Contemporary Ethical Issues In Health Care Analysis

Understanding Contemporary Moral Issues from a Catholic Perspective
‘Withdrawal of life-sustaining medical treatment’.
“And the dust goes back to the earth as it was, and the spirit goes back to God who gave it”.
(Ecclesiastes 12:7).

In order for me to comprehend and discuss the moral issue of withdrawal of life-sustaining medical treatment from a Catholic perspective, I needed to have an understanding of what Bioethics refers to. It is a shared reflective analysis and discussion of ethical issues in health care, health science, and health policies. It engages dialogue and thought from our society comprising of doctors, patients, scientists, politicians and the general public (What is Bioethics? 2014). Using Bioethics as a framework
to discuss withdrawal of life, it helps us to realise the position the Catholic Church has adopted in its views and beliefs. .The Catholic Church wishes to trigger a deeper thinking regarding moral issues and offers practical help in moral decision making by encouraging us to think about the role of the Church in society from two distinct roles; that of Doctrinal and of Pastoral (Rev Dr. Joe Parkinson, personal communication, July 18, 2014). One of my duties as a teacher facilitating in a Catholic Education School is not only to identify what the Catholic Church doctrine upholds, but also to counsel and support those in need. The Catholic doctrinal view is that there needs to be a prohibition on euthanasia, because society may create a sub-class if we approve assisted death and what the Church offers is a development when bringing about a change of society’s mindset in which you offer palliative care and managed pain relief instead of looking at euthanasia as the only option (Dr. Joe Parkinson). The Church acknowledges that this is a challenge in an aging society, but we need to promote an environment that upholds the dignity of the sick, vulnerable and the aged. From a pastoral approach, the Catholic perspective is that decision making regarding values and morals is based on a process of identifying the options and choosing what is most important to us. The Catholic Church advocates discussion and examination of what is driving the decisions and what are the other values and factors at play. Saying this, the Catholic Church also realises that the choices are often not perfect and one very important point is to emphasise that the Church will never abandon someone based on differences of viewpoint and acknowledges that individuals may have come to a decision, knowing that is the best that they can do, having balanced the ethical and moral decisions in their conscience. The Catholic Church appreciates that as human beings we are not remote controlled Catholics. However, the Church also recognises it has to take a position regarding morality, a standpoint that asks us to recognise that we are responsible for our decisions and that they impact the bigger picture in regards to the community as a whole entity (Dr. Joe Parkinson), thus, reminding us that the Catholic Church teaches us to value life, promote and to protect life (Pontifical Council for Health Care Workers, 1995). The Church also promotes prayer and counsel to assist individuals in the decision making process and urges individuals to examine whether they feel the outcomes are acceptable before God. Saying this, the Church also understands that we need to be true to ourselves. Whilst our ethics, our reasoned choices, may often be intuitive, they allow us to make choices that make us accountable as individuals. These ethical choices expresses our values and our actions as well as our intentions, it essentially defines our values. In the issue of withdrawing life-support, it is quite possible to go about getting the right thing, but going about it in the wrong way. Morals and ethics challenge the thought that if it does not break the law; than it is acceptable. However, some lawful acts are not morally right. From a Catholic teaching perspective the primary objective and value is “To preserve the dignity of the person” and this remains its fundamental value. Unfortunately, it is often forgotten. The Catholic Church advocates that life is a gift and acknowledges that we are part of all creation and therefore, we are the stewards of the world, not the dominators. The symbolism of the crucifix is a reminder to Christians that we understand and trust in Jesus, that there is eternal life and that we need to live through our mortal life. This viewpoint is that life is a gift and on that basis alone we have a responsibility to protect the weak, vulnerable, the young and the old. This is one of fundamentals of Christianity. Yet as human beings we experience illness, suffering and death and sometimes euthanasia may seem like the best choice. However, when we treat other human beings as expendable; we diminish our own humanity (Dr Joe Parkinson). The Catholic Church suggests that when we make moral decisions, we make these using a formula; a format for our moral decision-making, one in which we examine what the facts are and what is really going on. A set up that asks the individual whether their core values are being respected, upheld and what the guiding ethical principles involved are. The rhetorical triangle (Image 1) is helpful to visualise how it is used by the Catholic Church for teaching and passing on the values of the Church.

