This article critically examines the recent papal allocution on patients in a persistent vegetative state with regard to the appropriate conditions for considering “reformable statements.” In the first part of the article, the purpose and meaning of the allocution are assessed. O'Rourke concludes that given consideration of the individual patient's best interest, prolonging artificial nutrition and hydration is not, in every case, the best option. Although he stresses favorability for preservation of the life of the patient through artificial nutrition and (...) hydration, costs and benefits to the patient should be weighed. Ultimately, he argues in favor of leaving the decision to the patient, his caregivers, and others immediately involved in the case. (shrink)

In a single convenient resource, this book organizes and presents clearly the documents of the Catholic church pertaining to medical ethics.

Like Saint Paul, I was “born out of due time” insofar as the study of bioethics is concerned. I spent 15 years in teaching and administration at the Aquinas Institute of Theology, then in Dubuque, Iowa, now on the campus of Saint Louis University. I was given a sabbatical study year in 1972–1973 to refresh my mind and spirit. Though my major study and research emphasis prior to the sabbatical study had been in the field of Church law and religious (...) government, I determined to direct my attention to the study of moral theology and ethics, because at that time there was confusion in this area of discipline, especially insofar as the Catholic community was concerned. With this in mind, I chose the University of Chicago as the locale for my study and was awarded a postdoctoral fellowship. (shrink)

From Harry and Louise through the McCaughey septuplets, this book explains stories and issues in health care ethics that have appeared in the news media.

