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PubMed1990

Helping people prepare. Catholic healthcare facilities can give patients advice on advance directives.

Although state courts have tended recently to allow surrogates to make healthcare treatment decisions for incompetent patients, the Missouri Supreme Court went against the trend by denying Nancy Cruzan's family the right to withdraw her artificial nutrition and hydration. The U.S. Supreme Court upheld the Missouri decision. At the same time, however, the Court's opinions strongly implied that it would uphold other state courts' decisions affirming the right of surrogates to make treatment decisions for incompetent patients. In his majority opinion, moreover, Chief Justice William Rehnquist upheld a competent person's liberty interest in refusing medical treatment, including artificial nutrition and hydration. Catholic healthcare facilities should be prepared to provide information to the many patients and long-term care residents seeking advice on advance directives as a result of the Court's ruling. Because living wills are proving to be less effective than many at first thought they would be, providers can best help individuals by giving them information on preparing proxy documents.

Advance Directives↗
PubMed1990

Genetic counseling in Catholic hospitals. Facilities must provide guidance to keep pace with new knowledge and techniques.

As advances in the knowledge of human genetics change the practice of medicine, Catholic healthcare facilities will, according to ethicists, be increasingly obliged to provide genetic counseling services to their patients. Facilities should ensure that counselors make genetic information available in a context in which no pressure, overt or subtle, is exerted to use that information in a way that may violate an individual's value system. Some hospitals may, for example, set up a separate genetic counseling department, which does not diagnose or treat genetic disorders but does facilitate access to these treatments when patients need them. Effective counseling requires accurate, current knowledge about tests and treatments, as well as about theological discussions and Church decisions on the subject. Counselors also need to be aware of some typical misconceptions people have about genetic disease. Catholic hospitals should also work with other Catholic organizations to influence legislation addressing human genetic issues, especially when such legislation addresses reproductive rights.

Catholicism↗
PubMed1991

Opening doors to the needy. An archdiocese coordinates a physician referral network.

The availability and accessibility of healthcare to those unable to pay is deteriorating rapidly. One place this is clearly apparent is in our nation's capital, where extremes of poverty and wealth abound. In an effort to improve access to healthcare for the poor, homeless, and medically indigent in the Washington, DC, area, the Washington Archdiocese Health Care Network (AHCN) was formed in 1984 under the leadership of Card. James A. Hickey. The AHCN is a coordinating agency that refers people in need to physicians, physical therapy and rehabilitation services, and dentists who have agreed to volunteer their services to this vulnerable population. The formation, operation, and continuation of the AHCN are performed by five members of one steering committee on behalf of the hundreds of volunteers who make it work daily.

Catholicism↗
PubMed1991

Confronting conflict. A nursing home staff comes to grips with an elderly patient's decision to refuse nutrition.

For the most part, cases involving young or middle-aged persons such as Nancy Cruzan and Paul Brophy have shaped the legal and ethical landscape regarding the obligation to provide nutrition and hydration to nutritionally compromised patients. But the issue of care givers' responsibility in this area also arises frequently in the long-term care setting. One of the most difficult situations to address is what to do when an elderly patient begins to refuse adequate nutrition. Staff at Apartment Community of Our Lady of the Snows, Belleville, IL, had to wrestle with this question when Jane, a 90-year-old resident, decided her life had become too unbearable to continue. She refused to eat and demanded that nutrition not be forced on her. As they considered her situation, staff had to ask whether they clearly understood Jane's position, what actions would be in her best interest, what their professional obligations were, what they could do if her decision conflicted with professional or institutional values, and whether Church teaching shed any light on the issue. Unable to devise an alternative course of action acceptable to Jane, staff eventually acquiesced to Jane's request. Although they realized the difficulty of knowing with certainty what the right course of action is in such a case, they found support for their decision in Church teaching and in legal rulings on conflicts between the state's interest in preserving life and a patient's right to privacy.

Aged↗
PubMedDate not supplied

Advance directives for healthcare decisions--a Christian perspective.

