Bishop Raimo Goyarrola, who recently completed his doctorate on palliative care, reminds us that good palliative care begins long before the final days of life.
There are not many Catholic bishops who complete a doctorate in medicine in the midst of the busiest years of their ministry. Yet this is precisely what Bishop Raimo Goyarrola of the Catholic Diocese of Helsinki did when, in June, he successfully defended his doctoral dissertation at the University of Eastern Finland on the significance of spirituality in palliative care.
The research did not come about overnight. Its roots go back to the Covid-19 pandemic, when Father Raimo began gathering his research material. Since then, his life has changed profoundly: in 2023, he was appointed Bishop of Helsinki. Nevertheless, the research was not abandoned but progressed gradually alongside his other responsibilities. Sometimes, the Bishop says, he would have a one-hour window in the evening to work on his dissertation.
This summer, the work culminated in the public defence of his dissertation, which was also a personally significant experience for the Bishop.
“It was a great celebration. More than a hundred people attended, there was a great deal of discussion, and the defence lasted almost three hours. I came away with the feeling that this subject genuinely touches people. Spirituality at the end of life is seen as something important,” the Bishop says.
The lively discussion during the defence reinforced his conviction that the subject is not merely a question of medicine. It touches upon some of the most fundamental human questions concerning life, suffering and death.
The research is about good care
Although the dissertation was readily associated with the debate on euthanasia in public discussion, the actual focus of the research is different. Above all, it examines how a seriously ill person can be cared for as comprehensively as possible and how their spiritual needs can be recognised as part of good medical care.
According to the Bishop, a human being cannot be understood merely as a biological organism. Every person simultaneously has physical, psychological, social and spiritual dimensions, all of which affect how they experience their illness.
“Pain management in Finland is of a very high standard. We can be grateful for that. There is, however, still much room for improvement in the psychological, social and especially the spiritual dimensions.”
One of the central findings of the research is therefore that, towards the end of life, a person’s greatest suffering is not always physical pain.
“Many people at that point reflect on the meaning of their lives, their relationships, forgiveness, or why they in particular became ill. There is no medicine for these questions, but they must not be left unaddressed.”
Palliative care is not the same as end-of-life care
One of the Bishop’s most important messages concerns concepts that are easily confused in public discussion in Finland.
Palliative care is not the same as end-of-life care, and neither is the same as euthanasia. According to the Bishop, it is precisely the confusion between these concepts that makes constructive public discussion more difficult.
Palliative care begins when a person is diagnosed with an incurable illness. It may continue for months or even years, and during this period treatment may still be given to slow the progression of the disease or alleviate its symptoms. End-of-life care, by contrast, is the final phase of palliative care, when death is known to be approaching. Euthanasia is an entirely different matter and is not part of either palliative or end-of-life care.
For this very reason, the Bishop stresses the importance of using these terms accurately.
“Palliative care belongs to medicine. Its purpose is neither to prolong life artificially nor to hasten death. Its task is to alleviate symptoms, improve quality of life and accompany the patient until natural death.”
He points out that good palliative care is active care. It does not mean giving up on the patient. Much can still be done for the patient’s benefit, even when the illness can no longer be cured.
A human being is more than a diagnosis
During the interview, the Bishop returns several times to the subject of human dignity. In his view, the rapid development of medicine has brought many benefits, but it also carries the risk that a person may come to be seen primarily in terms of their illness.
“A patient is not merely a cancer patient. They are not a Covid patient or room number 12. They are a human being with a name, loved ones and a life story of their own.”
At the same time, those close to the patient also need support.
“Sometimes the family suffers more than the patient. That is why good care attends to the whole family, not just the illness.”
According to the Bishop, this is precisely where the true humanity of palliative care becomes apparent. The patient is encountered as a whole person, not merely as a medical case.
Spiritual questions belong in healthcare
One of the central findings of the research is that spirituality should not be something healthcare professionals are afraid to address.
The Bishop nevertheless distinguishes between spirituality and religiosity. Not everyone considers themselves religious, he says, but every human being has a spiritual dimension connected, for example, with the meaning of life, relationships, hope, fear and facing death.
“Every human being is spiritual, even though not everyone is religious. For many people, religion is an important source of strength, but spiritual questions concern every human being.”
For precisely this reason, he believes doctors and nurses should have the confidence to raise these issues with patients.
He acknowledges that one of the greatest challenges is lack of time. “And this work requires time. If someone stops and calmly listens to the patient, it can make a great difference to their well-being.”
Turning research into practical tools
The Bishop hopes that his research will not simply gather dust on a bookshelf. As part of the study, practical questionnaires were developed to help patients and healthcare professionals identify spiritual needs and discuss them naturally.
During the research, the questionnaires were used with approximately 300 patients.
“The experiences were very positive. They help both the patient and the doctor find a common language for discussing difficult matters. That also improves quality of life.”
Over the coming months, the Bishop will give several lectures on his research to doctors and nurses. His aim is that, in the future, the spiritual dimension will increasingly be seen as a natural part of good palliative care – perhaps eventually even as a self-evident part of it.
Perhaps the most important message of the interview, however, can be summed up in one simple thought. Good care does not begin with technology, nor does it end with medication. It begins by encountering the patient as a human being.
“We need more humanity in medicine. When a person is encountered as a whole human being, the final stage of their journey through life can also be made more dignified.”
Marko Tervaportti