychological and spiritual feelings may cause bodily sufferings or increase them. That is why the pains that a patient suffers are total and undifferentiated by nature; they overtake man on the whole as a person and cannot be reduced to exclusively somatic (bodily) factors.

At the same time, alleviation of physical condition of a patient by medical means opens possibilities of delivering assistance to a sick person, which in its turn, facilitates relieving of his bodily pains, and as a consequence, a conscious perception by the patient of his life and death.

That is why the palliative assistance can find its meaningful and functional completion only on condition of such a combination of medical, spiritual, social and psychological measures, when every separate component of assistance will be considered as precondition and means of implementation of the other ones, and all of them will work for the relief of a patient’s sufferings and facilitate spiritually conscious and worthy completion of the earthy life by the sick.

2.2 In accordance with its contents, palliative assistance may be embodied in those organizational forms, which can ensure natural combination of all its components.

In particular, there might be possibilities and conditions created for cooperation of the spiritual counsellors or other persons delivering spiritual care to the patient with medical personnel, social workers and other persons, who immediately patronize a patient. Such cooperation should proceed on a mutually consentient, stable and scheduled basis, it should imply acquaintance of the medical personnel, social workers and other people taking care of patients, with the contents and means of spiritual care.

2.3 Organizational implementation and delivery of palliative care should be carried out in such a way that correlates with existing cultural, religious, historical experience and tradition, and answers the claims and expectations of the society and does not derogate dignity and rights of a patient. In this connection one may pay attention to the following:

1. Probable functional and organizational delimitation of the measures of palliative assistance and specialized medical intervention should not cause alienation of palliative care from the system of specialized medical assistance, exclusion of palliative assistance from the context of the clinical care of the specialized medical institutions, or cause extrusion of incurable patients from the field of action of these institutions, and even more – to refusal of specialized medical assistance to such patients.
The presence of incurable disease and the limited life-term, prognosticated by medical criteria, can be regarded as a certain state of a patient, but not as his status. Thereat, mechanical isolation of incurable patients from other ones may cause psychological and social alienation of this kind of patients, their social exclusion and stigmatization, and in general can be negatively interpreted by social consciousness.

It also should be taken into account that it is also peculiar of the native medical tradition not to make principal division of the patients by their medical prognosis, but to deliver assistance to the sick in those aspects they need, combining active treatment measures with palliative measures.

At the same time, the whole context of rendering assistance to the sick requires presence of the facilities for palliative assistance at the medical institutions which render specialized medical care, both for inpatients and outpatients.

2. Addressing the experience of organization of the specialized establishments of palliative care, i.e. of the hospices, it should be taken into account that being continuation of the common Christian tradition of care for the necessitous, in a part of the modern western society they are specifically conditioned and interpreted. This interpretation is based on the concept of autonomy of human personality and the freedom of self-definition of man at any living conditions.

Thus, the hospice is considered as to some extent a proposition and alternative, intended to create for an incurable patients such conditions, in which he/she could take charge of him/herself and enjoy their lives as long as it is possible.

At the same time, the possibilities of the modern medicine in the sphere of artificial life-sustaining activity of some categories of patients contributed to the fact in some cases hospices served as their place of residence.

Not generalizing from these conclusions and not rejecting possibility of practical application of modern experience of the hospice care in native conditions, the Church believes that in our society the organization and implementation of the hospices should be aimed first of all at providing palliative care to those incurable patients who are devoid of family care, material wealth and conditions for worthy end of their lives.

Those patients, who have to stay in closed institutions, i.e. places of detention, psycho-neurological hospitals etc, might also be under the patronage of these institutions. This is the direction of the hospices’ work which would be approved of and find wide public and charitable support in our society.

At the same time the Church consider the home setting to be the most favorable place for a sick person to end his/her life, and the care of the sick should become the primary duty of his relatives and dear ones, and should not be fully transferred to professional organizations and institutions.

3. Role of the Church in the establishment and development of the palliative care

3.1 The Church considers her role in establishment and development of palliative care in two main aspects: first of all, in the aspect of pastoral care of patients and dying, second – in the aspect of her social ministry, aimed at asserting in the society of Christian values of love, mercy and compassion to the neighbor in their practical application.

The Church thinks it possible to take immediate part in the programs of palliative care to the extent it complies with the salutary mission of the Church and in which she will be able to facilitate performance of this mission.

The Church will support only those efforts of organization if palliative care and those forms of this care, which will ensure complex approach to the needs and wants of a sick person and which will enable creating conditions and opportunities for patronage of the patients.

3.2 Regarding palliative care as complex of interrelated steps, and not as a single medical and social branch, the Church directs her efforts to the development of the spiritual principles of the medicine, of the social and psychological work with the patients and their complex combination in practical usage.

That is why the Church believes that her role in the development of the palliative assistance lies in spiritual and moral upbringing of man, based on the values of love, mercy, compassion to the neighbor, in combination with practical embodiment of these values in the field of delivering assistance to the sick and dying and their dear ones.

The Church believes that a necessary precondition of successful implementation of palliative care is first of all the positive, spiritually purposeful attitude to incurable patients throughout the society, understanding and perception by the community of care of the dying as a social and spiritual necessity.

That is why the Church, the religious organizations and communities, proceeding from both the spiritual and socio-historical experience of care and service to the neighbor, have to become the introducers of the values, standards and examples of activity, facilitating the individualized, personally motivated and complex approach to needs and wants of a sick person.

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