REVIEWED BY FR. PHILIP S. KEANE, SS
MEDICAL ETHICS AND THE FAITH FACTOR: A HANDBOOK FOR CLERGY AND HEALTH CARE PROFESSIONS
BY ROBERT D. ORR, MD
Wm. B. Eerdmans Publishing, 2009
483 pages, $30 (paperback)
Drawing on his many years of experience as a physician and as an ethicist, Dr. Robert Orr has written a useful book on covering many of the key issues in clinical ethics today. The book makes extensive use of fairly short and succinct case studies, an approach many clergy and health providers will find very useful. The cases are divided into several categories including typical system failures in adults (heart, lungs, kidneys, brain, mind, etc.), issues involving children, newborns and pregnant women and issues involving health care as it relates to religious or cultural beliefs.
In general, Orr presents his selected cases with compassion and understanding. In many instances, I found myself agreeing with his conclusions and recommendations. His approaches to abortion and related matters (touched on in a number of the cases) were the most significant areas where I, as a Catholic, could not agree with his judgments. I liked the way in which he dealt with pediatric consent, especially as children get older and more aware of the health issues they are facing. In a review of one case, for instance, he speaks about the "developing adulthood" of adolescents. Overall, he concludes that, in numbers of situations, this developing adulthood makes it ethical to accept an adolescent's decision, either on a purely medical issue, or on issues where faith and medicine intersect, e.g., asking that the dying process not be prolonged any further.
A short section at the beginning of the book deals with religious issues such as suffering, death, the sanctity of life and the providence of God. These issues come up in various ways in the subsequent case discussions, and the book's conclusion on the priesthood of all believers returns again to the religious grounds for medical ethics. As a whole, the book makes it clear that Orr is a man of faith.
However, an even longer part of the book's introduction is devoted to the philosophical principles that ground modern medical ethics, and on the whole, the case discussions appear to be more dependent on these philosophical norms than they are on the theological context. It is clear that all medical ethics needs to be grounded in philosophical norms. Still, I would have preferred to see the author give the faith factor (from the book's title) a more extensive development. As an example, Orr asserts that the Christian approach to suffering is markedly different from the secular worldview, and he acknowledges a value in relieving suffering. But Christians can sometimes have confused views of suffering, including a tendency to seek it for its own sake. I felt the book could have benefitted from a deeper reflection on the meaning of suffering from a faith perspective.
From my perspective as a Roman Catholic, I was reminded that the Protestant concern for medical ethics comes mostly from the middle years of the 20th century and the decades since. Catholicism, with its 500-year history of writing about medical ethics, has many more theological and ethical precedents to which it can refer in discussing the sorts of issues Orr reviews. I mention this not as a criticism per se, but simply to note that Catholic readers will be aware of the absence of the strong historical tradition that marks Roman Catholic medical ethics.
Orr wrote his comments on Catholicism and artificial nutrition/hydration before the Catholic bishops of the U.S. adopted their helpful revision of the Ethical and Religious Directives for Catholic Health Care Services on this subject last November. His comments will need to be interpreted in the context of that revision.
The book contains two helpful appendices. The first explains some key medical terms. The second is a cross-reference guide, showing how the same ethical issues are treated in a number of different cases throughout the book.
FR. PHILIP S. KEANE, SS, recently retired after 35 years as Professor of Moral Theology at Saint Mary's Seminary and University, Baltimore. His numerous publications include articles in theological journals and four books: Sexual Morality: A Catholic Perspective, Christian Ethics and Imagination, Health Care Reform: A Catholic View and Catholicism and Health Care Justice. He currently serves as an ethics consultant to Catholic Charities of the Archdiocese of Baltimore, to the Bon Secours Health System and to several Catholic hospitals in the Baltimore-Washington area.