Health Care Ethics

332 Pages·2006·1.34 MB·English

H C E
EALTH ARE THICS
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H C E
EALTH ARE THICS
A C T A
ATHOLIC HEOLOGICAL NALYSIS
F E
IFTH DITION
Benedict M. Ashley, O.P.
Jean K. deBlois, C.S.J.
Kevin D. O’Rourke, O.P.
Georgetown University Press
Washington, D.C.
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As of January 1, 2007, 13-digit ISBN numbers will replace the current 10-digit system.
Paperback: 978-1-58901-116-8
Georgetown University Press, Washington, D.C.
© 2006 by Georgetown University Press. All rights reserved. No part of this book may be reproduced or
utilized in any form or by any means, electronic or mechanical, including photocopying and recording,
or by any information storage and retrieval system, without permission in writing from the publisher.
Nihil Obstat
Reverend Patrick J. Boyle, S.J., Ph.D.
Censor Deputatus
November 16, 2005
Imprimatur
Reverend George J. Rassas
Vicar General
Archdiocese of Chicago
November 23, 2005
The Nihil Obstat and the Imprimatur are official declarations that a book is free of doctrinal and
moral error. No implication is contained that those who have granted the Nihil Obstat and
Imprimatur agree with the content, opinions, or statements expressed. Nor do they assume any
legal responsibility associated with publication.
Library of Congress Cataloging-in-Publication Data
Ashley, Benedict M.
Health care ethics : a Catholic theological analysis / Benedict M. Ashley, Jean K. deBlois, Kevin
D. O’Rourke. — 5th ed.
p. cm.
Includes bibliographical references and index.
ISBN-13: 978-1-58901-116-8 (pbk. : alk. paper)
ISBN-10: 1-58901-116-3 (pbk. : alk. paper)
1. Medical ethics—Religious aspects—Catholic Church. 2. Medicine—Religious aspects—
Catholic Church. I. DeBlois, Jean. II. O’Rourke, Kevin D. III. Title.
[DNLM: 1. Ethics, Medical. 2. Delivery of Health Care—ethics. 3. Catholicism. 4. Bioethical
Issues. 5. Religion and Medicine.
W 50 A817h 2006]
R724.A74 2006
174.2—dc22 2006003222
This book is printed on acid-free paper meeting the requirements of the American National Standard
for Permanence in Paper for Printed Library Materials.
13 12 11 10 09 08 07 06 9 8 7 6 5 4 3 2
First printing
Printed in the United States of America
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C
ONTENTS
Introduction ix
List of Abbreviations Used in the Text and in Citations xv
Part I: Health Care Ethics and Human Needs
1 Bioethics in a Multicultural Age 3
Overview 3
1.1 The Emergence of Secular Bioethics 3
1.2 The Foundations of the Ethics of Health Care 5
1.3 Current Methodologies in Bioethics 9
1.4 Faith and Reason in Health Care Ethics 19
1.5 Conclusion 30
2 Ethics and Needs of the Common Person 31
Overview 31
2.1 An Ethics Based on Innate Human Needs 31
2.2 Jesus Christ, Healer, as Ethical Model 40
2.3 Character and the Major Moral Virtues 42
2.4 Prudent Decision Making 50
2.5 Moral Norms Especially Relevant to Health Care 53
2.6 Conclusion 60
v
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vi Contents
Part II: Clinical Issues
3 Sexuality and Reproduction 63
Overview 63
3.1 The Meaning of Human Sexuality 63
3.2 When Does Human Life Begin? 69
3.3 Ethical Issues in Reproduction 73
3.4 Pastoral Approach to Ethical Problems Arising from Sexuality 88
3.5 Conclusion 89
4 Reconstructing and Modifying the Human Body: Ethical Perspectives 91
Overview 91
4.1 Modifying the Human Body 91
4.2 Genetic Intervention 94
4.3 Genetic Screening and Counseling 98
4.4 Organ Transplantation 103
4.5 Reconstructive and Cosmetic Surgery 108
4.6 Experimentation and Research on Human Subjects 113
4.7 Conclusion 122
5 Mental Health: Ethical Perspectives 125
Overview 125
5.1 What Is Mental Health? 126
5.2 Medical/Surgical Therapies 130
5.3 Psychotherapies 136
5.4 The Christian Model of Mental Health 145
5.5 Ethical Problems in Mental Therapy 148
5.6 Conclusion 160
6 Suffering and Death: A Theological Perspective 163
Overview 163
