In 1994, the National Conference of Catholic Bishops revised the "Ethical and Religious Directives for Catholic Health Care Services." A goal of the Directives is to maintain the moral integrity of Catholic health care institutions and to address controversies in bioethics and health care. The Directives represent a shift to an exclusively principle-based approach to moral reason. This shift threatens to undermine the very tradition that (...) the bishops seek to protect. (shrink)

In 1994, the National Conference of Catholic Bishops revised the "Ethical and Religious Directives for Catholic Health Care Services." A goal of the Directives is to maintain the moral integrity of Catholic health care institutions and to address controversies in bioethics and health care. The Directives represent a shift to an exclusively principle-based approach to moral reason. This shift threatens to undermine the very tradition that (...) the bishops seek to protect. (shrink)

The first edition of the Ethical Religious Directives for Catholic Health Care Services was published in 1948. Since then, it has undergone two major revisions and several smaller ones. The following essay explores the history of the ERDs and the important aspects of these revisions.

Completely updated and revised, the third edition of Catholic Health Care Ethics: A Manual for Practitioners sets the standard for Catholic bioethicists, physicians, nurses, and other health care workers. In thirty-nine chapters (many with subchapters), leading authors in their fields discuss a wide range of topics relevant to medicine and health care. The book has six parts covering foundational principles, health care ethics services, beginning-of-life issues, end-of-life issues, selected clinical (...) issues, and institutional issues. Some highlights from the third edition include new entries on the Ethical and Religious Directives for Catholic Health Care Services, certitude in moral decision-making, the principle of double effect, clinical ethics consultation, natural family planning, prenatal testing and diagnosis, care of fetal remains, challenges to neurological criteria, the use of ventilators, POLST, alkaline hydrolysis, opportunistic salpingectomy, so-called lethal prenatal diagnoses, transgenderism, and new age medicine. The volume continues to provide insightful information on the topics previously covered in the second edition, but with significant updates throughout. (shrink)

Cochran has argued that Catholic health care occupies a “unique place on the border of public and private life”. Catholic health care is accountable to both its religious and sacramental traditions and its public responsibilities. It is inevitable that “border skirmishes” will arise. Yet there is no single formula for suggesting what public-private collaboration should comprise or how conflicts between values ought to be resolved. It may be, as Cochran suggests, that increasingly bitter (...) conflicts over widely valued services such as sterilization, combined with market pressures to conform to for-profit trends in health care, will make divestiture of faith-based hospitals in favor of other types of church-community partnerships the best course for the future. (shrink)

We argue that the American Society for Bioethics and Humanities has endorsed a facilitation approach to clinical ethics consultation that asserts that bioethicists can offer moral recommendations that are well-grounded in bioethical consensus. We claim that the closest thing the field currently has to a citable, nationally endorsed bioethical consensus are the 22 Core References used to construct the questions for the Healthcare Ethics Consultant-Certified (HEC-C) exam. We acknowledge that the Core References reflect some important points of bioethical consensus, but (...) note they are unwieldy, repetitive, and sometimes inconsistent on important issues faced by clinical ethicists. In this article, we draw carefully qualified inspiration from the Ethical and Religious Directives for Catholic Health Care Services (ERDs) to argue for the creation of a concise, nationally endorsed bioethical consensus document on moral issues commonly faced in clinical ethics, what we call the Standardized Ethical Guidelines for Secular Health Care Services (SEGs). We observe that such a document would better meet the expectations of stakeholders, clinical ethicists, and their trainees who desire moral recommendations grounded in a clearly articulated bioethical consensus, and we defend the SEGs from some common objections. (shrink)

The American Society for Bioethics and Humanities poses a chal­lenge in Core Competencies for Healthcare Ethics Consultation: health care ethics consultation services “should be able to demonstrate their value to those who pay for the service, as well as to those whom the service is intended to serve.” To respond to this challenge, this article provides a brief review of the literature on evaluating ethics consultation in its traditional frameworks of quality outcomes. The author follows this discussion (...) with a new methodology to evaluate ethics consultation on the basis of the intrinsic good of the service. He ends with a novel risk-based assessment to complement the evaluation of clinical ethics services grounded in the Ethical and Religious Directives for Catholic Health Care Services. (shrink)

