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Articulating the Concept of Palliative Care: Philosophical and Theological Perspectives

of her diagnosis, the first thing she said to the oncologist was that, when her suffering became unbearable, she would want to have euthanasia, which is tolerated in the Netherlands. In the sixth month after the diagnosis, she contacted a hospice physician. She asked for information about hospice care in order to make arrangements for the future. She was told that euthanasia was not performed in the hospice but that, should she decide to stay there, her caregivers would remain with her until the end. If she still preferred euthanasia, she would be discharged to a hospital where euthanasia would be provided. Her treatment program at the time was aimed at a cure, though she knew that chances for a cure were limited (6% long-term survival). The woman, a lawyer, had been extremely busy throughout her life. Her marriage had failed and she was divorced. She had two daughters, one of whom Jived with her ex-husband and the other with her. However, her relationship with both her children was very detached. The sisters had not seen each other for years. Thirteen months after the diagnosis, the woman was admitted to a university hospital with pain in her back. Metastases in the brain and spinal column were diagnosed. A course of radiotherapy and chemotherapy aimed at life prolongation and the palliation of symptoms were initiated. Sixteen months after the diagnosis, the woman decided to discontinue chemotherapy and, at her request, she was admitted to the hospice. At the time she was using opioids and suffering from dyspnea, constipation, and nausea. It appeared that the dose of opioids was far too high. Her dose was decreased and her symptoms were alleviated. Corticosteroids were prescribed to alleviate the headache and nausea. Because she was then paraplegic, she had to let others take care of her. This made her very unhappy. She felt guilty toward the caregiving team Articulating the Concept of Palliative Care: Philosophical and Theological Perspectives