(Image 1. The Rhetorical Triangle, reproduced from Google images).

This type of plan will question who should be involved in the decision making and whether the decisions will and should be reviewed?
This framework would also take into account what legal definitions need to be considered in terms of unwanted treatment versus the decision of suicide, it will identify what the core values involving the patient are, who are the other relevant people involved and also the duty of care that affects the hospital staff, whilst still protecting the individual’s autonomy (Euthanasia law is no cure-all for Dutch doctors, 2009). What is interesting to note, is that the Catholic perspective is that life should not be preserved at all costs if it does not take into account the dignity of the individual and their decision on whether they wish to take part with treatment and whether they have been given the opportunity to think and discuss if the means of treatment is morally disproportionate, does not offer any reasonable therapeutic benefit, is overly burdensome or, in some circumstances, not readily available. Catholic moral rationale believes that God has given us intelligence to think things through, yet the Church will never advocate the taking of a human life (Dr Joe Parkinson). On the other hand, the law takes the view that duty of care is higher than the individual’s autonomy. These laws impact on carers and hospital staff alike, as in the case of Christian Rossiter, a 49 year old man who was left quadriplegic after being hit by a car. A Western Australian landmark court decision ruled in favour of Mr. Rossiter, stating that a patient had the right to refuse treatment and to choose not to receive nutrition and hydration and any person or care group providing palliative care would not be criminally responsible (Physician-assisted suicide the same as euthanasia? 2014).To safeguard the autonomy of the person, the Catholic Church endorses the use of Advanced Care Plans and appointment of an Enduring Guardian to ensure that the patient is
treated and cared for respectfully and with dignity. In Christina Odone’s report entitled ‘Assisted Suicide. How the chattering classes have got it wrong, 2010 ’she writes about Debbie Purdy, who suffered from Multiple Sclerosis. Debby Purdy won the right to have the prosecution guidelines affecting those who assist suicide clarified and in 2010, the United Kingdom published guidelines that in no way pave the way for assisted suicide; but call for each case to be judged on its own merits. These guidelines are imperative in protecting those working with the sick, disabled, aged or terminally ill and for those worried that if assisted suicide were to be introduced on compassionate grounds, it would lead to death on request or euthanasia without consent. Finally, as a teacher in a Catholic Education system. I need to remember that my points-of-view when teaching need to reflect the Church’s teachings, that life is a gift and are we respecting life if we agree to assist someone to die? ‘Let God be God and not be God ourselves’ (Donom Vitae, 1987).
References
Assisted Suicide How the chattering classes have got it wrong. Christina Odone. 2010. Retrieved from http://www.bioethicsperth.org.au/Upload/39694762-Assisted-Suicide-How-the-chattering-classes-have-got-it-wrong[1].pdf

Catholic Health Australia. A guide for people considering their future health care. 2012. http://www.bioethicsperth.org.au/Upload/future%20health%20care[1].pdf Doman Vitae. Instruction on respect for human life in its origin and on the dignity of procreation replies to certain questions of the day. 1987. Retrieved from http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html

Euthanasia is no cure-all for Dutch doctors. Wubby Luyendijk. 30 November 2009. Retrieved from http://vorige.nrc.nl/international/Features/article2425897.ece/Euthanasia_law_is_no_cure-all_for_Dutch_doctors

Is physician assisted suicide the same as euthanasia? The World Federation of Right to Die Societies. 2014. Retrieved from http://www.worldrtd.net/qanda/physician-assisted-suicide-same-euthanasia Image retrieved Aug 8, 2014 from Google images.
Pontifical Council for Health Pastoral Care. The Charter for Health Care Workers. 1995. Retrieved from http://www.vatican.va/roman_curia/pontifical_councils/hlthwork/documents/rc_pc_hlthwork_doc_19950101_charter_en.html

The Official King James Bible Online. 2014. Retrieved from http://www.kingjamesbibleonline.org/Ecclesiastes-12-7/

What is Bioethics? Michigan State University. Centre for Ethics and Humanities in the Life Sciences. 2014 Retrieved from
http://www.bioethics.msu.edu/about/whatisbioethics