Prior to 1970 there was no such thing as “Catholic” Medical Ethics. All teachings on the topic of Medical Ethics were presented from the standpoint of official Catholic Church teaching . This teaching was based upon the inherent dignity of the human person and the fact that there are, in fact, transcendent values. Certain things are always either right or wrong, regardless of the situation or any other factors.
After the publication of the encyclical, Humane Vitae (On Human Life) by Pope Paul VI in 1968 there were numerous rumblings from within the Church. There was a great deal of dissent surrounding this encyclical and men such as Fathers Charles Curran, Richard McCormack, and others introduced the ethical methodology of Proportionalism into their courses. Proportionalism, a derivative of Utilitarianism, allows one to make an ethical decision solely on the basis of the fact that the good achieved by the decision outweighs any possible negative outcome. The challenge is that when making such a decision, what would be considered a good by one person can easily be seen as a negative by another person and there is no objective standard to base such a decision on. It is largely based upon the individual’s feeling. Father Charles Curran and others taught that Catholics should simply follow their conscience when making a decision regarding whether or not to use artificial contraception or have an abortion.
In reality, the Church has consistently taught, since the time of St. Thomas Aquinas (1225-1274) that Catholics are obligated to follow their conscience. However, Catholics are obligated to form their conscience properly. A properly formed conscience involves becoming educated on what the official Church teaching is on a given topic. The notion of a “properly formed” conscience was not taken into consideration by many Catholics and they simply based their decision on the fact that since their conscience did not bother them and they felt good about the decision then it must right.
While emotions are an essential part of what makes us human, simply making decisions based upon one’s feelings can be a very dangerous thing. Almost everyone has had the experience of listening to a particular song and having his or her emotions change instantly as a result of it.
Even though proponents of Proportionalism will argue against an objective standard of right or wrong, the fact is that they rely upon feelings as an objective standard when it comes to adding up the “pluses” and “minuses” of any decision and if the pluses outweigh the minuses then the decision must be correct. The truth is that sociopaths like Charles Manson and Ted Bundy, lack empathy for other people and can easily justify their behavior using proportionalist reasoning based upon the fact that their conscience does not bother them when they go out and kill someone. Also they easily come up with a list of “pluses” over “minuses” regarding why they should kill innocent people.
Since 1970, with the introduction of non-Catholic and even anti-Catholic medical ethics, there have been courses available in mostly Catholic colleges and universities which teach this subject based on Catholic Church teachings. Catholic, Jewish, and Islamic Medical Ethics all support the teaching that there are certain things which are objectively right or wrong regardless of the situation. For example, the intentional taking of a defenseless human life is understood to be murder which is always wrong. These values are not based upon a given situation or whether or not they are right in particular culture. They are universally right or wrong and no amount of good intentions can justify a wrong act.
Since 1973, abortion has continued to be a major issue for Catholic medical ethics professionals. The Church’s teaching on the sacredness of human life has never changed. As stated earlier, murder is defined as the intentional taking of a defenseless human life. However, there are circumstances where the taking of a human life is unintentional. In regard to medical ethics, the principle of “Double Effect” comes into play in these types of decisions. For example, a pregnant woman goes into the hospital to be operated on due to having cancer in her uterus. As a result of her surgery her pregnancy is terminated. In this case the intention of the doctor and patient was to remove the cancerous growth in the woman’s uterus. However, the unintentional secondary consequence was that the pregnancy was terminated. A woman cannot intentionally choose to end her pregnancy, but that was not the intention in this case. Intentionality is extremely important in all medical ethics decisions.
A cancer patient in the hospital is being given morphine in order to reduce his pain. There is no reasonable hope of this patient’s recovery. The doctor decides to increase the patient’s pain medication in order to make him more comfortable. As a result of this decision, the patient’s breathing becomes so shallow that he eventually dies from respiratory failure. Did the doctor murder his patient? The most important question to ask, in this regard, is, “What was the doctor’s intention?” If the intention was to relieve the patient’s suffering, then, according to the principle of “Double Effect” the patient’s death was an unintended secondary consequence. However, if the doctor’s intention was to bring about the death of the patient then it is considered euthanasia which is not permissible.
Modern medicine has brought about a rise in the notion of specialization among many doctors. While it can certainly appear to be a value to the patient to be able to see a physician who deals directly with a particular part of the body, for example, seeing an orthopedic surgeon when one is suffering from knee pain, the challenge is that many specialists do not take into consideration that they are dealing with a whole person. The patient simply becomes a knee or a wrist rather than a whole person. Such specialization has had a negative impact on the doctor-patient relationship. Since the specialist sees the patient simply as a body part rather than a whole person there is less willingness to get to know the person and this is certainly a major loss.
Since the time of Hippocrates (400 BC) the medical profession has always stressed the importance of maintaining a relationship between the doctor and the patient. However, with the rise of specialized medicine there has been a decreased in general practice physicians who dedicate themselves to getting to know the patient as a person rather than simply as a collection of illnesses or pains. It is essential that a patient speak to his or her physician when it comes to making decisions regarding end-of-life issues or other important choices. The decrease in the number of general practice physicians and the rise in Health Maintenance Organizations (HMOs) have made it very difficult for a doctor to spend any real quality time with a given patient. Spending seven minutes or less with a given patient is not uncommon for many doctors here in the United States.
At any given moment you or I could end up in the hospital and be unable to speak for ourselves regarding the type of treatments, such as whether or not we choose to be on life support. It is essential that we have someone to be able to speak on our behalf and a document available which puts in writing the choices we have made. We all watched the events surrounded the death of Terri Schiavo in FL and how the decision had to finally be made by the court regarding what to do in her particular case. Had she filled out an advanced directive prior to entering the hospital and named someone as a spokesman (medical proxy) the entire situation would have been completely different.
