Lawrence P. Ulrich; A Reaction to the Consensus Statement of the Working Group on Roman Catholic Approaches to Determining Appropriate Critical Care, Christian.

This article looks at the late John Paul II's allocution on artificial nutrition and hydration (ANH) and the implications his statement will have on the ordinary-extraordinary care distinction. The purpose of this article is threefold: first, to examine the medical condition of a persistent vegetative state (PVS); second, to examine and analyze the Catholic Church's tradition on the ordinary-extraordinary means distinction; and third, to analyze the ethics behind the pope's recent allocution in regards to PVS patients as a matter of (...) conscience. Rather than providing clarification, I argue that the papal allocution has raised many difficult questions. People in situations where decisions must be made about withdrawal or continued ANH are in need of guidance. Moreover, additional analysis is needed to determine whether the papal allocution is in conflict with the traditional Catholic medical ethics understanding of the ordinary-extraordinary care distinction. (shrink)

Because sin is anything that turns our heart from God, sins are both voluntary and jnvoluntary. As a consequence, double effect can only be adequately understood in a Christian context in which it is recognized that, even when evil is not willed, our involvement in its causation can still mar our hearts. The acknowledgement of involuntary sins resituates double effect so that the traditional Christian concern with spiritual harm and healing can be maintained. In this way, one can overcome the (...) underdeveloped Western theological appreciation of double effect, which ignores the effect on the heart of causing evil. (shrink)

Being a Christian involves metaphysical, epistemological, and social commitments that set Christians at variance with the dominant secular culture. Because Christianity is not syncretical, but proclaims the unique truth of its revelation, Christians will inevitably be placed in some degree of conflict with secular health care institutions. Because being Christian involves a life of holiness, not merely living justly or morally, Christians will also be in conflict with the ethos of many contemporary Christian health care institutions which have abandoned a (...) commitment to Christian spirituality. In this regard, managed care raises the special question of how Christian institutions can act morally under financial constraints and maintain their character while under the control of secular managers. This question itself raises the further question as to why health care institutions need even pose this query when there are Christian physicians and nurses who could work for less, or Christian men and women who could become sisters and brothers and work for nothing. Contemporary challenges to Christians to maintain their integrity in a post-Christian world have much of their force because Christians have failed to maintain traditional Christian spirituality. In the face of that failure, Christian physicians and nurses will find themselves in greater conflict with health care institutions, because few will any longer understand the requirements of traditional Christianity. In its place, they will have put a generic spirituality, a value-neutral understanding of the role of the health professional, and an anonymous commitment to social justice. (shrink)

In Roman Catholic Moral Theology, a direct abortion is never permitted. An indirect abortion, in which a life threatening pathology is treated, and the treatment inadvertently leads to the death of the fetus, may be permissible in proportionately grave situations. In situations in which a mother’s life is endangered by the pregnancy before the fetus is viable, there is some debate about whether the termination of the pregnancy is a direct or indirect abortion. In this essay a recent case from (...) a Roman Catholic sponsored hospital in Phoenix is reviewed along with the justifications for and arguments against viewing the pregnancy termination as an indirect abortion. After review of several arguments on both sides of the debate, it is concluded that termination of the pregnancy itself as the means of saving the mother cannot be considered an indirect abortion and that the principle of “double effect” does not justify the termination. In addition, the importance of a breakdown in communication between the local bishop and the administration of the hospital is shown to have contributed to the ultimate loss of Catholic sponsorship of the hospital. (shrink)

In Roman Catholic Moral Theology, a direct abortion is never permitted. An indirect abortion, in which a life threatening pathology is treated, and the treatment inadvertently leads to the death of the fetus, may be permissible in proportionately grave situations. In situations in which a mother’s life is endangered by the pregnancy before the fetus is viable, there is some debate about whether the termination of the pregnancy is a direct or indirect abortion. In this essay a recent case from (...) a Roman Catholic sponsored hospital in Phoenix is reviewed along with the justifications for and arguments against viewing the pregnancy termination as an indirect abortion. After review of several arguments on both sides of the debate, it is concluded that termination of the pregnancy itself as the means of saving the mother cannot be considered an indirect abortion and that the principle of “double effect” does not justify the termination. In addition, the importance of a breakdown in communication between the local bishop and the administration of the hospital is shown to have contributed to the ultimate loss of Catholic sponsorship of the hospital. (shrink)

Adequate response to physician-assisted suicide and euthanasia depends on fundamental philosophical and theological issues, including the character of an appropriate philosophically and theologically anchored anthropology, where the central element of traditional Christian anthropology is that humans are created to worship God. As I will argue, Christian morality and moral epistemology must be nested within and understood through this background Christian anthropology. As a result, I will argue that physician-assisted suicide and euthanasia can only be one-sidedly and inadequately appreciated through rational (...) appeal to central values, such as “human dignity” and “self-determination”, or through “sola scriptura” biblical interpretation, or individual judgments of conscience. Adequately addressing physician-assisted suicide and euthanasia will depend on a more fundamental spiritual-therapeutic approach. This cluster of moral, epistemological, anthropological, and bioethical claims will be explored by drawing on the texts of St. Basil the Great, St. Maximos the Confessor, and St. Isaac the Syrian. Their reflections on medicine, the human good, and its relationship to worship, spiritual therapy, and God will be used as a basis to indicate a broader philosophical perspective, which will be needed to avoid a one-sided, incomplete approach to the challenges of physician-assisted suicide and euthanasia. Medical morality, I argue, is best understood within categories that transcend the right, the good, the just, and the virtuous; namely, the holy. (shrink)