For various reasons, many people wish to execute an advance directive for healthcare. Like other important life decisions, choices about healthcare should be consistent with the person's religious faith and values. To help people prepare an advance directive that is both accurate and reflective of Christian teaching and values, we have written the following document. Copies of An Advance Directive for Future Health Care Decisions: A Christian Perspective may be obtained in booklet form from Center for Health Care Ethics, 1402 S. Grand Blvd., St. Louis, MO 63104.

Advance Directives↗
PubMed1991

From ethical dilemma to hospital policy. The withholding or withdrawing of artificially provided nutrition and hydration.

In 1990 St. Joseph's Hospital and Medical Center, Paterson, NJ, established a committee to create an institutional policy to facilitate the decision-making process when patients or their legally authorized surrogates request the withholding or withdrawing of artificially provided nutrition and hydration. Before drafting a policy, the committee agreed on the philosophical, ethical, and medical assumptions that would be the foundation for the policy. The group adopted nine policy assumptions and provided guidelines that address concerns common to all healthcare facilities. No policy that addresses the issue of when to withhold or withdraw life-sustaining treatment will be perfect, nor will it resolve all the complexities of such a decision. However, an imperfect policy is preferable to the absence of a policy, which can lead to an abuse of patients' rights and contribute to arbitrariness in medical decision making.

Catholicism↗
PubMed1992

A matter of integrity.

Catholic healthcare providers today can live out their vision and values only if they become public policy advocates. They must learn how to shape effective public policy to help heal the ailing U.S. healthcare system. Although from a political perspective they might feel ill-equipped to advocate in the public policy arena, Catholic healthcare providers are richly endowed from the perspective of their tradition of social teaching. They must uphold the common good as a primary criterion in healthcare reform. Two important issues provide an extraordinary opportunity and challenge for Catholic healthcare leaders to demonstrate their commitment to the common good: euthanasia and healthcare reform.

Catholicism↗
PubMed1992

Toward a just healthcare system.

The U.S. healthcare delivery system is a patchwork nonsystem full of inequities, whose symptoms include the prolongation of the dying process, a lack of preventive care, and patient dumping. What can be done to make this nation's healthcare delivery system more just? The U.S. healthcare system should be modeled on the same underlying assumptions and justice-related values as the U.S. education system, a system based on need. Americans would find such a model psychologically acceptable because they are familiar with it, even though it is not perfect. Because they have the facilities and resources at their disposal, care givers must experience solidarity with all those who need care. The unity and solidarity of all creation is an explicitly Christian theme and is an appropriate value to emphasize with regard to compassionate healthcare. To establish a fairer healthcare delivery system, providers must consider their own Christian responsibilities and those of the Church, as well as the civic responsibilities of the government. If Catholic healthcare professionals do their part to change the status quo, Americans will be able to enjoy a fair system of healthcare delivery based on need, not on ability to pay.

Catholicism↗
PubMedDate not supplied

Removing life support: motivations, obligations. An opinion on NCCB Committee for Pro-Life Activities' statement on artificial hydration and nutrition.

In April 1992 the Committee for Pro-Life Activities of the National Conference of Catholic Bishops issued a resource paper titled "Nutrition and Hydration: Moral and Pastoral Reflections." At best, this document and its conclusions may be viewed as a pastoral statement, offering some tentative reasoning and conclusions to be considered in cases that concern the use of medically assisted nutrition and hydration. When discussing the question, is the withholding or withdrawing of medically assisted hydration and nutrition always direct killing? the document applies two principles--"no reasonable hope of benefit" and "involving excessive burdens." The document's crucial part is its admission that artificial hydration and nutrition may be removed without the intention of causing death, and that "this kind of decision should not be equated with a decision to kill or with suicide." The committee assigns decision-making responsibility to patients, families, and healthcare professionals, but continues its discussion for 20 pages and offers cautions conclusions concerning removal of such therapy. Two assumptions seem to underlie the document's overly cautious conclusions, the first being that mere vegetative function mandates continued life support. The first assumption overemphasizes the value of physiological functioning insofar as the purpose of human life is concerned. It also is contrary to the goal of medicine, which envisions restoration of cognitive-affective function as an element of successful therapy. The second assumption is that withdrawal of artificial hydration and nutrition from persons in PVS may lead to euthanasia. But mandating the continuation of nonbeneficial therapy simply because it prolongs physiological function seems to lead people to favor euthanasia rather than reject it.(ABSTRACT TRUNCATED AT 250 WORDS)

Catholicism↗
PubMed1993

Why we should not legalize euthanasia. The foundational ethical principle obliging us to protect life must be translated into a concrete norm.