In 1992, the Catholic Bishops of the State of New Jersey prepared an Advanced Health Care Directive following the passage of the Advanced Directives for Health Care Act. When preparing an advanced directive, it is essential that you clearly explain your desires to your health care proxy and physician so that there will be no confusion if the time comes that you are unable to speak for yourself. Since your health care proxy will serve as your spokesperson, it is recommend that you have two other people witness/sign the document and then have it notarized.
The Catholic teaching regarding life support, surgery, and other issues in regard to those with a terminal medical condition has remained consistent throughout the years. In the 1950s, Pope Pius XII spoke to various medical professionals throughout Italy and addressed the issue of extraordinary vs. ordinary care.
Extraordinary care is defined as those medicines, treatments, or operations which may be very expensive, may cause excessive pain, or other extreme difficulties or which may offer no reasonable hope or benefit. Ordinary care includes pain reduction medication, food, water, or any other care which provides comfort to the patient and allows them to maintain basic functions.
It is the Catholic Church’s teaching that at no time should a patient be denied food or water as part of any medical treatment. This includes anyone who is presently in a persistent/permanent vegetative state or coma. In the same way that you would not deny food or water to an infant, who is incapable of feeding him or herself, one should not deny should basic care to someone who is unable to respond to the doctor, nurse, or family member. Should a patient be unable to receive nourishment orally there are other options available which need to be discussed with the physician.
While Pope Pius XII spoke of extraordinary vs. ordinary care, the medical community now uses the terms proportionate vs. disproportionate care to define the same truths. It is the official teaching of the Church that one is under no obligation to accept disproportionate/extraordinary care. Such care would include risky surgery which may cause excessive pain to the patient and/or be extremely expensive while at the same time providing no reasonable hope of either recovery or extension of a positive quality of life. This would also include dialysis.
Even though there have been numerous advances in medical science and technology over the past few decades, the fact still remains that no amount of science or technology will ultimately prevent someone from dying. Death is a natural part of the human experience and it is during this time of suffering that one can make use of his/her time to deepen their relationship with God as they prepare to come to the end of their life.
Once a patient is placed on a long-term life support system it is very difficult to have that system removed. The hospital is often reluctant to remove a patient from such a system out of fear of a potential lawsuit from family members. If a patient chooses not to be placed on a life support system it is essential that it be known beforehand so that removal of the system will not become an issue.
While the Church teaches that a patient is not obligated to accept disproportionate/extraordinary care, this does not mean that by doing so one is going against Church teaching. Should a patient choose to go on life support, the Church will support him or her, to the best of its ability, through prayer, the Holy Eucharist, Anointing of the Sick, and sacramental reconciliation. These supports are also available for those who choose not to go on life support.
Should you be chosen to serve as a health care proxy for a family member or friend, please keep in mind that it will be your responsibility to speak for that patient when he or she cannot speak for themselves. This can be an extremely difficult and highly emotional experience. Therefore, it is essential that you discuss the advanced directive with your family member or friend so that you are aware of their wishes and are able to carry them out. It is not the healthcare proxy’s role to judge whether or not you agree with the patient’s decisions. It is the proxy’s responsibility to carry out the patient’s wishes. Should you object to the decisions made by the patient you should recommend that he or she choose someone to be their proxy.
Euthanasia, a Greek term meaning “good death”, has become a more common occurrence in our present culture. One will often hear the argument that if your dog was suffering the way your family member is wouldn’t you put the dog out of its misery? The fact is that animals do not benefit from their suffering. As Christians, we are called to unite our sufferings to those of the Lord Jesus. Suffering has a redemptive quality for Christians. This is not true for dogs, cats, or any other animal. What inspires many people, both the patient and the family members, to actually consider euthanasia as a viable option is not the illness itself, but the intense pain that the patient experiences. Pain management such as palliative care and hospice are available in the hospital and by helping the patient to manage their pain they can alleviate the patient’s desire to want to end their life prematurely.
Another issue facing the medical ethics community is the subject of stem cell research. Stem cell research is being done on two different levels, namely adult stem cells and embryonic stem cells.
In England there is actually research going on regarding cloning of human beings with other animals. These beings would be known as hybrids. When it comes to such research the most important thing to keep in mind is the notion of can vs. should. Just because we can engage in such research and do not mean that we should. Can vs. should is not within the preview of science since it is an ethical issue. Dr. Ian Helmut, the doctor responsible for the cloning of Dolly the Sheep, stated that he can find no justifiable reason for the cloning of human beings.
Based upon the direction that science is moving in it will not be long before a couple will actually be able to determine the eye color, height, and other characteristics of their unborn child even before the woman becomes pregnant. This is an example of eugenics, a Greek term meaning “good genes”, which was actually quite popular with the Nazis. Another major issue is that many children who are determined to have either downs’ syndrome or a cleft pallet are aborted every year. This is also an example of eugenics.
In regard to embryonic stem cells, the fact is that there have been 73 cases of cures from adult stem cells (primarily from placenta blood), but there have been no cases of cures from embryonic stem cells. The pharmaceutical companies have actually stopped investing money in embryonic stem cell research due to this fact.
The scientific community is outpacing the Church regarding the fact that there are many more scientific “breakthroughs” on a regular basis than the Church can examine from an ethical standpoint. While this article does not go into depth on any of these issues, it does offer an overview of Church teachings and provide the reader with information in order for them to do their own research into a given subject to find out more information.