6.1 Mystery of Death 163
6.2 Fear of Death 166
6.3 Defining Death 169
6.4 Truth Telling to the Dying 173
6.5 Care for the Corpse or Cadaver 175
6.6 Suicide, Assisted Suicide, and Euthanasia 178
6.7 Allowing to Die: Withholding or Withdrawing Life Support 182
6.8 Care of Permanently Unconscious Patients 194
6.9 Treatment of Pain 197
6.10 Conclusion 198
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Contents vii
Part III: Social and Pastoral Responsibilities
7 Social Responsibility 203
Overview 203
7.1 Professions: Depersonalizing Trends 204
7.2 Characteristics of Medicine as a Profession 206
7.3 Health Care Counseling 210
7.4 Professional Communication and Confidentiality 212
7.5 The Political Situation of Health Care Today 215
7.6 Principles of Health Care Policy 218
7.7 Health Care Ethics and Public Policy 225
7.8 Responsibilities of Catholic Health Care Facilities 227
7.9 Conclusion 233
8 Pastoral Care 235
Overview 235
8.1 The Goals of Pastoral Ministry 235
8.2 Pastoral Care of the Health Care Staff 239
8.3 Pastoral Care and Ethical Counseling 241
8.4 Spiritual Counseling in Health Care 244
8.5 Celebrating the Healing Process 249
8.6 Conclusion 255
Glossary 257
References 265
Index 305
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I
NTRODUCTION
PURPOSE OF THE BOOK
IN THE MID-1970s, BENEDICT ASHLEY, O.P., a fellow of the Institute of Religion at
the Texas Medical Center, Houston, Texas, and Kevin O’Rourke, O.P., vice president for
Medical Ethics at the Catholic Hospital Association, St. Louis, Missouri—both former
presidents of the Aquinas Institute of Theology then located in Dubuque, Iowa—sought
to produce a volume that would explain The Ethical and Religious Directives for Catholic
Health Care Facilities of the United States Catholic Bishops Conference (ERD). We had a
twofold purpose: (1) to present a study that would consider the basic principles under-
lying the Catholic understanding of health care ethics and (2) to assist Christian, and es-
pecially Catholic, health care professionals and health care facilities in their task of offering
service and witness in the Christian tradition, in a milieu influenced by diverse and con-
flicting value systems. Thus we sought to consider the nature of the human person seek-
ing to fulfill human needs under the influence of grace, explain the principles of Catholic
theology that are pertinent to the practice of health care, and present individual clinical
issues in health care from this perspective.
As we present this fifth edition of Health Care Ethics, our purpose remains the same as
it was when we prepared the first edition. We proceed from the theological perspective of
the Catholic Church, and this theological perspective is founded upon sacred scripture but
also depends upon human reason, usually referred to as natural law. Hence, as indicated
in chapters 1 and 2, we believe that the Catholic theological perspective has much to con-
tribute to the discussion of bioethics in the twenty-first century.
We welcome a third author to this edition, Sister Jean deBlois, C.S.J. Jean was a registered
nurse before pursuing studies in moral theology and ethics. She received a Ph.D. in moral
ix
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x Introduction
theology from the Catholic University of America in 1987, and she was a faculty member
of the Center for Health Care Ethics at Saint Louis University Health Sciences Center for
a number of years before going to the Catholic Health Association. There she served as
ethicist and vice president for mission and sponsorship for a number of years. Currently
Jean is on the faculty of Aquinas Institute of Theology in St. Louis, Missouri, where she is
associate professor of moral theology and director of the Master of Arts in Health Care
Mission program. She is also sponsor liaison to Ascension Health for the Sisters of St. Joseph
of Carondolet. In that capacity, she serves on the board of trustees of Ascension Health.
