James W. Heisig S.V.D.
I wish to argue here for an adjustment of the Catholic perspective on technologically intensive medical care. The immediate context for these remarks is the effort under way to produce a set of moral guidelines, based on Catholic principles, to govern the apportionment of limited critical care facilities to a surplus of patients. I would like to take a step back from the complexities of that question to consider what it means for Catholicism to put the weight of its tradition and institutional presence behind such guidelines. In particular, I mean to suggest that the primary audience for Catholic moral guidance in matters of health has been eclipsed by excessive attention to the problems generated by the medical profession. I have no illusions about the irrelevance of these remarks to the question as framed. No doubt, for many of those who devote themselves to the management of intensive care units (ICUs), the skepticism in these pages will ring hollow and out of touch with the realities of health care. I ask only that they listen between the lines for the faint echoes of a rising chorus of voices looking for another kind of guidance altogether, and consider whether this clamor is really as secondary a concern for Catholic moral reflection as their professional interests lead them to believe.
The ICU is more than an ensemble of equipment and technicians designed to perform a specific range of tasks for a specific class of patients. It is a metaphor for a wider set of beliefs about the place of science and technology in health. Independently of whom the wires and tubes happen to be attached to at any given moment, the whole kit is permanently attached to a wider network of ideas. Whatever the rate of efficiency of the tools and techniques of the unit, the very fact that it is functioning at all implies a commitment of resources from outside the ICU itself that could have been committed otherwise. And those decisions in turn rest on a set of assumptions and decisions about what things are more valuable than what other things.
For those committed to providing high-technology intensive care, the ICU is an index of the state of medical science as a whole. Whatever goes on within its walls testifies to the level of progress that has been achieved and justifies further expenditure for what has not yet been achieved. This symbolism is real enough, and its meaning is hardly lost on anyone devoted to the betterment of intensive care. But this symbolic meaning is itself wrapped