This issue of Christian Bioethics explores foundational debates regarding the orientation and application of Christian bioethics. Should Christian bioethics be approached as essentially a human activity, grounded in scholarly study of theological arguments and religious virtues, oriented toward practical social ends, or should Christian bioethics be recognized as the result of properly oriented prayer, fasting, and asceticism leading to an encounter with God? The gulf between these two general perspectives—the creation of immanent human goods versus submission to a fully transcendent (...) God—is significant and, as ongoing debate in Christian Bioethics: Non-Ecumenical Studies in Medical Morality over the past nearly three decades has made clear, the implications are both intellectually engaging and spiritually profound. (shrink)

With rare exception, Roman Catholic moral theologians condemn the sale of human organs for transplantation. Yet, such criticism, while rhetorically powerful, often over-simplifies complex issues. Arguments for the prohibition of a market in human organs may, therefore, depend on a single premise, or a cluster of dubious and allied premises, which when examined cannot hold. In what follows, I will examine the ways in which such arguments are configured. For example, Thomas Aquinas’(1224-1274) understandings of embodiment and moral uses of the (...) body are usually interpreted as, and cited in support of, foreclosing a market in human organs. Aquinas’ principle of totality requires that one preserve the wholeness of the human body. In approaching Aquinas’ texts, I will assume the role of a revisionist who takes seriously his core commitments, while at the same time indicating that one can further develop his understanding of the body in ways which are supportive of the sale of human organs while remaining in conformity with the author's core concerns. Such considerations will provide significant grounds for concluding that a market in human organs for transplantation appreciates the embodied nature of the human person, respects the body and its parts as personal, rather than as mere things, is consistent with acknowledging God’s dominion over our lives and bodies, and constitutes an appropriate utilization of God's gifts to us. Moreover, such a market would likely create significant opportunities charitably to help others, to enhance human dignity and to protect against the serious dehumanization of current national bureaucratic procedures for organ donation. (shrink)

Dr Gillian Craig (1) has argued that palliative medicine services have tended to adopt a policy of sedation without hydration, which under certain circumstances may be medically inappropriate, causative of death and distressing to family and friends. We welcome this opportunity to defend, with an important modification, the approach we proposed without substantive background argument in our original article (2). We maintain that slowing and eventual cessation of oral intake is a normal part of a natural dying process, that artificial (...) hydration and alimentation (AHA) are not justified unless thirst or hunger are present and cannot be relieved by other means, but food and fluids for (natural) oral consumption should never be 'withdrawn'. The intention of this practice is not to alter the timing of an inevitable death, and sedation is not used, as has been alleged, to mask the effects of dehydration or starvation. The artificial provision of hydration and alimentation is now widely accepted as medical treatment. We believe that arguments that it is not have led to confusion as to whether or not non-provision or withdrawal of AHA constitutes a cause of death in law. Arguments that it is such a cause appear to be tenuously based on an extraordinary/ordinary categorisation of treatments by Kelly (3) which has subsequently been interpreted as prescriptive in a way quite inconsistent with the Catholic moral theological tradition from which the distinction is derived. The focus of ethical discourse on decisions at the end of life should be shifted to an analysis of care, needs, proportionality of medical interventions, and processes of communication. (shrink)

Despite recent advances in ways to prevent transmission of HIV from a mother to her child during pregnancy, infants continue to be born and become infected with HIV, particularly in southern Africa where HIV prevalence is the highest in the world. In this region, emphasis has shifted from voluntary HIV counselling and testing to routine testing of women during pregnancy. There have also been proposals for mandatory testing. Could mandatory testing ever be an option, even in high-prevalence settings? Many previous (...) examinations of mandatory testing have dealt with it in the context of low HIV prevalence and a well-resourced health care system. In this discussion, different assumptions are made. Within this context, where mandatory testing may be a strategy of last resort, the objections to it are reviewed. Special attention is paid in the discussion to the entrenched vulnerability of women in much of southern Africa and how this contributes to both HIV prevalence and ongoing challenges for preventing HIV transmission during pregnancy. While mandatory testing is ethically plausible, particularly when coupled with guaranteed access to treatment and care, the discussion argues that the moment to employ this strategy has not yet come. Many barriers remain for pregnant women in terms of access to testing, treatment and care, most acutely in the southern African setting, despite the presence of national and international human rights instruments aimed at empowering women and removing such barriers. While this situation persists, mandatory HIV testing during pregnancy cannot be justified. (shrink)