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PubMed1985

Surrogate motherhood: unacceptable answer to infertility.

Although many see surrogate motherhood as a solution to female sterility, it produces problems with the marriage relationship, parental responsibility, and parent-child bonding. Pope Pius XII condemned artificial insemination from a donor (surrogate fatherhood) because it separates procreation from marriage. This condemnation would extend to surrogate motherhood for the same reasons: Human procreation is reduced simply to transmitting biological life rather than a Christian way of living, which is a task that requires parents' commitment to each other and the child. Many other problems make this procedure unacceptable. These include commercialization, the child's possible anxiety because of its ambiguous parentage, and the surrogate's wanting to keep the child.

Adoption↗
PubMed1985

Catholic theology and the "right to die".

Catholic moral theology teaches that life is sacred but not absolute. Because life and all activities are subordinated to spiritual ends, it is moral to allow oneself to die when efforts to prolong life will bring no significant benefit and may even make it more difficult to finish life in peace, composure, and union with God. This is not the moral equivalent of suicide, but rather an acceptance of the human condition. In making such a decision, the distinction between morally ordinary and extraordinary means is crucial and based on the patient's total good. Ordinary means are those which offer a reasonable hope of benefit without excessive expense, pain, or other inconvenience. Extraordinary means are those which cannot be obtained without excessive burden or which, if used, would not offer a reasonable hope of benefit. Whether a medical procedure is standard or experimental does not, from a moral viewpoint, affect whether it is ordinary or extraordinary. In Catholic teaching, the patient has the paramount right to decide whether life-preserving measures will be used. If the patient is unable to make this decision, then the family should make it as the patient's representative.

Catholicism↗
PubMed1985

Medical humanism: pragmatic or personalist?

Those in health care practice and research must depend on humanism for guidance in making difficult judgments and decisions that involve the individual patient's dignity and value. But what kind of humanism will inform those choices? Pragmatic humanism tends to view dignity in terms of human functioning: One is human because he or she acts, produces, thinks, achieves. The comatose, the insane, the hopelessly senile, fetuses and the newborn may be accorded human dignity as well, but only because society grants it to them. Thus such dignity can be manipulated or diminished in the name of overall human progress or the common welfare. By contrast, personalist humanism holds that human dignity is rooted in "being human" rather than in "doing human things." An individual has full human value simply by being a living person. This humanism suggests that health care providers must use their capabilities even for nonproductive patients. This may be difficult in the face of today's cost-benefit analyses. But if the individual's basic value is not defended, human dignity will vary in direct ratio to a person's social usefulness. And that would be obscene.

Bioethical Issues↗
PubMed1985

Ethics committee develops supportive care guidelines.

In response to widespread physician noncompliance with "do not resuscitate" (DNR) guidelines in 1983, the ethics committee at St. Joseph's Hospital, St. Paul, MN, set out to clarify the confusion over "supportive care only" (SCO) and DNR orders. A task force of nurses and physicians developed tentative supportive care guidelines and a subcommittee related ethical principles to the supportive care concept. The completed draft, "Principles and Guidelines in Deciding to Forego Life-Sustaining Treatment," was reviewed by the medical executive board and hospital attorney. St. Joseph's medical staff and board of trustees approved it in May 1985, and the document became hospital policy. The policy addresses patient autonomy, the burden/benefit principle, informed consent, and patient competency. It lists six guidelines for making supportive care plans. St. Joseph's has implemented the policy in several ways. Committee members make "ethics rounds" to discuss patient cases and the guidelines with hospital personnel. A brochure acquaints patients and their families as well as community groups with the guidelines. Nurses have introduced the guidelines to physicians in critical care units. When necessary, new insights will be incorporated into the guidelines.

Catholicism↗
PubMed1986

Five key players shape institution's ethical character.

Various individuals or groups play important roles in achieving moral insight and direction in a health care facility. The administration, medical and nursing staffs, the professional theologian, and the bishop all contribute unique perspectives to the complex process of developing an institution's ethical character. An institutional ethics committee's (IEC's) effectiveness depends largely on the administrator's ability to support educational programming in ethics for the entire staff, coordinate ethical reflection throughout the organization, and shape ethically informed policy based on an IEC's practical experience. The medical staff brings its scientific background and practical experience to ethical issues under a committee's consideration, and nurses offer valuable insights based on their close contact with patients and family. The theologian provides resources and background on Catholic tradition as well as information on current theological developments. The IEC also should maintain a relationship with the local bishop whose duty is to articulate the Church's positions in health care ethics. Forthright dialogue among all parties is central to the IEC's task.

Catholicism↗
PubMed1987

In vitro technology: a threat to the covenant.