The public responsibilities of nonprofit hospitals have been contested since the advent of the 1969 community benefit standard. The distance between the standard's legal language and its implementation has grown so large that the Internal Revenue Service issued a new reporting form for 2008 that is modeled on the Catholic Health Association's guidelines for its member hospitals. This article analyzes the appearance of an emerging moral consensus about community benefits to argue against a strict charity care mandate (...) and in favor of directing efficient care delivery and healthy community initiatives to underserved populations. The analysis turns on three moral conceptions of community benefits, the social contract model of hospital critics and the common good and covenantal models of Catholic and Jewish hospitals. (shrink)

Part Five is in considerable need of revision. There have been many developments in medicine and health care that present serious moral challenges to the teachings of the Church. The recommendations below include new emphasis on palliative care and hospice, the right of Catholics to receive the sacraments and visits from the family during illness, further safeguards to protect those in a persistent vegetative state, the immorality of voluntary stopping of eating and drinking (VSED), the permissibility of (...) do not resuscitate (DNR) orders, the limited use of palliative sedation, and the requirement that the standards for determining death be rigorously applied by medical professionals. Other minor recommendations seek to bring greater clarity to the existing directives. (shrink)

Part Two of the Ethical and Religious Directives outlines the responsibility to care for the spiritual needs of patients and residents, following the example of Christ who both healed the sick and forgave them their sins. The proposed revisions to the introduction add a more explicit focus on the dignity of the sick, the redemptive value of suffering, and the potential evangelization that takes place through institutional health care. The proposed revisions to the (...) class='Hi'>directives emphasize that patients and residents have a right to receive spiritual and sacramental care. Likewise, Catholic healthcare institutions, medical staff, and pastoral care personnel have an obligation to arrange and provide adequate spiritual and sacramental care. (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)

Part One of the ERDs addresses the balance Catholic health care institutions must strike between their mission to carry out the healing ministry of Christ and the demands of the US health care system. Divided into two sections, the commentary begins by proposing revisions to the Part One introduction focusing on enhanced application of Catholic social teaching principles and a renewed call for robust conscience and religious liberty protections. It then proposes additions to (...) the Part One directives designed to help Catholic health care respond with integrity to the many contemporarychallenges it faces, and to more full live out its mission and identity. (shrink)

Directive 36 of the Ethical and Religious Directives for Catholic Health Care Services gives guidance to health care professionals on the reactive administration of contraceptives to women in instances of isolated rape. This paper examines the moral permissibility of long-term proactive contraceptive use in instances of repeated marital rape by comparing it to the moral permissibility of reactive contraceptive use in cases of isolated rape found in directive 36.

Roman Catholics have a long tradition of evaluating medical treatment at the end of life to determine if proposed interventions are proportionate and morally obligatory or disproportionate and morally optional. There has been significant debate within the Catholic community about whether artificially delivered nutrition and hydration can be appreciated as a medical intervention that may be optional in some situations, or if it should be treated as essentially obligatory in all circumstances. Recent statements from the teaching authority of the (...) church have attempted to clarify this issue, especially for those with a condition known as the persistent vegetative state. I argue that these recent teachings constitute a “general norm” whereby artificial nutrition and hydration are considered obligatory for most patients, but that these documents allow for exception in cases of complication from the means used to deliver nutrition and hydration, progressive illness, or clear refusal of such treatment by patients. While the recent clarifications do not constitute a major deviation from traditional understanding and will rarely conflict with advance directives or legal statutes, there may be rare instances in which remaining faithful to church teaching may conflict with legally enshrined patient prerogatives. Using the Texas Advance Directives Act as an example, I propose ways in which ethics committees can remain faithful to their Roman Catholic identity while respecting patient autonomy and state law pertaining to end of life health care. (shrink)