The euthanasia debate is really the backdrop for a discussion within our society about the very nature of human life and meaning. Because the origin of life is in God, human beings do not have dominion over life but are stewards of life. The powerful combination of sanctity and stewardship is expressed in the foundational ethical principle. This principle says that no person has the right to directly take innocent human life and in fact there is a positive obligation to nurture and protect life. In our secular society there is a need to develop a "natural" metaphysic of sacredness. Such a metaphysic can serve as bedrock from which a foundational principle can be developed and then applied in concrete moral norms. It can show that life contributes to the full dignity of the human person. For this perspective to be effective in countering the movement to legalize euthanasia, this sense of integral wholeness of human personhood must be demonstrated in a convincing manner. It can be because a dualistic philosophical bias has been found wanting by Western culture. We must arrive at what ethicists would call concrete norms that guide individual choices. At issue is how we translate our foundational principle--Do not directly attack innocent human life--into a concrete norm when confronted with the possibility of death. Some persons question whether the concrete norm opposing euthanasia should be a matter of public morality. To answer this question, we must turn to our foundational principle.(ABSTRACT TRUNCATED AT 250 WORDS)

Catholicism↗
PubMed1993

Does compassion include euthanasia? Physicians' roles in caring for the terminally ill preclude the use of euthanasia.

As technological advances continue to allow physicians to prolong dying patients' lives, healthcare providers face many issues surrounding physician-assisted suicide and euthanasia. When a physician performs euthanasia or assists in suicide, he or she is killing the patient. The action can in no way be interpreted as allowing an eventually inevitable death to occur earlier rather than later. The physician is culpable. Physicians play three important roles when caring for terminally ill patients: adviser, friend, and priest. The risks inherent in each of these could create an illusion that performing euthanasia and assisting in suicide are humane and logical options. Finally, physicians should not miss opportunities for grace when caring for dying patients. When physicians convey the diagnosis, when patients express the desire to control the timing of the death, and when patients are feeling sadness and anger, physicians must rise to the occasion to act as friend and minister and to introduce grace and healing to the dying.

Catholicism↗
PubMed1993

In the best interest of the patient. Applying this standard to healthcare decision making must be done in a community context.

Acting in the "best interest" of another implies taking certain steps or following certain rules so that the person and his or her concrete human community will survive and potentially flourish. The long-term understanding of best interest refers to the balance of benefits and burdens with respect to the ultimate goals or purposes of a community within which an individual is situated; short-term best interest refers to that balance with respect to a specific healthcare decision, without reference to the overall situation. However, considering only short-term best interest is unsatisfactory in the final analysis. Any decision to sacrifice individual preference for communal best interest should include three crucial aspects: (1) The individual must be a willing (or potentially willing, in the case of a child) member of the community, (2) individuals never lose their moral standing in the community, and (3) society can justify failure to accept the autonomous decisions of some individuals only (a) if it is impossible, (b) that failure is necessitated by attempts to meet the needs of other individuals, and (c) that decision is not based on unfair or unjust practices. Applying the concept of best interest to nontherapeutic research on children, one can conclude that the indirect benefit to the child is in his or her best interest only when the long-term benefit to the community, in terms of both survival and flourishing, is adequately considered. In addition, healthcare surrogate decision makers, acting in the best interest of a person who cannot make decisions and has not previously expressed his or her wishes, must take into account the long-term interests of the community.

Bioethical Issues↗
PubMed1993

The case. What should Leah be told?

Fearing that his 18-year-old daughter will value her fertility more than her life, an Orthodox Jewish father implores physicians not to seek her informed consent for surgery for vaginal cancer.

Adolescent↗