The meaning of human sexuality, according to Catholic moral theology, can be appropriately expressed only within the confines of the marital covenant. Children in this moral perspective are created within the sphere of the marital embrace, which is expressive of conjugal intimacy and procreative power. In vitro fertilization and other artificial reproductive methods, which carry the risk of procreating new life beyond the sphere of marriage, therefore pose significant ethical questions concerning respect for life, the integrity of marriage, and the need to guide technological mastery with wisdom. Some ethicists suggest that in vitro technology may be permissible if embryo wastage is not significantly greater than during normal reproduction. Other moralists, however, recommended stronger protections for nascent life. The human embryo, they caution, should not become an object to be manipulated or used as a means to an end, even though the goal is to alleviate infertility. Concern for depersonalization, one of the chief reasons for Catholic moral teaching's objection to artificial insemination by donor, also applies to the new reproductive technologies. Ethicists have reached a wide consensus on this point, agreeing that procreation should not be divorced from the context of martial intimacy. As society deals with the problems of infertility and advances its technology, those who are involved in the new reproductive methods must also explore the ethicl issues concerned. One possible resource would be a broad-based ethics committee to advise couples, medical professionals, infertility clinics, and other agencies about the risks and possibilities of new research. Hospital ethics committees also could help resolve complex issues.(ABSTRACT TRUNCATED AT 250 WORDS)

Advisory Committees↗
PubMed1987

Family ethics in caring for newborns with impairments.

The technological advances of modern society mean that family members have expanded obligations to care for newborns with severe impairments, who would have died in previous eras. This biological imbalance has created a moral one as well, for to care is to be penalized. Often this moral heroism can be sustained as a vacation only in communities based on the ideal of Christian love. Severely impaired children impose great physical and emotional stress on their parents, which can push the parents to the limits if they are unable to tap into altruistic emotions. Historically, children were not accorded moral status in the West until the Christian influence brought them into the moral community and encouraged parental responsibility. To fulfill their obligations, perhaps parents should bring their child with impairments home and relinquish care only when they find the burden too great. They are obligated to try because they brought the child into existence (biological-causal argument), because this caring is a reflection of God's image, and because children have a moral claim on their parents. Limits to parental obligations exist when continued care would be psychologically destructive for the parents, would conflict with obligations to other family members, particularly siblings, or would be harmful to the child because the atmosphere is no longer nurturing and loving.

Congenital Abnormalities↗
PubMed1987

Euthanasia: a Catholic perspective.

According to the Roman Catholic perspective, we are not obliged to ward off death at all costs, but we should not deliberately intervene to bring death about. The "sanctity of life" principle, which rests on the human person's unique relationship with God, is the basis of the Church's honoring of human life as a basic value. Under this principle, direct intervention to end the life of a patient in a terminal condition would not be condoned. This negative position also follows from the religious principle of divine sovereignty--the idea that God alone is Lord over life and death, and the end of human life is not subject to a person's free judgment. Catholic moral tradition distinguishes between actions, on the one hand, or omissions that constitute intervention to put the patient to death and, on the other hand, the withholding of useless treatment that could not significantly reverse or prolong the progressive deterioration of life. The distinction rests on the difference between ordinary and extraordinary means. Also to be considered is the intention--the physician's goals versus the foreseeable yet unintended results. Thus death may not be directly sought, but it may be tolerated as an inevitable side effect of one's goal (such as the relief of suffering). These moral principles need to be rooted in the specific ways a moral community cares for its sick and dying. The religious convictions of grace and covenant and corresponding virtues of gratitude and fidelity enable the community to uphold its convictions about euthanasia.

Catholicism↗
PubMed1988

Advance directives compatible with Catholic moral principles.

Decisions regarding life-sustaining treatment for incompetent patients are typically difficult and stressful for surrogate or proxy decision makers. Although substituted judgment and best interest provisions are helpful to next of kin or guardian and help replicate an incapacitated patient's wishes, a more definitive expression of treatment preferences is needed. Advance directives allow currently competent persons to express their wishes about medical treatment before a possible incapacitating situation. Such directives seek to realize basic values of human dignity, respect for self-determination and human life, and communication and discussion with the person concerning treatment. Three types of directives are the living will or instruction directive, proxy directive or durable power of attorney, and a combination of the two. Legislative concerns over advance directives mainly focus on possible legal euthanasia, patient protection, ambiguous language, and other inadequacies. Catholic healthcare facilities can respond to concerns about advance directives in four positive ways: Make information about directives available to patients and providers. Contribute to constructive debate in states without legislation. Include provisions for proxy decision making in states with existing patients' bill of rights. Consider legislation to protect physicians from litigation when patients' written directives are followed.

Catholicism↗