Some hold that the revision to directive 58 of the Ethical and Religious Directives for Catholic Health Care Services—which sought to incorporate the language of Pope John Paul II’s 2004 statement regarding the obligation to provide patients in a persistent vegetative state—represents a threat to patient’s end-of-life decisions. I argue this position is unfounded. The revision to the directive, and the statements that inspired this linguistic modification, do not represent a substantive change in (...) the Church’s teaching. I support this position based on two claims. First, in his statement, the Holy Father speaks of food and water and care personnel’s obligation to provide them as relative to the patient’s status as a person. That is, relative to the patient’s human nature, food and water represent a per se useful means for preserving life and, as such, should be considered ordinary and obligatory. Second, since his teaching is directed toward care personnel, John Paul II does not discuss the patient’s judgment of the means with the assumption that the Tradition has already clearly established the legitimacy of patients refusing means they judge to be extraordinary. Finally, I argue that one of the effects of the Pope’s statement is that it manages to reaffirm the Church’s teaching on euthanasia and ordinary and extraordinary means without institutionalizing a particular theologian’s vision of anthropology. (shrink)

There is controversy in the Catholic medical ethics community surrounding assisted nutrition and hydration (ANH). Recently, the Ethical and Religious Directives for Catholic Health Care Services were amended to make ANH “obligatory.” The persistent vegetative state is cited specifically in the document, and the sentence following its mention states that ANH is “optional” when it cannot be expected to “prolong life” or when it would be “excessively burdensome.” For patients suffering from other (...) medical conditions, such as dementia and frailty, ANH may be excessively burdensome and may not prolong life. For these patients, ANH may be of no real benefit and may even have significant morbidity and mortality. Competent individuals with these conditions can ethically elect to forgo ANH. National Catholic Bioethics Quarterly 10.3 (Autumn 2010): 481–488. (shrink)

Hospitals sometimes refuse to provide goods and services or honor patients’ decisions to forgo life-sustaining treatment for reasons that appear to resemble appeals to conscience. For example, based on the Ethical and Religious Directives for Catholic Health Care Services , Catholic hospitals have refused to forgo medically provided nutrition and hydration , and Catholic hospitals have refused to provide emergency contraception and perform abortions or sterilization procedures. I consider whether it (...) is justified to refuse to offer EC to victims of sexual assault who present at the emergency department . A preliminary question, however, is whether a hospital’s refusal to provide services can be conceptualized as conscience based. (shrink)

Theological basis -- Religion and health care -- The dignity of human life -- The integrity of the human person -- Implications for health care -- Theological principles in health care ethics -- Method -- The levels and questions of ethics -- Freedom and the moral agent -- Right and wrong -- Metaethics -- Method in Catholic bioethics -- Catholic method and birth control -- The principle of double effect -- Application -- (...) Forgoing treatment, pillar one: ordinary and extraordinary means -- Forgoing treatment, pillar two: killing and allowing to die -- Forgoing treatment, pillar three: decisions by competent patients -- Forgoing treatment, pillar three: decisions for incompetent patients -- Forgoing treatment, pillar three: advance directives -- Hydration and nutrition -- Physician-assisted suicide and euthanasia -- Medical futility -- Pain and pain management -- Ethics committees -- Embryonic stem cells and the beginning of human personhood -- Genetic engineering -- Allocating health care resources -- The use and misuse of the allocation argument. (shrink)

In March 2010, President Obama signed into law The Patient Protection and Affordable Care Act (ACA). Although there is much in the ACA that is endorsed by the Catholic health ministry, the many positive provisions of the ACA have been overshadowed for the Catholic Church and the Catholic healthcare community by the controversial provisions requiring access to all FDA-approved sterilization and contraceptive medications (75 Fed. Reg. 137 (19 July 2010)) Typically, these drugs and services (...) have not been covered by the health plans of many religious employers including Catholic hospitals, universities, and social service agencies. Acknowledging the existence of religious-based objections to the provisions of these .. (shrink)

Advertising by health care institutions has increased steadily in recent years. While direct-to-consumer prescription drug advertising is subject to unique oversight by the Federal Drug Administration, advertisements for health care services are regulated by the Federal Trade Commission and treated no differently from advertisements for consumer goods. In this article, we argue that decisions about pursuing health care services are distinguished by informational asymmetries, high stakes, and patient vulnerabilities, grounding fiduciary responsibilities on (...) the part of health care providers and health care institutions. Using examples, we illustrate how common advertising techniques may mislead patients and compromise fiduciary relationships, thereby posing ethical risks to patients, providers, health care institutions, and society. We conclude by proposing that these risks justify new standards for advertising when considered as part of the moral obligation of health care institutions and suggest that mechanisms currently in place to regulate advertising for prescription pharmaceuticals should be applied to advertising for health care services more broadly. (shrink)

In this volume, leading scholars in ethics, theology, and health care address conscience and how it relates to Catholic health care. Topics addressed include end-of-life care, abortion, and sterilization. The book is particularly useful for ethics boards and chaplains in Catholic hospitals, especially those merging with non-Catholic chains.

