| (cont)
II. Ordinary vs. Extraordinary Medical Procedures
As I noted earlier, the consistent
ethic of life poses a challenge to two kinds of problems.
The first are "classical" medical ethics questions
which today include revolutionary techniques ranging
from genetics to the prolonging of life. How do we
define the problems, and what does it mean to address
them from a Catholic perspective?
One of the most critical
moral questions today is the appropriate use of ordinary
and extraordinary medical procedures, especially in
the care of the terminally ill. I would like to explore
this issue with you in some detail.
Two fundamental principles
guide the discussion. The first is the principle which
underlies the consistent ethic: Life itself is of
such importance that it is never to be attacked directly.
That is why the Second Vatican Council taught:
All
offenses against life itself, such as murder, genocide,
abortion, euthanasia, or willful suicide . . all
these and the like are criminal; they poison civilization.
(Pastoral Constitution on the Church in the Modern
World, 31)
Consequently, even in those
situations where a person has definitively entered
the final stages of the process of dying or is in
an irreversible coma, it is not permitted to act directly
to end life. In other words, euthanasia—that is, the
intentional causing of death whether by act or omission—is
always morally unjustifiable.
The second guiding principle
is this: Life on this earth is not an end in itself;
its purpose is to prepare us for a life of eternal
union with God. Consistent with this principle, Pope
Pius XII, in 1957, gave magisterial approval to the
traditional moral teaching of the distinction between
ordinary and extraordinary forms of medical treatment.
In effect, this means that a Catholic is not bound
to initiate, and is free to suspend, any medical treatment
that is extraordinary in nature.
But how does one distinguish
between ordinary and extraordinary medical treatments?
Before answering that question, I would like to point
out that the Catholic heritage does not use these
terms in the same way in which they might be used
in the medical profession. That which is judged ethically
as extraordinary for a given patient can, and often
will, be viewed as ordinary from a medical perspective
because it is ordinarily beneficial when administered
to most patients. That being said, it is, nevertheless,
possible to define, as Pope Pius XII did, what would
ethically be considered as extraordinary medical action:
namely, all "medicines, treatments, and operations
which cannot be obtained or used without excessive
expense, pain, or other inconvenience or which, if
used, would not offer a reasonable hope of benefit."
This distinction was
applied by the Congregation for the Doctrine of the
Faith to the care of the terminally ill in its 1980
Declaration on Euthanasia, which states:
When inevitable death is imminent in spite of the
means used, it is permitted in conscience to take
the decision to refuse forms of treatment that would
only secure a precarious and burdensome prolongation
of life, so long as the normal care due the sick
person in similar cases is not interrupted.
In other words, while the
Catholic tradition forcefully rejects euthanasia,
it would also argue that there is no obligation, in
regard to care of the terminally ill, to initiate
or continue extraordinary medical treatments which
would be ineffective in prolonging life or which,
despite their effectiveness in this regard, would
impose excessive burdens on the patient.
Recently the American
Medical Association's Council on Ethical and Judicial
Affairs adopted a policy statement on withholding
or withdrawing life-prolonging medical treatment.
Earlier this year the National Conference of Commissioners
on Uniform State Laws adopted a "Uniform Rights of
the Terminally Ill Act" for proposed enactment by
state legislatures. While containing some helpful
insights, this latter document raises serious moral
questions which could result in ethically unsound
legislative efforts that would further undermine the
right to life and the respect for life in American
society.
In addition, there has
been a good deal of media attention given to certain
cases involving seriously ill patients. In light of
all this, there is need for serious reflection on
the question of our ethical responsibilities with
regard to the care of the dying.
Again, the consistent
ethic of life will prove useful in such reflection.
Here I will limit myself to two observations. First,
an attitude of disregard for the sanctity and dignity
of human life is present in our society both in relation
to the end of life and its beginning There are some
who are more concerned about whether patients are
dying fast enough than whether they are being treated
with the respect and care demanded by our Judaeo-Christian
tradition.
To counteract this mentality
and those who advocate so-called "mercy killing,"
we must develop societal attitudes, policies, and
practices that guarantee the right of the elderly
and the chronically and terminally ill to the spiritual
and human care they need. The process of dying is
profoundly human and should not be allowed to be dominated
by what, at times, can be purely utilitarian considerations
or cost-benefit analyses.
Second, with regard
to the manner in which we care for a terminally ill
person, we must make our own the Christian belief
that in death "life is changed, not ended." The integration
of such a perspective into the practice of a medical
profession whose avowed purpose is the preservation
of life will not be easy. It also is difficult for
a dying person's family and loved ones to accept the
fact that someone they love is caught up in a process
that is fundamentally good—the movement into eternal
life.
In order that these
and other concerns may be addressed in a reasoned,
Christian manner, the dialogue must continue in forums
like this. The consistent ethic, by insisting on the
applicability of the principle of the dignity and
sanctity of life to the full spectrum of life issues
and by taking into consideration the impact of technology,
provides additional insight to the new challenge which
"classical" medical ethics questions face today. It
enables us to define the problems in a broader, more
credible context.
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