Medical Ethics

Sources of Catholic Teachings, Fourth Edition

Kevin D. O'Rourke

• Publisher: Georgetown University Press
• Year: 2011
• ISBN:
  9781589017566
• Edition: 4
• Topic: Medicina
• Subtopic: Etica in medicina

In a single convenient resource, this revised and updated edition of a classic text organizes and presents clearly the documents of the Catholic Church pertaining to medical ethics. Introductory chapters provide the context for interpreting the Church's teachings and theological values, guiding the reader in how to apply the teachings to particular ethical dilemmas and helping the reader to understand the role of conscience within the Catholic tradition.

The teaching of the Church in regard to health care ethics is pertinent not only for health care professionals and students, but for all who are concerned about the common good of society. Medical Ethics examines specific teachings of the Church on over seventy issues in clinical and research ethics, including abortion, AIDS, artificial insemination, assisted suicide, cloning, contraception, euthanasia, gene therapy, health care reform, organ donation and transplantation, organizational ethics, stem cells, surrogate motherhood, and withholding and withdrawing life support.

O'Rourke and Boyle bring this fourth edition up to the present day by incorporating recent papal documents regarding the social aspects of health care, assent to Church teaching, and the 2008 papal instruction Dignitas personae, an extremely influential document that illuminates such controversial dilemmas as prenatal adoption, frozen embryos, and genetic diagnosis.

Part I

Understanding Church Teaching

1
The View of the Person

The Christian life consists essentially of human fulfillment in Jesus Christ, not in following rules. Under grace, one follows the norms proposed by the Catholic Church primarily to draw closer to Christ. Catholics believe that through the interpretation of sacred scripture and tradition the church communicates the means to follow Christ more authentically. “Sacred Scripture is the speech of God as it is put down in writing under the inspiration of the Holy Spirit.”¹ Insofar as medical ethics is concerned, the teaching of the Church emanates from knowledge of the human person and the relationship of people to God and to one another drawn from sacred scripture and tradition. Natural law helps to explicate these sources of knowledge. For this reason in this chapter we consider what it means to be human—the meaning of health, sickness, death, and sexuality—in order to better understand the content of Catholic teaching as it concerns health care in theory and practice.

The teaching of the Church in regard to medical ethics can be understood through a study of the worth and activity of the human person.² The Church’s view of the human person is based on the biblical teaching that each human being is created by God in his own image and likeness and differs from the animals by possessing a spiritual intelligence and free will (cf. Gn 1:26–31). Although the human body is brought into being through the cooperation of human parents, the creation of the human soul is a direct act of God (cf. Gn 2:7; Mt 7:22–23). Each person is unique and irreplaceable (cf. Mt 10:29–31), and all are called not only to personal maturity but also to eternal freedom of choice, which is “an exceptional sign of the image of God in man.”³ Through free choice, each person shapes his or her character and destiny. If there were no human freedom, there would be no morality, because good and evil result from human choice. In making choices, Christians believe that God’s grace helps all to overcome the weakness of human nature. The differences of sex, race, or individual talents in no way detract from this basic equality of all human beings (cf. Rom 2:11; Gal 4:38; Eph 6:0). Because of each person’s relationship to God, human life is sacred. From this overriding value follows the specific teaching of the Church that it is a heinous crime to directly intend the death of an innocent person or to injure another person physically, emotionally, or spiritually. In a more positive aspect, revelation and human reason mandate that we strive to protect and foster human dignity.

The worth of human persons was confirmed when God sent his divine son to assume human nature (cf. Jn 3:14; Heb 4:14–16). In recalling us to our dignity and restoring to us the hope of perfect happiness, which God intended when he created us, Jesus Christ worked miracles of healing (cf. Mk 1:32–29) and was concerned with even the most neglected and powerless members of society (cf. Mt 26:31–46).

Moral Norms

Theology seeks to study the teachings of sacred scripture as it applies to the human person in order to formulate moral norms that express the actions that help or hinder human dignity and enable people to strive for salvation. In their writings theologians utilize human learning as well as scripture and tradition. Hence they utilize philosophy and the psychology and sociology of human behavior in order to know more precisely the human person. The Catholic view of person taught in sacred scripture and tradition is often expressed in theology by considering the needs of the human person and the powers or functions human beings possess in order to fulfill these needs.

Thomas Aquinas, one of the great theologians of the Church, described the fundamental needs of the human person as follows: to preserve life, to procreate children, to know the truth, and to live in community.⁴ Briefly, the powers or functions that enable people to fulfill these needs are divided into four general categories: the physiological (biological), the psychological (emotional), the social (communities), and the spiritual (creative).⁵ Being precise about human needs and functions enables theologians to formulate more clearly moral norms for helpful human behavior. Over the years the teaching authority of the Church accepted the moral norms developed by theologians and included them in conciliar documents or official statements. Thus teachings that the theologians formulate on the basis of sacred scripture, traditions, and human disciplines sometimes become the official teachings of the Church. In numerous statements, Church teaching speaks about the human person and his or her spiritual, social, psychological, and physiological needs and functions as the “measure and criteria of good and evil in human affairs.”⁶ If we understand the human person and his or her needs and the functions that enable him or her to fulfill these needs, then we understand what is necessary for human fulfillment in Christ.