As the other entries in this section have surely made clear, Carolyn McLeod's outstanding monograph, Conscience in Reproductive Health Care: Prioritizing Patient Interests, is fertile ground for fruitful philosophical analyses of issues pertaining to conscience, trust, autonomy, and more, all of which are sure to be of great interest and benefit to scholars in areas such as bioethics, health policy, and feminist ethics. Conscience in Reproductive Health Care provides a compelling response to a timely bioethical (...) dilemma: What do we do when healthcare providers refuse certain health services to patients on grounds of conscience? McLeod contends that healthcare providers, in light of their fiduciary... (shrink)

Disagreement over the legitimacy of direct sterilization continues within Catholic moral debate, with painful and at times confusing ramifications for Catholic healthcare systems. This paper argues that the medical profession should be construed as a key moral authority in this debate, on two grounds. First, the recent revival of neo-Aristotelianism in moral philosophy as applied to medical ethics has brought out the inherently moral dimensions of the history and current practice of medicine. Second, this recognition can be linked (...) to Catholic morality through Vatican II’s affirmation of the legitimate autonomy of culture, including the sciences. A partial precedent for understanding the moral authority of medicine can be found in the recent history of Catholic medical morality, and we further argue that a full contemporary recognition of that authority would weigh against an absolute prohibition of direct sterilizations. Institutionally, we propose the allowance of direct sterilizations in cases where the clinically perceived biomedical good of the patient is at stake. (shrink)

Little is known about how certain patient characteristics can affect the timing of an ethics consultation, which has been hypothesized to affect patient length of stay. This study assessed how specific patient characteristics affect the timing of an ethics consultation, namely, age (over 65 years), race, Medicaid status, the presence of a living will, the presence of a health care proxy, and the absence of decisional capacity. Moving beyond the typical case-series evaluation of an ethics consultation service, this (...) study used an innovative approach to model how predisposing, enabling, and need factors affect health behavior and subsequently affect health outcomes for patients who received an ethics consultation at a Catholic health care system in Oklahoma. (shrink)

We suggest edits to Part Four of the Ethical and Religious Directives (ERDs) to help the US bishops address and clarify essential Church teachings on specific beginning-of-life issues facing Catholic health care today. As a teaching tool, Part Four must be updated so that Catholic health care professionals and the lay faithful can understand and apply Church teachings to new ethical challenges. Further, more direction and clarity from the ERDs is (...) needed in applying general principles to assisted procreative technologies, pre- and post-viability induction of labor, ectopic pregnancies, genetic screening and diagnosis, and contraception. Catholic health care clinicians and administrators also need to receive ongoing instruction on the ERDs’ teachings as well as the theological and philosophical rationales that undergird them. (shrink)

The British National Health Service (BNHS) was founded, to quote Minister of Health Aneurin Bevan, to ‘universalise the best’. Over time, however, financial constraints forced the BNHS to turn to incrementalist budgeting, to rationalise care and to ask its practitioners to act as gatekeepers. Seeking a way to ration scarce tertiary care resources, BNHS gatekeepers began to use chronological age as a rationing criterion. Age-rationing became the ‘done thing’ without explicit policy directives and in a (...) manner largely invisible to patients, to Parliament, and to the public. The invisibility of the practice, however, violates the publicity principle that John Rawls and other philosophers believe essential to fairness. BNHS invisible age-rationing practices are thus a test case of the principle that fairness presupposes publicity; they raise the question: is it possible to preserve equitability in a system that uses non-public criteria to allocate scarce resources? To seek an answer, published data on access to end-stage renal disease (ESRD) treatment in Britain and the European Community (EC) are analysed. Among the findings are: that BNHS age-rationing acts as an excuse for denying care to those most likely to need ESRD treatment; and is, moreover, arbitrary and inequitable. It is further argued that no age-rationing policy can sustain visibility, and that, if the BNHS is to be fair to its patients, it must reform its present age-rationing practices, replacing them by a publicly visible, outcome-based rationing policy that rations either in terms of QALYs or triage categories. (shrink)

