Palliative care, with its millenary roots deeply embedded in the essence of humanity, is a medical discipline dedicated to the assistance of the most complex and fragile patients. We had the privilege of discussing this delicate topic with Dr. Andrea Manazza, a renowned palliative care doctor and member of the new National Committee of Italian Bioethics.
Dr. Manazza shed light on the origins of palliative care, which emerged as a discipline serving the terminally ill, particularly those with advanced phase tumors like cancer. Over time, the scope of palliative care expanded to encompass patients facing complex symptoms and therapies, including both adults and pediatric cases.
The historical roots of palliative care date back to ancient times when a Roman matron established the first hospice, a recovery center for sick pilgrims. Throughout continental Europe, numerous centers dedicated to assisting pilgrims and impoverished sick individuals followed suit. In the 20th century, a remarkable turning point occurred when Cicely Saunders, an English nurse, realized the need for specialized care for the terminally ill, particularly those with advanced tumors.
Andrea Manazza: “Cicely Saunders is the name of this nurse. She went to speak with her primary and he told her she was right, but that the problem wasn’t a nursing problem, it was a problem for doctors. He told her that it was the doctors who abandoned patients at the end of their lives, not the nurses… And she, with a great spirit of initiative and willpower, decided to get a degree in medicine. She became a doctor and brought a group of people around her who began to assist the sick, do research, and teach. She started the first hospice of the contemporary age: Saint Christopher’s in London, in 1967.”
As palliative care evolved, some countries associated it with medical assistance at the time of death, including the possibility of requesting euthanasia or assisted suicide. Dr. Manazza, in a compassionate manner, recognzied the reality that certain patients – when suffering becomes unbearable – may express a desire to end their lives. However, he emphasized that this request should not be perceived as a failure of medicine or as a form of autonomy, but rather as a manifestation of extreme fragility. Palliative care’s objective is to confront suffering, study it, and to offer tailored aid to each patient, helping them die with dignity and without unnecessary pain.
Andrea Manazza: “So, we accept the situation of the patient. We seek to take out all or almost all of the suffering. We don’t propose that we’ll take it all away and you won’t feel anything because that would be a lie, but the objective is that one die without suffering and with dignity.”
Discussing the role of Christianity in promoting palliative care, Dr. Manazza acknowledged its profound influence. Palliative care was born as a cultural push within the Catholic Church and, throughout the centuries, the link between religious motivation and personal commitment fostered advancements in this field. Cicely Saunders, a devout Anglican, exemplified this connection, providing attentive and religiously inspired care to her patients. The clarification by Pope Pius XII regarding the use of the principle of double effect in patient treatment further propelled the development of palliative care.
Andrea Manazza: “Surely there is an undeniable contribution of Christianity to the birth and development of palliative care, which is nevertheless a good clinical practice. That is, it is not a confessional response, but a rational response born thanks to the contribution of faith, but that must be made available to all, not imposed, but made available to all. And so it is right now. It is widespread in all nations in a different way, but it is included as part of medicine, with its own dignity.”
