Ten Commandments That Should Shape Palliative Care

The Ten Commandments that are found in the Old and New Testament are meant to set limits to human freedom so that when obeyed, they produce within human beings a set of virtues or inner strengths, which enable a certain flourishing of one’s human nature on the personal level. Likewise, these commandments indicate the rights of others to be respected in addition to duties to be fulfilled toward God, parents and neighbor. They are based on human nature’s fundamental inclinations to certain created goods and God himself, all oriented to producing human happiness when chosen and obeyed according to right reason under grace. They are not arbitrarily imposed by a cruel God but flow reasonably from within.

Given fallen human nature, more than easy or ordinary human effort is required to live them in tense or trying situations. For Catholics, the fundamental human weakness is supplemented by infused virtues and assisting graces, together with guardian angels, to choose the right path to one’s ultimate goal, namely, heaven. Nevertheless, any one of the baptized may freely reject divine and other world helps and choose the easy way of setting aside commandments from many differing motives. Emotions can make disobeying the commandments seem productive and fulfilling.

Years ago, I saw on the Internet the “10 commandments of caring.” It was produced by the HCR Manor Care company (declared bankruptcy in 2018) which owned rest homes around the country. While it was not religiously affiliated, its message was quite good and I would like to take the reader through it from a Catholic perspective. If the following ideals, based upon the biblical ten commandments as applications, were followed in the rest homes of the country, comfort care would greatly improve and the elderly would not languish in some of these homes, but feel loved and wanted by the men and women who take care of them. And perhaps some of the nasty odors that sometimes exist in these places would be banished more often than not.

The first commandment said that “our residents, patients, their families and their friends are the most important people in our facilities.” This notion fits in quite well with the dignity of the human person as do all the rest of their “commandments.” The word “importance” implies respect and reverence for the vulnerable as well as the strong. Patients are comparable with friends and family. Being weak does not make them less human. What flows from this concept is quite interesting in the rest of their “commandments” because rest homes are extensions of their loved ones who have placed their parents or siblings there in the first place, unable to care for them for many legitimate reasons.

The second commandment, “all these people in our homes are not dependent on us, we are dependent on them.” At first this seems counter-intuitive. What it means rationally is that the administrators and employees of these homes are servants to their constituents, not means or mere objects for the company’s profit. Of course, the company needed money to pay its bills, but the commandment here suggests that this is not primary even though a necessity. People are primary.

The third commandment, “the people in these homes do not interrupt our work, they are the purpose of our work.” Managing a carehome can become so routine that the loss of the human element may easily harden people working here. If this were a Catholic institution, one could add that the purpose includes the love of God, which in turn sees in our vulnerable neighbor the Lord Jesus Christ. “In so far as you did it for the least of my brothers, you did it for me.” Often, these limited and hurting people in their beds are the “least” of his brothers and sisters.

Fourth, they “do us a favor when they request our assistance. We do not do them a favor in serving them.” While this looks rather upside down, the idea behind it is also very Catholic. The more we serve and sacrifice for others, the more human and fulfilled people become even when it may hurt. And if service to others weaker than ourselves is the goal, the employees are being called not to justice but generosity, and this kind of love that requires sacrifice of one’s ego. St. Thomas Aquinas once wrote somewhere in his commentary on St. Matthew, “Justice without mercy is the mother of ruin.” By that pithy comment he was referring to what occurs when mercy and love are not part of even ordinary human relationships.

Fifth, the guests in the carehomes “are the most vital part of our health care facilities. They are not outsiders.” Working with those in decline and waiting for death can lead the staff to think these people are strangers rather than equals and perhaps even potential friends. When this happens, patients begin to feel that they are not being understood because they do not feel empathy and cheerfulness from the staff. This comes about from putting in eight or more hours a day primarily for the pay. Then loneliness and anguish may set in when people working for them do not see their work as a particular vocation from the providence of God for them.

Sixth, they “are not collections of charts, prescriptions and bills — they are flesh and blood human beings with feelings and emotions like our own.” Because of the legal situation in the USA, the record keeping, a tedious part of administration, can also become an end in itself to the forgetfulness of the human persons they serve. Routine hardness of heart is a terrible affliction that can come into a staff member by looking at the vulnerable as a chart and as less than human. Furthermore, often one is tempted to become furious with their demands.

Seventh, they are “not to be argued with.” When dealing with people whose minds are not always alert, or debilitated with dementia or even Alzheimer’s disease, it is very easy to take insults personally and forget that often what the vulnerable say comes down to “they know not what they saying.” They would not speak in such a tone or with such harshness if they were well or living in their own homes, which they have left. The temptation is to take their words too literally. Often their complaining or criticizing a staff member is merely a reflection of the dissatisfaction they are having within themselves.

Eighth, they “bring us their wants — it is our job to fill those wants.” The commandment assumes that the “wants” are reasonable, appropriate, proportionate, and not contrary to the best interest of the patient. Often many want to die and wish that the staff would help them die with the comfort care of empathy. This is usually a call for love and affection lacking in the lonely, especially if their friends and loved ones have abandoned them with fewer and fewer visits.

Ninth, they “are deserving of the most courteous and attentive treatment we can give.” Often, patients think and hope that they can get well. This is an illusion when someone is in decline. But still, the staff needs to be attentive and treat them, if not with cure, then with sharing their discomfort with some solace. Palliative care is something owed to the patient suffering from the emptiness that goes with pain or sorrow, and the inability to take care of one’s self.

Tenth, they “are the lifeblood of our business.” This is the only commandment which implies the fact of the carehome as a company or enterprise. This is not a bad thing; this commandment reminds the company that money is not its first priority, even though essential to keep the business from collapsing, but people are, similar to the other commandments. Making a profit or keeping to budget is not the ultimate end of the company but is a subordinate, pre-conditional goal; otherwise, the company could not give care in the first place.

To keep these commandments is very difficult in the hot-house atmosphere of a rest home. It requires a healthy discipline and high ideals with a sense of mission on the part of the staff and administrators. When the guests become upset sometimes over the smallest thing that to them seems more important than it really is, an inner virtue called meekness is needed to restrain one’s desire to retaliate with harsh words. Without the help of divine grace, such patience, longanimity and perseverance in this calling is almost impossible from the point of view of Catholic teaching. Only the Lord can make this way of life somewhat sweet while being sometimes somewhat bitter. The fallen human being, with the inherited sin of Adam, cannot live this high vocation by his or her own efforts alone, as we Catholics and especially the Little Sisters of the Poor, among other religious communities, already know.