For some time we have benefited from the wisdom of our bishops when reflecting on our obligations to God, ourselves, and others. Therefore, it is appropriate that we.................
For some time we have benefited from the wisdom of our bishops when reflecting on our obligations to God, ourselves, and others. Therefore, it is appropriate that we return to our study of the Ethical and Religious Directives for Catholic Health Care Services on this Feast of the Epiphany. The third area of concern for our leaders is the professional-patient relationship. “A person in need of health care and the professional health care provider who accepts that person as a patient enter into a relationship that requires, among other things, mutual respect, trust, honesty, and appropriate confidentiality. The resulting free exchange of information must avoid manipulation, intimidation, or condescension. Such a relationship enables the patient to disclose personal information needed for effective care and permits the health care provider to use his or her professional competence most effectively to maintain or restore the patient’s health. Neither the health care professional nor the patient acts independently of the other; both participate in the healing process.” Out of these general principles come directives which intersect with civil expectations. The bishops will state explicitly that the Catholic person and institution must always prioritize their faith perspectives. “The inherent dignity of the human person must be respected and protected regardless of the nature of the person’s health problem or social status. The respect for human dignity extends to all persons who are served by Catholic health care.” (23)
When we look at medical treatment over the course of decades it is clear why laws have been passed to protect the vulnerable. For instance, many people were incarcerated in mental institutions for nefarious reasons. They were fed medications which limited their mental capacities. They could not refuse them. In a famous case that many of us older people remember discoveries were made about the sufferings of patients in Willowbrook Hospital. In the name of the people of New York thousands of handicapped people were warehoused deprived very often of the most basic necessities. Protocols for medical experimentation were must looser than a respect for human dignity would require. While we see many virtues in the protections thus offered in the civil arena, we evaluate any reforms offered in terms of moral theology. “In compliance with federal law, a Catholic health care institution will make available to patients information about their rights, under the laws of their state, to make an advance directive for their medical treatment. The institution, however, will not honor an advance directive that is contrary to Catholic teaching, and explanation should be provided as to why the directive cannot be honored.” (24) Though do not resuscitate orders (DNR) are frequently signed and done so in line with the Church’s teachings, instruments such as “living wills” are very often problematic. This is because we cannot envision in advance all of the circumstances which might arise concerning our physical and/or mental status. However, as the directives point out we are not without adequate remedies. “Each person may identify in advance a representative to make health care decisions as his or her surrogate in the event that the person loses the capacity to make health care decisions. Decisions by the designated surrogate should be faithful to Catholic moral principles and to the person’s intentions and values, or if the person’s intentions are unknown, to the person’s best interests. In the event that an advance directive is not executed, those who are in a position to know the patient’s wishes – usually family members and loved ones – should participate in the treatment decisions for the person who has lost their capacity to make health care decisions.” From personal experience I can attest to the importance of the “health proxy.” As our shepherds assert it is important for one to speak extensively to one who literally holds your life in their hands about what procedures should be followed or not. Some information should be given to you. First, health proxy forms are available from the Archdiocese. Second, in addition to an individual being named there should be a secondary and tertiary individual appointed. Third whenever one is to enter a clinical area a proxy form should be available. In two allied directives the subject of fully informed consent is discussed. In the past some family members would request that medical personnel would keep the patient in the dark concerning their condition. Experimental protocols in the past were less than forthcoming in terms of risks and outcomes. Taking in the views of professional ethics and legislative acts the Bishops state: “The free and informed consent of the person or the person’s surrogate is required for medical treatments and procedures, except in an emergency situation when consent cannot be obtained and there is no indication that the patient would refuse consent to the treatment.” (26) Further, “free and informed consent requires that the person or the person’s surrogate receive all reasonable information about the essential nature of the proposed treatment and its benefits, its risks, side-effects, consequences, and cost; and any reasonable and morally legitimate alternatives, including no treatment at all.” (27)
The next directive covers an issue which has great moral implications in view of medical progress,. “All persons served by Catholic health care have the right and duty to protect and preserve their bodily and functional integrity. The functional integrity of the person may be sacrificed to maintain the health or life of the person when no other morally permissible means is available.” (29) Under this dictum amputation is approved when the excising of a part of the body permits life to continue for the individual. For example, a person might lose a limb because of a gangrenous condition or a cancerous kidney so that the disease might not spread. In a related issue we read: “The transplantation of organs from living donors is morally permissible when such a donation will not sacrifice or seriously impair any essential body function and the anticipated benefit to the recipient is proportionate to the harm done to the donor. Furthermore, the freedom of the prospective donor must be respected, and economic advantages should not accrue to the donor.” (30) In fact, Catholics are encouraged to sign up in organ donor programs. To compatible types one might share organs as one continues to live. In all cases, there can be no exchange of funds.
May the example of the Magi lead us as we seek the Lord here and in eternity.
Vivat Jesus
Fr. Brian