Pro-dignity, life-affirming palliative care: An interview with Dr. Natalie King

Dr. Natalie King, with a medical degree from Tulane University School of Medicine, is a Catholic palliative care physician who lives in Utah. Concerned about proper and ethical care for patients at all stages of life, she is the author of Intensive Caring: A Practical Handbook for Catholics about Serious Illness and End-of-Life Care, just published by Ave Maria Press.

She spoke recently with Catholic World Report about palliative care, her own journey into that discipline, and moral issues connected with end-of-life.

CWR: You are a “palliative care” doctor. What is “palliative care?” How do you see “palliative care” as related to your being a Catholic doctor?

Dr. King: Growing up, I had not even heard of palliative care. I went to medical school, like most people, to be able to understand the human body’s function, diagnose when it dysfunctions, and work to treat and correct it if needed to return to health.

Along the way, I discovered the field of palliative medicine, which is a medical subspecialty focused on the care of people with serious or chronic (often incurable) medical problems. Think of issues like congestive heart failure, strokes, dementia, kidney failure, lung problems, and many cancers. With the way healthcare technology has evolved, many people find themselves living for years with medical issues like these. They may not be immediately fatal, but they will substantially affect how people live with them.

These medical problems can affect people’s lives tremendously—with many symptoms, stresses, and even side effects from the necessary treatments. The stresses can extend beyond physical to also include emotional, financial, spiritual, and relational dimensions. Often, the serious illness does not just impact the patient, but also all the people in their life who love them.

Palliative medicine doctors are trained to help people in these kinds of situations to live the best lives possible for as long as possible. We work with an interdisciplinary team (often including nurses, social workers, and chaplains) to identify how the patient is being affected by their illness and find creative solutions to support them.

As a Catholic, working as a palliative medicine physician is a huge gift. It is such a privilege to care for patients and their families as they are journeying through serious illness. I get to witness the richness of their personhood and the love between them, their families, and God. I have the opportunity to accompany them, helping to advocate for them and shed light on their intrinsic dignity and worth. I find such beauty in it and my faith makes it all even more meaningful.

CWR: Some people confuse palliative care with “hospice” care, imagining “palliative care” as a nice euphemism for “dying.”

Dr. King: There are many things people find confusing about my field of palliative medicine. I’m with you: even as a general internal medicine physician, I did not understand some aspects of palliative care before I specialized in the field. The misunderstandings and confusion I have encountered inspired me to write the book Intensive Caring.

Furthermore, dealing with serious illness is very stressful. And then to be challenged with navigating the healthcare system, advocating for the best care, and ensuring that this care is also respectful and life-affirming? It is so hard, and I want to help to clarify things.

One common misunderstanding is that palliative medicine is the same as hospice care. This is not true. You should think of palliative care as a big umbrella of care and that hospice is a subset within it. Hospice is a type of palliative care, but not all palliative care is hospice care.

Medicine typically “fights” disease, and palliative care seeks to provide holistic balance across all aspects of the life of a patient-as-person when that disease is “chronic,” i.e., not going away. Hospice, as a subset of palliative care, is a Medicare benefit that focuses on symptom support and care when a patient has decided no longer to pursue restorative or disease-directed medical care. The focus of care shifts from that of using chemotherapy, hemodialysis, or other life-prolonging treatments to that of centering on comfort and meaningful time away from the hospital, aiming for remaining good days with loved ones. Up until that point, hospice is not appropriate care, and palliative medicine should work alongside the patient’s other doctors, focused on staving off the disease as best as possible while working to live the best life possible.

Palliative medicine is not focused on a patient’s dying. It is focused on a patient living—living the best they can despite a serious illness. It works to understand a patient’s goals and values and guide toward medical care that is aligned with that. Studies show that for patients dealing with a lot medically, the support of a palliative care team can help them live longer and spend more time out of the hospital. (see here for an example).

Having a palliative care team in your corner as you journey through a serious illness takes nothing away from your care—it only adds support and help from professionals trained in helping manage issues common to what you may be experiencing.

If you feel that you or a loved one may benefit from a palliative care consultation, you can bring it up with your primary care physician or other specialist physician. They can place a referral. If you are hospitalized, you can ask to have a palliative care consultation while you are in the hospital. In many places, there are palliative medicine clinics or even home-based palliative medicine services where the team comes to you.

CWR: There is pressure in ever more states to legalize some form of euthanasia, whether by the patient himself (with lethal chemicals or “suicide” machines) or with a doctor’s help (“physician-assisted suicide” or “medical assistance in dying”). Can “palliative care” help staunch the juggernaut for euthanasia and, if so, how?

Dr. King: It is very important for Catholics to realize that physician-assisted suicide is now legal in 11 jurisdictions in the United States (ten states and Washington D.C.) and comes up in the legislation in other states each year. (West Virginia just adopted a proposal to ban assisted suicide on November 5). The Catholic Church ardently opposes hastening death by assisted suicide (often termed “medical aid in dying,”) and there are several Church documents that reiterate this.