NEW EDITION
The fourth edition of Health Care Ethics: A Theological Analysis was published almost ten
years ago. Since that time there have been many new clinical innovations and theoretical
issues that have arisen in the field of health care, which necessitate another edition of our
work. To name just a few of the recent developments in medicine, we consider in this most
recent edition of this book the completion of the Human Genome Project and its poten-
tial for radically changing the practice of medicine, recent efforts at controlling sexual se-
lection of infants, efforts at genetic modification of the human genotype and phenotype,
cloning, development of palliative care as a medical specialty, the acceptance of persons
without beating hearts as organ donors, the retrieval and cultivation of embryo and adult
stem cells as a source of therapy, development of reconstructive and cosmetic surgery, the
use of pharmacology to treat mental illness and awareness, and the weakening of man-
aged care as a method of controlling costs of medical care. In addition to these develop-
ments in clinical practice, the role of the federal government in regard to funding health
care has increased and technology has proliferated, as has the influence of health manage-
ment organizations of one kind or another. Because these changes in the health care envi-
ronment tend to weaken the bonds of the patient-physician relationship, we once again
devote attention to personalizing the health care profession.
After the many encyclicals of Pope John Paul II in the early 1990s, such as The Gospel
of Life, The Splendor of Truth, and Faith and Reason, which have relevance for the study of
health care ethics, and since the publication of the last edition, the Church did not offer
any new encyclicals influencing the ethics of health care. However, there were two signifi-
cant allocutions issued by Pope John Paul II that merit our attention: one concerning the
care of patients in a persistent vegetative state, and the second considering palliative care
for dying patients. In addition, the Catholic Bishops of the United States revised a few
norms of the ERD. The complete text of these important directives is found on the U.S.
Catholic Bishops website (see ERD 2001).
GENERAL OUTLINE
In the course of twenty-five years and five editions of this work, this is the most thorough
revision that we have undertaken. We have long maintained that health care ethics is
“everybody’s business.” It is not an esoteric topic reserved for a few. Realizing that many
people with a general interest in health care ethics, as well as health care professionals, have
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Introduction xi
used our book for reference and education, we have sought to make it more “user-friendly.”
With this in mind, we have limited some of the theoretical considerations and engaged as
soon as possible in the main discussion clinical issues that are of interest to our readers.
We have retained, however, considerations of the various methods of engaging in the study
of bioethics and the ethical responsibilities of social organizations such as the federal govern-
ment and the Church.
We believe that each person bears primary responsibility for personal health and the right
to retain ultimate control over his or her health. We also believe that each person has the
right to help from the community in achieving personal health, as well as the reciprocal
obligation to assist other members of the community in the same search. Fulfilling these
personal and social responsibilities is a value-centered, ethical endeavor. For this reason,
in part I, we devote attention to the various methods of ethical discourse utilized in the
United States today, explaining why these methods do not fulfill our purpose, and present
the method of ethical decision making utilized in Catholic tradition, with Jesus Christ as
the model for human well-being.
One of the unique features of our study is the question “What does it mean to be hu-
man?” In answer to this question, we consider the needs of the human person and the quest
to fulfill these needs. In this consideration of what it means to be human, we consider per-
sons as individuals—but also as members of a community—an essential factor of human
identity and fulfillment. We conclude this section with a consideration of the virtues that
are needed to develop a habit of Christian ethical decision making.
