Resources: A Roman Catholic
Perspective on Setting Limits to
Critical Care, or, Can Roman
Catholic Moral Theology Offer More
than Secular Morality Provides?
H. Tristram Engelhardt, Jr.
This is as much a volume on moral theology as one on bioethics, at least if one understands theology as a discursive reflection on the moral requirements of God. It addresses moral issues involved in limiting access to medical treatment, using critical care as a heuristic point of focus in order to determine the nature of the moral guidance that Roman Catholic moral theology can bring to this cluster of issues. Throughout the industrial and the developing worlds, new and costly diagnostic and therapeutic interventions have spurred a rise in health care costs, both in absolute terms and as a percentage of gross domestic product. Critical care dramatically illustrates the drama of these cost pressures: The use of intensive care generates some 15–20 percent of health care hospital costs in the United States. It also contributes significantly to costs in all industrial countries. Critical care places special burdens on health care budgets and the energies of health care units. And critical care is an especially attractive area for study, because it is one of the few areas where there are good clinical predictive measures regarding the likelihood of survival or death. As a result, one can with increasing accuracy predict the likelihood of saving lives and at what cost. Still, one can rarely be sure there is no chance of success, only that the likelihood is very remote and at great cost. Critical care forces one to face how to gamble with life and death in the face of finitude. Though there is an emerging literature focusing on the appropriate use of critical care resources, the secular bioethical literature remains underdeveloped.1
There have been some attempts to frame a Christian—indeed, a Roman Catholic— perspective on these issues, but they have only provided beginnings (Wildes 1995). This work uses the example of critical care to frame a moral understanding of the appropriate limits on access to medical treatment, drawing on moral insights from within Roman