Why the world needs a global ethics of care

A “global ethics of care” for the elderly is needed to ensure dignity and compassion during end-of-life care, health experts have said during an inter-faith symposium in Rome that also heard the pain older members of society feel is often “trivialized”.

Speakers at the Religion and Medical Ethics: Palliative Care and the Mental Health of the Elderly symposium in Vatican City – organized by Qatar Foundation (QF) initiative the World Innovation Summit for Health and the Pontifical Academy for Life (PAL) - also agreed that embracing a person’s religion and spirituality can ensure better health outcomes and must be at the core of palliative care, particularly to safeguard the mental health of the elderly. 

The Vatican City conference – held in collaboration with academic partner BMJ - has examined the role that religion plays in providing holistic care in the context of medical ethics, focusing on the intersection of belief-based and evidence-based approaches to care.

And on its second day, Bishop Noel Simard of Valleyfield, Quebec, told the audience: "Some principles are agreed on by the health community in healthcare – the need for justice, dignity and respect, quality of healthcare, responsible stewardship, solidarity, compassion, and care.”

However, he pointed out that these conflict with emerging trends in healthcare – patients’ choice, freedom increasingly-sophisticated demands, the ever-expanding scope of medicine, and the marginalization of the poor. “It is therefore very important to be aware of the main principles and values that must guide all actions and reflections,” he said.

“When we talk about inherent dignity, it should not be diminished by the deterioration of a health condition. It lasts, and must always be looked for, at all stages and walks of life.

"The frail, the elderly, and people with dementia confront us with the limits and vulnerability of the human life. We need a global ethics of care - we are all inter-dependent and in need of each other.”

Bishop Simard believes treating elderly people requires a model that takes their holistic needs into consideration, saying: “We have to try to ensure physical, emotional, social and medical needs, as well as the spiritual, religious, and existential needs, are met, which means helping a patient to know the meaning and purpose of life, and the meaning of suffering. We need to reinsert the need for internal peace."

Addressing the mental health of the elderly from an Islamic perspective, Dr. Ayman Shabana, Associate Research Professor at QF partner university Georgetown University in Qatar, said ageing is a “pressing worldwide issue", with the World Health Organization estimating that, between 2015 and 2050, the percentage of over-60s among the world’s population will rise from 12 per cent to 22 per cent - but negative stereotypes about the elderly persist.

He emphasized the need for every elderly member of society to have “integration within the family and larger social fabric”, saying: “They should never be isolated or left to suffer loneliness or other problems.

“In our religion, the elderly are seen as the ones that have already contributed in life; and now it is their turn to enjoy the fruits of their hard work. Serving the needs of these people can serve as a practical testimony to our faith commitments."

Dr. Ferdinando Cancelli, a member of PAL and a palliative care specialist, said WHO estimates show that by 2050, told the symposium that one common drawback in the treatment of elderly people is the attitude toward managing their pain, saying: “In many cases, it is insufficiently controlled and pain is trivialized.”

People - including caregivers - view pain as a common symptom of ageing, he said, meaning there is often insufficient alleviation of elderly people’s symptoms which can lead to them hoarding and accumulating medicine, self-administering, and increasing the risk of complications. 

Addressing the issue of spirituality, Dr Cancelli said it should “absolutely” be offered with palliative care, as it can be an alternative pain-reliever for the elderly, but added that patients can refrain from speaking about their religion beliefs

“Some patients fear talking about God as they are worried they will be perceived as someone who should be discarded or put to one side,” said Dr Cancelli, adding that patients and their families need to be offered answers to religious and spiritual requests or queries.