This article critically examines, from the perspective of a Roman Catholic Healthcare ethicist, the second edition of the Core Competencies for Healthcare Ethics Consultation report recently published by the American Society for Humanities and Bioethics. The question is posed: can the competencies identified in the report serve as the core competencies for Roman Catholic ethical consultants and consultation services? I answer in the negative. This incongruence stems from divergent concepts of what it means to do ethics (...) consultation, a divergence that is rooted in each perspective's very different visions of autonomy. Furthermore, because of the constitutive elements of Catholic ethics consultation, such as the Ethical and Religious Directives for Health Care Services, the tradition needed to apply those directives, and the Catholic facility’s membership in the institutional Church, the competencies needed for its practice differ in kind from those identified by the report. While there are many practical points of convergence, the competencies identified by the report should not be adopted uncritically by Catholic healthcare institutions as core competencies for ethical consultation services. (shrink)

Artificial Intelligence (AI) contributes to common goods and common harms in our everyday lives. In light of the Collingridge dilemma, information about both the actual and potential harm of AI is explored and myths about AI are dispelled. Catholic health care is then presented as being in a unique position to exert its influence to model the use of AI systems that minimizes the risk of harm and promotes human flourishing and the common good.

Laverty, Martin This article is a slightly edited version of a speech given by Martin Laverty to the 2013 Annual General Meeting of the Caroline Chisholm Centre for Health Ethics. It views the movement towards consumer-directed care in Australia not as a threat to Catholic health and aged care, but as an opportunity to deepen our understanding of our mission and to develop services which are distinctive in their commitment to providing excellent care (...) in response to the changing needs of the community. It explores consumer-directed care, highlights limitations in our current understanding of mission and ethics, and challenges us to be prophetic as the founders of our institutions were in responding to community need. (shrink)

Abstract:Recently the scope of protections afforded those healthcare professionals and institutions that refuse to provide certain interventions on the grounds of conscience have expanded, in some instances insulating providers (institutional and individual) from any liability or sanction for harms that patients experience as a result. With the exponential increase in the penetration of Catholic-affiliated healthcare across the country, physicians and nurses who are not practicing Catholics are nevertheless required to execute documents pledging to conform their patient care to (...) the Ethical and Religious Directives for Health Care Services as a condition of employment or medical staff privileges. In some instances, doing so may result in patient morbidity or mortality or violate professional standards for respecting advance directives or surrogate decisionmaking. This article challenges the ethical propriety of such institutional mandates and argues that legal protections for conscientious refusal must provide redress for patients who are harmed by care that falls below the prevailing clinical standards. (shrink)

USING QUALITATIVE INTERVIEWS AT CATHOLIC AND JEWISH HOSPITAL organizations, this essay contrasts the market-driven reforms of consumer-directed health care and physician entrepreneurship with the mission-driven structures of religious nonprofits. A structural analysis of values in health care makes a convoluted system more transparent. It also demonstrates the limitations of market reforms to the extent that they erode organizational structures of solidarity, which are needed to pool risks, shift costs, and maintain safety nets in a (...) complex and expensive health economy. (shrink)

The present ethical advice tackles the question as to how caregivers in a Catholic mental health service can take care of psychiatric patients requesting euthanasia because of their unbearable mental suffering. The question arises because the Belgian act on euthanasia allows euthanasia under certain conditions, while the Roman Catholic Church forbids euthanasia in all circumstances. The ethical advice is based on the assessment of fundamental values: the inviolability of life, the patient’s autonomy, and the (...) care relationship between caregivers and patient. To integrate these values, caregivers should in a timely fashion make clear that life is inviolable, attentively respect the patient’s autonomy, and provide the best possible care relationship, including counseling for existential questions. If the request for euthanasia persists, the only sensible option is to refer the patient to another physician, guaranteeing the continuity of the care relationship. In the tension between the inviolability of life and the patient’s autonomy, the care relationship is the binding value. (shrink)

This essay chronicles the development of Catholic health care in the United States during the Nineteenth and Twentieth Centuries. The author points to the religious pluralism and the respect for that pluralism as well as to the evangelical drive for conversion evident in Catholic hospitals. This essay is a phenomenological study of this commitment to pluralism and the evangelical impulse within the contexts of health care.

