Academic journal article Theological Studies

"Unbind Him and Let Him Go" (Jn 11:44): Ethical Issues in the Determination of Proportionate and Disproportionate Treatment

Academic journal article Theological Studies

"Unbind Him and Let Him Go" (Jn 11:44): Ethical Issues in the Determination of Proportionate and Disproportionate Treatment

Article excerpt

THE PUBLICATION OF "On Basic Care for Patients in the 'Vegetative' State" in the May-June 2008 issue of Health Progress and "Human Dignity and the End of Life" in the August 4-11, 2008, issue of America by Cardinal Justin Rigali, Chairman of the U.S. Conference of Catholic Bishops' (USCCB) Committee for Pro-Life Activities, and Bishop William Lori, Chairman of the USCCB's Committee on Doctrine, continues the discussion of questions surrounding the ethical issues related to end-of-life care and particularly the use of assisted nutrition and hydration (ANH). I wish to discuss this topic, first, by framing it within some issues in U.S. culture and Catholicism; second, by examining the moral evaluation of medical interventions within the Roman Catholic tradition, showing how these perspectives have been changing over the last several years; finally, I will comment on the articles by Cardinal Rigali and Bishop Lori.

U.S. CULTURE AND CATHOLICISM

One of the first major problems confronted in the newly developing area of bioethics was the technological imperative: if we can do it, we should. Capacity generated obligation. The imperative was a driving force in the development and implementation of various technological advances. Joined with this was the medical imperative that says, if a physician prescribes a treatment, then there is an obligation to use it. This is also known as the "medical indications policy": specific and obligatory interventions necessarily follow from the diagnosis. Authority and capacity join together to generate an obligation for the patient, but an obligation not necessarily of the patient's choosing.

In both of these imperatives, personal moral analysis and accountability are diminished because the obligation comes from either the technological capacity or the expertise or both together. No further moral analysis is needed if both or either are present. This was conspicuously the case in the funding of the Human Genome Project (HGP). While in fact the funding for the project included a massive amount of money to be spent on examining ethical issues raised by the HGP, this funding was available only after the decision to fund and undertake the project itself.

This lack of moral analysis is particularly critical in the medical context, for the patient is either marginalized or left out of the decision-making process altogether. What is determinative of moral obligation to treat is either the capacity to intervene or a medical judgment that this is the proper course. Absent is a consideration of either the patient's wishes or the effect of the intervention on the patient. Thus, instead of a personal standard of morality for evaluating what to do or not do, we have an impersonal standard rooted in technical capacity and/or medical expertise.

A second issue, a first cousin of the technological and medical imperatives, is fear of entrapment: the fear that once an intervention or technology is started, it may not be stopped. To stop would violate the technological imperative and would be a sign of defeat in the face of the traditional enemy of medicine: death. The intervention and/or technology may have been started appropriately--for example, the patient needed emergency stabilization, or the patient or family in consultation with the physician determined the intervention was appropriate. However, after initiating the intervention, it was found to be either ineffective or too burdensome or both. Yet for many the assumption is that once a technology or therapy has been started, you are on it until you die.

Because of the fear of technological entrapment some people may in fact refuse to initiate an intervention that may actually be beneficial, because they fear that if it is not, they will not be able to stop the intervention. This is a major harm, but one that is likely to occur as long as these imperatives hold sway.

A third critical context is authority and its structuring. …

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