I delve into several of these in my book, but one I would like to particularly highlight is the Dicastery for the Doctrine of the Faith’s 2020 letter Samaritanus Bonus (The Good Samaritan): On the care of persons in the critical and terminal phases of life. This letter is not just for clergy or physicians, it is for all who come into contact with the sick and dying. It provides guidance that is attentive to the issues in modern culture and how to address them. It specifically emphasizes the need for palliative care to accompany people through the journey that God directs (our lives are not for us to direct in the way of controlling/hastening our death).

Pro-dignity, life-affirming palliative care is the antidote to the physician-assisted suicide movement. It looks at a patient with their intrinsic dignity as a son or daughter of God as a person to love, not a problem to treat. I share more about this in my book.

I do not deny that in the field of palliative medicine, like any other medical specialty, there are people practicing in ways that are contrary to the Catholic Church’s teaching. Just as there are physicians in obstetrics and gynecology who celebrate abortion, there are palliative medicine physicians who feel the answer to relieving the suffering of a patient is to extinguish the sufferer themselves. To me, this is opposite to the inherent aims of medicine. Physicians helping to kill their patients destroy the sacred physician-patient relationship, built on trust and willing one’s good. Like in other fields of healthcare, we must reclaim and champion the good, true and beautiful of palliative medicine.

Remember: if your palliative or hospice care physician is not respecting your values as a Catholic concerning the dignity of human life, you can always choose another.

CWR: What are some of the moral problems a faithful Catholic today might face when dealing with the American healthcare system amidst a serious illness?

Dr. King: Navigating the health system in the midst of serious illness is daunting. It can feel overwhelming. Not to mention, most patients dealing with issues like this are limited in some way, making them even more vulnerable.

To best help advocate for yourself or your loved ones, I would work to communicate your values to your loved ones and your healthcare team. This can be done verbally, but better yet, through the aid of advance directives. Advance directives are legal forms that provide information about your healthcare preferences and communicate them to your healthcare team. For Catholics, the most important one is having a medical durable power of attorney, or legal healthcare surrogate. The ideal situation is that you can always make your own medical decisions, but for many people, there may come a time when they are unable to adequately represent themselves (perhaps they are confused, sleepy, or in a serious medical condition where communication is not feasible). They need to have someone named who can speak in their stead if this situation arises. In many states, this defaults to one’s spouse, adult child, or parent. However, the default choice may not always be the best person to speak for you.

It is important that your medical durable power of attorney knows your values and can be your voice when you cannot speak for yourself. That they can say what you would say, want, and do. If your Catholic faith is important to you, this person needs to communicate that and make choices according to your faith. They can also advocate to get a priest to come give you anointing of the sick and attend to other spiritual needs.

Often, people have specific questions about their particular healthcare situations. They are trying hard to follow what the Catholic Church teaches and want to be most respectful of the dignity of life. From feeding tubes to ventilators and dialysis, to organ donation and brain death and more, in my book I work to address many things, to give Catholics a better sense of peace if they ever find themselves in a situation needing to address them.

CWR: Your new book, Intensive Caring, is intended to help Catholics navigate those challenges. Tell us about the book and why you wrote it.

Dr. King: Two months after I moved to a new state to start my first job, physician-assisted suicide passed into law in that state. I was devastated. How was I to navigate this as a Catholic, as a palliative medicine physician? I most certainly would not have moved there if I had known that was going to happen.

Well, it was through the struggles that I was motivated to learn more about Catholic Church teaching, moral theology, and ethics. I got involved in my local hospital and larger healthcare system. I began getting invited to speak on end-of-life issues as a Catholic. At my talks, people would come up to me with questions–it was agonizing to see their struggles trying to best live their Catholic faith while dealing with a serious illness themselves or helping care for a loved one.

I wrote the book to help them. I want to shed light on the beauty of palliative care, how it can be successfully practiced in alignment with the Catholic faith, and how to practically navigate common and challenging situations in serious illness. I wrote this book to shed light on the beauty of accompanying people through serious illness and that physician-assisted suicide should never be the answer. There is life-affirming, dignifying care out there. No matter what health issue you may be facing, you are valued, and you matter.

CWR: November is traditionally a month when Catholics focus on prayer for the faithful departed as well as taking stock of their own mortality. As a Catholic physician, what would you recommend to Catholics as they look towards preparing for their future, for illness and eventual death?

Dr. King: Any conversation you can have with your loved ones (or those who would be helping speak for you if you ever lost the ability to speak for yourself) about your healthcare preferences and values is a gift to them. Having conversations like this can be very difficult, but I encourage you to be as open as possible (and there are some guides to doing this in my book). What you convey could very well impart much peace to a loved one making a decision for you one day, knowing that they are assured they are doing what you would want.

(Editor’s note: The views presented above are those of Dr. Natalie King and not necessarily those of her employer).