Nature and Cultural Needs

In order to understand the needs and functions of the human person from a Christian perspective, we must realize that each level of human need comprises a complex of natural and cultural needs—the cultural needs being rooted in the natural needs but greatly expanding them. It cannot be emphasized too strongly that the four levels of human needs—physiological, psychological, social, and spiritual—and the corresponding functions directed to fulfilling them are related not as stories in a building but as dimensions of a cube. Thus the powers or activities of the human person can no more be separated from one another than can the length, breadth, and height of a cube. Every human act or event has all four dimensions. A human spiritual activity, whether it be creative, scientific, or artistic, also involves biological, psychological, and social activity.

Moreover, the relationship between these levels of need and the function of the human personality is ordered hierarchically so that spiritual activities are the deepest, most central, and most integrating; biological activities are the least unified and the most peripheral; and psychological and social activities have intermediate positions. Saint Thomas makes it clear that there is an order among these needs, the lower needs being subordinate to the higher needs. At the same time, the higher activities in this hierarchy are rooted in and depend on the lower activities in a network of interrelations. Nevertheless, each level has a certain genuine autonomy and differentiation in its structure and modes of functioning. Though needs are fulfilled through human functions, there must be an integration of functions, lest the person lead an unbalanced life. For example, a person may so emphasize fulfilling intellectual needs to the extent that she or he forgoes physiological or social needs and thus never develops as an integral human person. The good of the whole person requires that all the basic aspects of human personality be simultaneously respected, even when it is necessary to subordinate or even sacrifice in some measure a lower function to a higher function.⁷ This general teaching of Catholic theology concerning the integration of human functions is expressed in the “principle of totality and Integrity” (cf. chapter 2) and is extremely important in medical ethics because it is the principle by which surgery is justified and contraceptive sterilization is rejected.

Person in Community

Human beings do not respond to the word and grace of God and reach fulfillment in isolation from other persons. Because we realize that effective social relationships are an essential element in human fulfillment, we must consider the Christian vision of person in community. Jesus indicated our need for community and the key to successful community living when he said, “Treat others the way you would have them treat you” (Mt 7:12) and “You shall love your neighbor as yourself” (Mt 22:39). According to this teaching, we are not asked to love our neighbor and not love ourselves, but to love our neighbor as we love ourselves. In other words, if we really love ourselves, not selfishly, but intelligently, we will realize that we cannot be happy in isolation, because we are created as social beings. We can attain integral human fulfillment only in a community of people, and that means that we each must not only respect the rights of others but also be actively concerned with promoting each other’s welfare: the needs that the person could not attain by himself or herself.

In the twentieth-first century world, two extreme views about the relation of person to community are in constant competition. One is collectivism. Generally collectivism favors a system in which the state closely regulates all human activity in that the welfare of individual persons is strictly subordinated to the welfare of the total community (the rights of persons can be sacrificed to the interest of the nation).

The other extreme, individualism, favors individual freedom and considers responsibility to the community as a burden or interference. Though individualism does not eliminate all community responsibility, it seeks to keep it at a minimum.⁸ The ideal for individualism is the detached and self-sufficient person. We often hear individualism called “the democratic way of life.” In defense of individualism, many argue that the goal of government should be to protect and foster the maximum of individual freedom, because any restriction on freedom is believed to be an attack on the well-being of the individual.

Both of the aforementioned views of community—collectivism and individualism—are inconsistent with Christian teaching insofar as health care is concerned. On the one hand, the subordination of persons to collectivism in the name of equality will lead persons to a life of drudgery and oppression. Individualism, on the other hand, produces individuals who never experience fulfilling social relationships and victimizes the poor and less talented persons in society who are never allowed to participate fully in the good and prosperity of the community. The popes and bishops who apply the Catholic tradition in regard to the human community urge us to work for a world community based on spiritual goods or values and economic cooperation. They link human health and world poverty as the most fundamental ethical problems of our time, problems that are often ignored in the United States by ethicists and health care professionals alike while they devote their attention to more esoteric problems such as genetic engineering and heart transplants.⁹