This essay attempts to describe contemporary Catholic sponsored health care in the United States and to describe the purpose and structure of these particular Christian charitable organizations within the broader society. As health care has become more complex, critics claim that there is not a need for Catholic sponsored health care any longer. The author attempts to evaluate critically whether Catholic health care has a place in contemporary society. He (...) reviews some salient biblical, ecclesial, and justice teachings of the Church to demonstrate why religious institutional presence is still needed. The author reviews contemporary health care structures to show how this is accomplished. He also uncovers additional issues which need to be addressed in order for these charitable institutions to carry on the ministry of the Church, to shape social structures, and to proclaim the reign of God. (shrink)

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health (...) class='Hi'>Care Ethics Consultants, the American Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

McGovern, Kevin This is a slightly edited version of a talk given on 23 August 2010 at the Catholic Health Australia National Conference at the Adelaide Convention Centre. Three bioethicists were asked to reflect on Ethical Challenges Ten Years from Now. This talk focussed not on new issues but on current concerns which will continue to challenge us.

McGovern, Kevin Pope Francis's Evangelii Gaudium calls us to both service and silence. This article explores the theological underpinning of this call, and considers its implications for Catholic health, aged and community care services in Australia.

Crowdfunding websites allow users to post a public appeal for funding for a range of activities, including adoption, travel, research, participation in sports, and many others. One common form of crowdfunding is for expenses related to medical care. Medical crowdfunding appeals serve as a means of addressing gaps in medical and employment insurance, both in countries without universal health insurance, like the United States, and countries with universal coverage limited to essential medical needs, like Canada. For example, as (...) of 2012, the website Gofundme had been used to raise a total of 8.8 million dollars for seventy-six hundred campaigns, the majority of which were health related. This money can make an important difference in the lives of crowdfunding users, as the costs of unexpected or uninsured medical needs can be staggering. In this article, I offer an overview of the benefits of medical crowdfunding websites and the ethical concerns they raise. I argue that medical crowdfunding is a symptom and cause of, rather than a solution to, health system injustices and that policy-makers should work to address the injustices motivating the use of crowdfunding sites for essential medical services. Despite the sites’ ethical problems, individual users and donors need not refrain from using them, but they bear a political responsibility to address the inequities encouraged by these sites. I conclude by suggesting some responses to these concerns and future directions for research. (shrink)

This article analyzes the contribution Christian ethics might be able to make to the ethical debate on policy and caregiving in health and social care in the United Kingdom. The article deals particularly with the concepts of solidarity and subsidiarity which are essential in Christian social ethics and health care ethics, and which may be relevant for the ethical debate on health and social caregiving in the United Kingdom. An important argument in the (...) article is that utilitarian and market-driven policies in the National Health Service (NHS) and the social care system have marginalized the position of the elderly and have seriously impoverished the quality of care for the elderly. The neglect of the elderly and other vulnerable groups is also the result of widespread consumerist attitudes among patients and of libertarian models of noninterference which are affirmed by a public ethos of self-sufficiency and counter-dependency. Those who need care dare not make their need known to others and ask for help, while simultaneously those who could help are so intimidated by the public affirmation of privacy and negative rights that they do not dare to offer help except if this is explicitly demanded. This distant and standoffish attitude is in an important way responsible for the fact that the voice of those in need is altogether lost to the public forum. Christian ethics puts much emphasis on responsibility and solidarity with the needy other but is not able to have much impact on the delivery of care in a secularized society and health care system like the NHS. Nonetheless, Christianity still has a powerful and respected voice, by speaking up for those who cannot speak for themselves, such as the elderly and the handicapped. Christians can find allies in the ethics of care and other relational approaches in health care ethics in order to combat libertarianism, consumerism, and utilitarianism. (shrink)

Catholics have been at the forefront of efforts over many years to secure universal access to health care in the United States. These efforts suf­fered a serious setback when the federal government enacted the Affordable Care Act and then quickly used it to assault rights of conscience. This assault has brought into serious question the once promising hope that a partnership might be forged between church and state to benefit those at the margins of society. Given recent (...) events, Catholics and others are compelled to reassess their willingness to trust the power of government to carry out this aim in a manner that respects fundamental human rights, including the rights of religious believers. The words of our founders and framers, who warned against the dangers of an overbearing government, merit renewed attention. (shrink)