Next, in part II, we consider the more common ethical questions and dilemmas oc-
curring in clinical care. When considering these questions we offer, first of all, arguments
from human reason, sometimes called the natural law. We confirm natural law reason-
ing with the teachings of the magisterium of the Catholic Church, whether contained
in papal statements or in the ERD promulgated by the United States Conference of
Catholic Bishops (USCCB, 2001). Because the teaching of the Church often is open to
various interpretations, we seek to present the various responses that have been offered
by different voices from within the Catholic community. For example, the Directives
concerning Extra Uterine Pregnancy (D. 48) and Treatment of Rape Victims (D. 36)
prohibit any therapy that would be a direct abortion. But which method of therapy in
these clinical situations is truly a direct abortion is open to discussion. Hence we seek
to provide options that will further this discussion. When discussing clinical issues, and
in other places throughout the text, we often refer to physicians, but we really wish to
include in that word all other medical personnel engaged in serving others in their quest
for health. If sometimes we seem to devote more attention to physicians than to other
members of the health care team, it is only because they are more visible and their re-
sponsibilities are more clearly defined by professional standards. However, what is predi-
cated for physicians should be applied to other health care professionals as well.
Having considered the various particular ethical issues that arise in the study of health
care ethics in part III, we conclude our study by presenting the major social concerns and
investigating the nature and responsibility of health care professionals involved in pastoral
care. Social concerns are the responsibility of the health care profession, the federal gov-
ernment, and the health care facilities sponsored by juridical persons within the Church.
Because of our conviction that social concerns are an important part of our study, we have
chosen the term health care ethics rather than bioethics to designate the matter under study
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xii Introduction
due to the former’s wider connotation. Pastoral care concludes our study because it is an
integral element of health care ethics, insofar as it focuses on spiritual development, which
in a certain sense is the goal of all human activity.
DIVERSE VALUE SYSTEMS
Too often, bioethical controversies are confusing and frustrating because participants do
not define their value system or have little idea of the ethical system they are using and its
theoretical implications. Many today assume that there is an accepted neutral system of
bioethical decision making. Many also assume that any discussion of issues in bioethics
will be made in light of this neutral and often value-free system. We take a different view
and believe that the Roman Catholic system of moral decision making has much to offer
a public discussion of these issues. To give a privileged position to a humanistic perspec-
tive from the outset only frustrates honest debate and prevents cooperation in our plural-
istic society. Now, the humanistic or value-neutral method of decision making is considered
self-evident in our society. The President’s Commission on Bioethics (PCB) shows some
signs of mitigating this presumption by openly considering values presented by different
religious communities.
Catholics reason ethically in terms of a value system rooted in a view of reality con-
tained in the Christian Gospel interpreted by the Church in its life of faith and authorita-
tively formulated by the Pope and the bishops. Catholics believe in this teaching founded
upon the Gospels with a commitment of faith, and they accept its ordinary formulation
and application by the Pope and bishops with “religious assent,” even when these state-
ments lack the authority of a final definition. This commitment to authoritative teaching,
as well as respect for a long tradition of theological reflection, however, cannot exempt
educated Catholics from listening honestly to other systems of belief nor from comparing
their beliefs with the findings of science and history and with the personal experience of
life (Vatican Council II 1965). For Catholics, therefore, faith and reason are complimen-
tary, not contradictory sources of truth and value (John Paul II 1998b).
Because our ethical discussion of concrete issues is presented within the Catholic value
system, we have subtitled this book A Catholic Theological Analysis. We define analysis as
an effort to solve concrete ethical problems in terms of principles rooted in sacred scrip-
ture and tested by the experience of individuals and communities motivated by and rooted
in faith. We hope that in doing so we are in line with intellectual independence, combined
with respect for authority and tradition that, to us, is one of the chief characteristics of a
Catholic and Christian ethical system.
GRATITUDE
As in the past, we have been aided in the production of this work by many different
medical, nursing, and hospital administrative personnel and ethicists too numerous to
mention. We thank them for their willingness to read and critique sections of our book
that pertain to their specialties. We also offer our grateful thanks to Mark Kuczewski, Ph.D.,
director of the Neiswanger Institute for Bioethics and Health Policy at the Stritch School
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