Allocating Scarce Medical Resources: Roman Catholic Perspectives

By H. Tristram Engelhardt Jr.; Mark J. Cherry | Go to book overview

Quality of Life and Human
Dignity: Meaning and Limits of
Prolongation of Life

Ludger Honnefelder

Within only a few decades, the development of contemporary biomedicine has enlarged the possibilities of medical diagnostics and therapy to a hitherto unknown extent. That in turn has led to questions, which until now we have hardly had to address with the same scope and urgency. The most fundamental of these asks: Is everything that is technically possible also medically mandated? Moreover: Does the patient desire what is technically possible and medically mandated? This leads to the further question: Can what is technically possible, medically mandated, and desired by the patient be made available to everyone within the resources of a public health care system? Those questions then yield several restricting perspectives: individual restrictions, from the perspective of the patient; medical restrictions, from the perspective of the physician; and economic restrictions, from the perspective of the health care system.

Within each of those perspectives, what restrictions are both required and responsible? Because ethics demands that restricting possible courses of action through omission must be justified as much as actually following a particular practice, we are obliged to furnish a moral justification for the restrictions within each of those perspectives. What are the criteria for such a justification? Because the problem of restricting possible courses of action arises within each of the three perspectives, and because all are necessary conditions of contemporary medical practice, we can address that question only according to the criteria that are regarded as morally relevant within each perspective. That approach yields the following proposition: We can only find an adequate justification for restricting medical practice, especially in the area of contemporary intensive care medicine, if we succeed in relating the relevant moral criteria of the different perspectives to one another in a convincing way.

In its approach, this proposition is identical to the position developed within the Catholic tradition of Christian theology, at least if one accepts as the fundamental assumption of that tradition that the moral criteria for our actions emerge from an insight of reason into the law-like structure of the type of actions in question. However, this by no means exhausts that position. For it holds that all of human life, from beginning to end, including all

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