Ethics of Health Care: An Introductory Textbook, 3rd Ed.
By Benedict M. Ashley, OP, & Kevin D. O'Rourke, OP
Georgetown University Press, Washington, DC
2002, 272 pp., $27.50 (paperback)
REVIEWED BY JOSEPH J. PICCIONE, JD
In recent years, health care ethics has become a common topic in contemporary
culture. As such, it tends to become a series of debated controversies in the
news. Even many introductory college courses present health care ethics simply
as a range of issues. But Dominican priests Frs. Benedict Ashley and Kevin O'Rourke
have a better vision, and they offer an introductory textbook that is ideal
for medical and nursing education; it deals with many of the same topics they
treated in their fuller text, Healthcare Ethics: A Theological Analysis (4th
ed., 1997).
The newer book does not begin with the controversies of the day but, rather,
arrives there after first describing the Christian foundation of the human person
called into communion with the Holy Trinity and with other persons. In this
Christian vision, ethics is not simply a way to deal with problems. It is, first,
an invitation to a higher level of human flourishing, and, second, a coherent
manner of addressing relationships and issues that challenge this flourishing
in human communion.
Fr. Ashley's and Fr. O'Rourke's book is all the more important in our radically
individualized and secularized culture, in which the Christian vision is increasingly
excluded from health care and bioethical discussion. The Christian witness to
human dignity is at the basis of health care ethics, and the authors share this
recognition with those members of the next generation of health care professionals
who use the book. Included in this work are both the foundations for clinical
health care ethics and, perhaps as important, the foundations for ethics in
the conduct of health care professionals.
This text should be greatly appreciated for its advocacy of Christian personalism
both in professional health care relationships and as a fundamental norm for
the Catholic health care ministry. For example, the authors, while noting their
appreciation of the advances in contemporary medical practice, nevertheless
express a serious concern for the methodology of the current scientific method,
prone as it is to a depersonalizing biological reductionism of the person to
a disease process. "When reductionism is rigidly applied, the patient is treated
as a soulless machine," the authors write. "In the history of medicine, this
mechanistic approach has been profitable to the degree that it has allowed the
intensive use of the scientific method, but it has ultimately limited the advance
of medicine" (pp. 76-77).
The book's first seven chapters provide the basis for the specific issues
addressed in chapters 8-13. The first two chapters, substantially revised from
the second edition (1994), now provide an overview of fundamental issues and
trends in ethics from the Enlightenment to the present (Chapter 1) and an introduction
to Catholic ethics (Chapter 2), both of which are most helpful to the student.
Chapters 3-5 explore the meanings of health and individual responsibility. Chapter
6, titled "Responsibilities of Health Care Professionals," has particular and
unique value for the health care professional's formation; it continues the
Christian personalist theme and is a lovely exploration of the professional
as competent, yes, but also in relationship with other human persons who experience
the vulnerability of illness. Chapter 7 considers models for delivery of health
care but also continues the personalist professionalism theme of Chapter 6 in
its examination of the health care team and the Catholic health care facility.
An examination of particular topics begins with Chapter 8, regarding ethical
norms in research involving human subjects; it then takes up human sexuality
and reproduction (Chapter 9), genetic research (Chapter 10), mental illness,
addiction, and ethical issues in psychotherapy (Chapter 11), issues related
to death and dying (Chapter 12), and, finally, pastoral care and spiritual ministry
in health care (Chapter 13). One of the appendices is the current edition of
the Ethical and Religious Directives for Catholic Health Care Services.
Throughout the book, the authors maintain the Christian, trinitarian, and
personalist norms with which they begin, so that there is no disconnection from
the foundational elements in the consideration of the particular topics. This
third edition of Ethics of Health Care incorporates the most recent moral
teaching documents of the Catholic Church, and cites them well. As we live in
a diverse society, the authors know that their readers and those with whom they
will interact as health care professionals are not all Catholic or Christian;
they make their case and find common cause with a range of persons of good will
through persuasive argument.
With such a breadth of issues, it is reasonable that there will be, in some
topics, a range of prudent Catholic approaches. In both end-of-life care (Chapter
12) and in assisted reproduction (Chapter 9) there are limited specific issues
in which the authors take a particular position; in these instances, they relate
other moral approaches to the questions.
This is a work by noted scholars of the Catholic health care ministry, made
available in an introductory text. Readers will find an invitation to view their
profession in the light of faith, and, thus prompted by the Holy Spirit, can
experience the love of charity, expressed in solidarity with individual human
persons at a time of vulnerability, as their work. Such prompting seems so necessary
because, without it, the 21st century will continue the depersonalizing trends
of the 20th century. Ethics of Health Care can also be used as a resource
for the ongoing renewal for the Catholic health care ministry and for those
persons, Catholic and other, who will direct and serve in the ministry.
Joseph J. Piccione, JD
Corporate Ethicist
OSF Healthcare System
Peoria, IL