James Walsh and Moira McQueen accurately conclude that the early delivery of anencephalic fetuses is morally acceptable, but the reasoning they use to reach that conclusion is flawed. First, the principle of double effect does not require a weighing of good and evil, but rather seeks a sufficient reason for tolerating the physical evil indirectly intended. Second, the principle of double effect requires a clear distinction between physical and moral causality. Third, the Catholic moral tradition will not admit direct and (...) intended killing of the innocent. Rather, early delivery of anencephalic fetuses is permissible because of the pathology associated with delivery of anencephalic fetuses at full term. Thus, the early delivery of an anencephalic infant is acceptable if the purpose of the moral act is avoiding a pathological condition on the part of the mother. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:LettersJames L. Walsh, Moira M. McQueen, Kevin O'Rourke, and Jean deBloisEarly Delivery of the Anencephalic InfantMadam:In the March 1994 issue of the Kennedy Institute of Ethics Journal, Kevin O'Rourke and Jean deBlois have replied to an article of ours (KIEJ, December 1993) on the early induction of the anencephalic fetus. They agree with our conclusion that such early delivery may be morally acceptable, but argue that our justification is (...) flawed. Exchanges on the subject probably could continue ad nauseam; here we simply state some of the elements of their article that leave us perplexed.1. The phrase "prolonging the life of" (p. 49) has one meaning in the case of artificial life supports, which may be unwarranted interventions, but it has a different meaning when it refers to not interfering with a person's enjoyment of necessary natural means of preserving his or her life. Inducing labor prior to viability, which denies the natural means of life support without a possible substitute, has more in common with smothering a dying patient than the nonemployment of or withdrawing of artificial means of life support. To refer to the death of the fetus here as an effect is rather like saying that I suffocated you and the effect of the suffocation is your death. This is quite different from induction after viability where the induction can have different effects.2. If the authors were correct that "the prohibition on inducing delivery before viability is predicated upon the assumption that the fetus in utero is a human being with the potential for further development" (p. 49) and the anencephalic has none, why is there need to employ the principle of double effect? They say that there is no moral obligation to prolong the life of the anencephalic fetus. Just as there is no need for the principle in cases of withdrawing unwarranted artificial life support, so there would be no need for it here. Because the authors seem to perceive a complete disjunction between direct and indirect killing (allowing to die being in the category of indirect killing), it seems that they are unable to let their argument rest here, but have to justify the death that occurs.3. The example concerning smothering and the nonemployment of aggressive interventions (p. 49) explains well the difference between killing and allowing to die. But allowing to die is not indirectly killing since it occurs as a result of the disease and not from the causality of the agent.4. How can we cause something and not intend it? There are instances in which we simply "permit" evil events, but where we are not the cause. For example, evil events may be attributable to the bad will of others. Legislators make just laws knowing that some people of bad will will break them for their own advantage. Here the legislators really do permit evil. Neither are we the cause of death when we allow a person to die by not imposing unwarranted means of life support; we permit his or her death. But can we so readily designate by "permit" [End Page 184] what we knowingly choose to bring about? O'Rourke and deBlois use interchangeably "indirectly intended" and "unintended" for what is caused by our actions; "indirectly intended" is a better designation than "unintended." The whole package, including all foreseen effects, is intended. Evil "happening" (p. 51) as a result of an action that I place can refer either to evil as caused by my action or to evil as arising from a cause apart from my action. Only in this latter sense do I permit evil and not intend it, either directly or indirectly.5. The fourth condition of the principle of double effect is given as follows: "There must be a proportionately grave reason for placing the act. The greater the evil, the more cogent the reason must be for performing the act" (p. 50). How the authors can abstract from balancing goods and evils here is beyond us.6. We cannot follow the authors' use of the term "morally good" with respect to the induced delivery (p. 50). The problem is concerned with the morally right... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:LettersJames L. Walsh, Moira M. McQueen, Kevin O'Rourke, and Jean deBloisEarly Delivery of the Anencephalic InfantMadam:In the March 1994 issue of the Kennedy Institute of Ethics Journal, Kevin O'Rourke and Jean deBlois have replied to an article of ours (KIEJ, December 1993) on the early induction of the anencephalic fetus. They agree with our conclusion that such early delivery may be morally acceptable, but argue that our justification is (...) flawed. Exchanges on the subject probably could continue ad nauseam; here we simply state some of the elements of their article that leave us perplexed.1. The phrase "prolonging the life of" (p. 49) has one meaning in the case of artificial life supports, which may be unwarranted interventions, but it has a different meaning when it refers to not interfering with a person's enjoyment of necessary natural means of preserving his or her life. Inducing labor prior to viability, which denies the natural means of life support without a possible substitute, has more in common with smothering a dying patient than the nonemployment of or withdrawing of artificial means of life support. To refer to the death of the fetus here as an effect is rather like saying that I suffocated you and the effect of the suffocation is your death. This is quite different from induction after viability where the induction can have different effects.2. If the authors were correct that "the prohibition on inducing delivery before viability is predicated upon the assumption that the fetus in utero is a human being with the potential for further development" (p. 49) and the anencephalic has none, why is there need to employ the principle of double effect? They say that there is no moral obligation to prolong the life of the anencephalic fetus. Just as there is no need for the principle in cases of withdrawing unwarranted artificial life support, so there would be no need for it here. Because the authors seem to perceive a complete disjunction between direct and indirect killing (allowing to die being in the category of indirect killing), it seems that they are unable to let their argument rest here, but have to justify the death that occurs.3. The example concerning smothering and the nonemployment of aggressive interventions (p. 49) explains well the difference between killing and allowing to die. But allowing to die is not indirectly killing since it occurs as a result of the disease and not from the causality of the agent.4. How can we cause something and not intend it? There are instances in which we simply "permit" evil events, but where we are not the cause. For example, evil events may be attributable to the bad will of others. Legislators make just laws knowing that some people of bad will will break them for their own advantage. Here the legislators really do permit evil. Neither are we the cause of death when we allow a person to die by not imposing unwarranted means of life support; we permit his or her death. But can we so readily designate by "permit" [End Page 184] what we knowingly choose to bring about? O'Rourke and deBlois use interchangeably "indirectly intended" and "unintended" for what is caused by our actions; "indirectly intended" is a better designation than "unintended." The whole package, including all foreseen effects, is intended. Evil "happening" (p. 51) as a result of an action that I place can refer either to evil as caused by my action or to evil as arising from a cause apart from my action. Only in this latter sense do I permit evil and not intend it, either directly or indirectly.5. The fourth condition of the principle of double effect is given as follows: "There must be a proportionately grave reason for placing the act. The greater the evil, the more cogent the reason must be for performing the act" (p. 50). How the authors can abstract from balancing goods and evils here is beyond us.6. We cannot follow the authors' use of the term "morally good" with respect to the induced delivery (p. 50). The problem is concerned with the morally right... (shrink)