Ambitious but Uneven Guide for Catholics

Intensive Caring: A Practical Handbook for Catholics about Serious Illness and End-of-Life Care
Natalie King, MD
Ave Maria Press, 2024
Softcover, 160 pp
ISBN: 9781646803187
$28 USD
Also available: Kindle

By Romayne Gallagher, MD

Intensive Caring: A Practical Handbook for Catholics about Serious Illness and End-of-Life Care by Dr. Natalie King is a brave attempt to cover Roman Catholic Church teachings as they apply to almost every challenging serious illness situation. Dr. King, a palliative medicine physician with a masters in ethics, practises in Indiana, USA, and provides details uniquely relevant to the American palliative care and hospice care system. Using this book in any other country will be confusing for patients and their families. 

This book effectively presents patients with differing medical situations and palliative needs. Sometimes they are not linked clearly to further discussions, which tend to focus on Catholic teachings at a high level of literacy in Catholicism, as underlying principles are not explained. This book strives to answer every question one might have about Catholic Church teachings, but fails to educate on the body's natural processes and the practical ways in which we can journey alongside our loved ones. The book has minimal guidance on how a community of people (i.e., a Catholic parish) can come together to help throughout serious illness and dying. 

Strengths & weaknesses

The Introduction indicates that the book's intention is to empower and support Catholics considering advance care planning and those who need to make healthcare decisions. A few examples of its strengths and weaknesses include:

• Chapter 3, Communication in Serious Illness, has fine suggestions to help patients get answers to their questions, and identifies the problematic mismatch between what clinicians feel they have discussed and patient awareness of their illness. There is a useful list of questions one should know about a serious illness, but neglects to caution that it may take multiple doctor visits to have these answered. Guidance on getting the most out of a limited appointment time and how the patient/family can identify credible information sources are lacking. 
• Chapter four, Navigating Treatment Options, starts “Are Pain Medications Safe to Take? Do they cause bad side effects?” This is not clearly answered. It does not mention that opioids are both essential and safe when prescribed correctly to those with significant pain, perhaps due to collateral damage from the opioid crisis where these medications were demonized to the detriment of many active cancer and palliative patients.
• Chapter five, Advance Care Planning, includes an “aside” on key criteria to making healthcare decisions, instead of emphasizing them as the necessary basis. This speaks to the book’s lack of organization and foundational information for patients and family to understand their rights and responsibilities. 
• Chapter six, Understanding the Dying Process, is what one would have wished for as a basis to understanding how to deal with life’s end. Sadly, this chapter doesn’t explain the biology and natural process of what is happening and how it results in what the family sees and feels. With understanding comes lowered anxiety and with support helping loved ones to be involved comes less fear. “Persistent vegetative state” is discussed here but no mention is made of how rare this is and how common is an orderly, peaceful death.
• Chapter seven, Premature Hastening of Death, contains useful information as well as a lovely quote on page 79 that “affirmation that the possibility of experiencing, rediscovering or creating meaning exists…even in the last days of life is at the heart of psychiatric, psychosocial and existential palliative care.”¹ This is the first time that existential distress is mentioned, followed by a short paragraph describing it but only saying the team should recognize this. This would be something to explore, to understand why some Catholics choose hastened death.

In describing patients with admirable attitudes to suffering Dr. King says, “They view their suffering in light of its more transcendent properties with an inherent redemptive nature.” This is far too complex language to convince people—we learn through stories and examples. The chapter on advocacy, which talks about when palliative care might be beneficial, has a brief patient story that is useful but is abandoned in favor of warnings to Catholics about safeguarding themselves from systemic healthcare issues in violation of Catholic teaching. 

In a nutshell

This book tries to answer every question one might have about Catholic Church teachings but fails to educate on the body's natural processes and the many ways in which we can journey alongside our loved ones. Interventions are explained from the standpoint of whether it is acceptable to the Catholic Church; the book has minimal guidance on how a community of people (i.e., a Catholic parish) can come together to help throughout serious illness and dying. As for topics, there is too much discussion of zebras rather than horses and cows (i.e., ventilation, feeding tubes in brain death vs. antibiotics, stopping medications) and little or no discussion of the elephant (existential suffering) that can weaken faith at a crucial time.

Reference

1. Alici Y, Modhwadia K, Breitbart WS. Psychosocial and Psychiatric Suffering. In: Quill TE, Miller FG (Eds.), Palliative Care and Ethics (p. 155). Oxford University Press, 2014.