The social teaching of the Catholic Church, derived from the teaching of Jesus, insists therefore that the human community, including its government, must be actively concerned in promoting the health and welfare of every one of its members so that each member can contribute to the common good of all. This concern cannot be a matter of mere trickle down, by which the weak live on the leavings of the powerful, but must be aimed directly at enabling the weak to share in the goods of life. The Christian view of person in community, then, should influence the manner in which we plan health care and the way we seek to care for the poor. This teaching of the Church in regard to the individual and community is summed up in the “principle of common good and subsidarity” (cf. chapter 3). This principle is the basis for many teachings of the Church as it relates to allocation of resources and responsibility of the community to offer health care to the indigent. The practical implications for specific moral norms can be seen when the church speaks about the right to health care and how it should be implemented or about concern for the aging.¹⁰

The Notion of Health

The Christian notion of health also serves as the basis for specific normative statements of the Church. Generally speaking, health is optimal human functioning, but the term may be used in a narrower sense or in a wider, more holistic sense. In the narrow sense, health refers only to the physiological and psychological functions of the person; therefore a healthy person is one who meets all the requirements for “normal” psychological and physiological functioning. He or she has a “normal” pulse rate, “normal” stamina, “normal” blood count, and so on. In a wider sense, health includes social and spiritual functions as well as physiological and psychological functions. In sacred scripture, health is used in the wider sense of the term. Jesus was the divine healer who came to the world to help us become fully human, to help us realize our human dignity as creatures made in the image of God (cf. Lk 11:33). From a Christian perspective, then, health envisions optimal functioning of the human person to meet physiological, psychological, social, and spiritual needs in an integrated manner.

While Catholic teaching encourages a balanced development of all human power, it is clear from faith and experience that this is something very difficult to accomplish (cf. Rom 7:14). We all live with handicaps, ranging from minor to severe; though everyone seeks health, we are all wounded. But the tribulations we suffer, though we do not welcome them, are not meaningless. As the information in this book illustrates, the ultimate reason for tribulation and suffering is spiritual growth in Jesus Christ (cf. Jn 16:33). As Christians, then, our health goals must always be realistic and we must realize that living with infirmities and deprivations in an integrated manner is necessary for pursuing human health.

Many people and professionals are concerned almost exclusively with health in the narrow sense, confining their major interest to the physiological and psychological functions. While a certain concentration on health in this narrow sense is required on the part of health care professionals, if they are to be good scientists, they must also become cognizant of the social and spiritual functions of their patients if they are also truly concerned about their patients as persons and want to help them to a better life. Thus the physician may be better informed about the needs of a person at the physiological or psychological levels because of his or her greater scientific knowledge. But if one is to use the Christian view of the person as a norm of action, fulfilling these physiological and psychological needs should be subordinated to the social and spiritual needs of the patient. This realization of the hierarchy of needs influences the teaching of the Church as it pertains to informed consent and proxy consent.

The Notion of Sickness and Death

When discussing the Catholic view of health, there is always a sense of loss lurking in the background. We know that health is a great human value and that by striving for health and enabling others to have access to health care we are returning the love God has shown us by wisely using the gifts he has bestowed upon us. Indeed, we remember that Jesus often used healing in the physiological sense to remind us of his power to heal spiritually (cf. Lk 5:10). He demonstrated that illness could be an occasion to prove God’s love for his people and was not a sign of punishment. Yet a sense of loss is present because it is obvious from human experience that all efforts to promote and increase health will not prevent the inevitability of death. How are people to think about this paradox?

“Death was not God’s doing; he takes no pleasure in the extinction of the living. God had not wished to include in a man’s destiny suffering and death.”¹¹ Whence, then, came suffering and death? St. Paul says, “Through one man sin entered the world and with sin death, death thus coming to all men inasmuch as all sinned” (Rom 5:12). Even if man had not sinned (original sin), life in this world still would have ended; yet because of original sin, fear of death distorts human vision and choices.¹²

Although people have turned their backs on God, he has not turned from them but has offered them forgiveness and restoration. Yet in his mercy, he cannot deny their human freedom but has called them to return to him, not simply by restoring them to grace, but by a long history of struggle and learning from experience, an experience in which sickness and suffering are inevitable. For the Christian and for all who travel the same road in less clear ways, God has revealed in Christ the direction of their journey and the power of grace by which it can be traveled. In baptism, according to St. Paul (cf. Rom 6:1–11), through the cross of Christ man has died and been reborn in a new creation that will be completed in the resurrection of the body in eternal life. Men and women live now in such unity with Christ that all events of their lives take on meaning from his life and death. Consequently both the joy and the suffering of this life have a Christian meaning: Its joys are signs of the hope for everlasting life in his kingdom, which is already present here on earth in promise, and its sorrows are a sharing in his cross through which a victorious resurrection is to be achieved (cf. Rom 8:11–25).

Jesus came to conquer suffering and death. In what sense has he succeeded? People still get sick and continue to suffer, and death is inevitable. Jesus conquered sickness, suffering, and death in the sense that he gave them a new meaning, a new power (cf. Jn 4:25). By believing in Jesus as savior, by joining our suffering and death to his, humankind overcomes the evil aspect of suffering and death through hope in the resurrection. T...