Toronto physician Brian Goldman had thought about “joining the camp that favours private health care for Canada.” Writing in the Canadian Medical Association Journal, he tells us that he changed his mind after one of his cats experienced a series of illnesses and misadventures that resulted in a Can$3,101 medical bill. “I’m just glad,” he says, “that the cost of health care never entered my deliberations.”’Canadian citizens and permanent residents are similarly free from most worries about (...) the direct costs of their own medical care, and have been for more than a generation. This reflects a fundamental difference between the Canadian and United States contexts for health policy. Since the failure of President Clinton's first-term efforts to provide something approximating universal health insurance, reforms to the existing regime of providing and financing health care in the United States have been incremental, and primarily responsive to the changing nature of the health care marketplace. In Canada, universal publicly funded first-dollar coverage for most physicians’ and hospitals’ services has been a reality since the early 1970s. (shrink)

Toronto physician Brian Goldman had thought about “joining the camp that favours private health care for Canada.” Writing in the Canadian Medical Association Journal, he tells us that he changed his mind after one of his cats experienced a series of illnesses and misadventures that resulted in a Can$3,101 medical bill. “I’m just glad,” he says, “that the cost of health care never entered my deliberations.”’Canadian citizens and permanent residents are similarly free from most worries about (...) the direct costs of their own medical care, and have been for more than a generation. This reflects a fundamental difference between the Canadian and United States contexts for health policy. Since the failure of President Clinton's first-term efforts to provide something approximating universal health insurance, reforms to the existing regime of providing and financing health care in the United States have been incremental, and primarily responsive to the changing nature of the health care marketplace. In Canada, universal publicly funded first-dollar coverage for most physicians’ and hospitals’ services has been a reality since the early 1970s. (shrink)

This book offers a comprehensive overview of the compatibility of palliative care with the vision of human dignity in the Catholic moral and theological traditions. The unique value of this book is that it presents expert analysis of the major domains of palliative care and how they are compatible with, and enhanced by, the holistic vision of the human person in Catholic health care. This volume will serve as a critically important ethical and (...) theological resource on palliative care, including care at the end of life, for bioethicists, theologians, palliative care specialists, other health care professionals, Catholic health care sponsors, health care administrators and executives, clergy, and students. Patients receiving palliative care and their families will also find this book to be a clarifying and reassuring resource. (shrink)

At Providence St. Joseph Health in Oregon, many factors contribute to the integration and success of the ethics services. There are three principal lenses through which one can understand the distinct way in which the ethics services are operationalized and integrated: the theological foundations of ethics as a service, the institutional ecology, and the professionalization of the field of health care ethics. The authors review key realities that have shaped their work through these three lenses (...) and then describe the activities of the Providence Center for Health Care Ethics regarding its strategic objectives and clinical and administrative integration. (shrink)

Catholic health care has long been a key place where the Church embodies its social doctrine. However, the moral methodology that shapes Catholic bioethics relies on an act-based approach to decision making, which is rooted in the pre–Vatican II manualist tradition, focusing primarily on clinical issues related to the beginning and end of life. This essay argues that given the doctrinal status of Catholic social thought, Catholic bioethics must revisit its scope and methodology. It (...) proceeds in three steps: a meta-analysis of traditional Catholic bioethics, validating the claim made above; an overview of the limited literature published since 1980 engaging Catholic bioethics and CST; and a map of a Catholic bioethics informed by CST generated from a dual starting point. The essay concludes by focusing on both the places where marginalized persons encounter Catholic health care and the ethical issues presented, including race, health care disparities, immigration status, and gender inequality, as well as the interrelated perspective of the common good, expanding the array of issues to include environmental degradation, unions, health care financing, and more. (shrink)

Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (...) (HCEC) standards. This revised report was prompted by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

Following publication of the influential Flexner Report on medical education in 1910, the US built a health care system on a foundation of science that, by the end of the 20th century, provided some of the best medical care in the world. Now, at the start of the 21st century, we are in real danger of destroying those impressive achievements. The primary reason is the failure over many years to change our increasingly dysfunctional health insurance system. (...) Chief among its problems is reduced access to medical services as growing numbers of Americans lose health insurance altogether, and coverage for the rest is eroding. (shrink)