Catholic Health Care Ethics: A Manual for Ethics Committees
By Peter J. Cataldo, PhD, and Albert S. Moraczewski, OP, PhD, STM, eds.
The National Catholic Bioethics Center, Boston
2002, 480 pp., $39.95 (plus $6 for shipping and handling)
REVIEWED BY ELLEN W. BERNAL, PhD
This book is intended as a comprehensive guide for ethics committees in Catholic health care facilities. The articles, commentaries, and source materials collected in it are an extension of the research of the National Catholic Bioethics Center (NCBC), Boston. Established in 1972 as the Pope John XXIII Medical-Moral Research and Education Center, the NCBC conducts ongoing, systematic study of new developments in the health care field from the perspective of the Catholic moral tradition. The Ethical and Religious Directives for Catholic Health Care Services are used effectively in the various topics analyzed.
The manual comes in a three-ring binder format to permit ready updating. It is organized into six parts: Foundational Principles, Process Topics, Beginning-of-Life Issues, End-of-Life Issues, Selected Clinical Issues, and Institutional Issues. Although several authors contributed to the volume, a sense of continuity pervades the manual from one chapter to the next because of the authors' shared theological commitments and the editorial summaries that follow each chapter. Appendices contain a selection of Magisterial and other official Catholic Church documents and a general bibliography.
As Fr. Dennis A. Brodeur, PhD, observes in Chapter 5B, Catholic health care ethics committees draw appreciable strength from Catholic philosophical anthropology, the mission commitment to service, and extensive study of values and morality within the Catholic tradition. Issues in the beginning of life and at the end of life have received special attention here. The manual reflects these traditional commitments, both in its organization and in the number of chapters and pages devoted to particular topics. Part One concerns foundational principles, including the nature of the human person, the definition of moral action, totality, the distinction between ordinary and extraordinary means, double effect, the common good, conscience, virtue, and natural law. Clearly, an ethics committee seeking to deepen its understanding of foundational principles in Catholic ethics could usefully select one or more of these chapters for review and discussion during meetings.
Part Two focuses on "process topics." The chapters give excellent practical advice on how to establish ethics committees in various health care settings, as well as how to lead meetings effectively. Overall, the section is a fine beginning, but it is all too brief. Ethics committees will need to supplement the information provided in it with further guidance on ethics consultation, policy review/development, and education. They will, for example, need to establish a process for conducting, evaluating, and maintaining records of ethics consultations. Along with consulting the references listed here, ethics committees may wish to network with bioethics organizations at state and national levels, including the Catholic Health Association and the American Society for Bioethics and Humanities (ASBH). Ethics committees should be aware that the ASBH has published proposed standards, Core Competencies for Health Care Ethics Consultation,1 that describe the knowledge and skills needed for conducting ethics consultation, whether done by individual consultants, subcommittees, or the full committee. Clinical ethics guidebooks, in particular Clinical Ethics by Albert R. Jonsen and his colleagues,2offer practical advice in a format appreciated by clinicians of many backgrounds.
Self-evaluation, education, and policy review are other expanding areas of ethics committee responsibility. Some committees find that setting yearly goals is a way to provide focus and to document progress at the end of the year. Committees may conduct surveys of health care professionals' knowledge about the committee, and, after that, develop education and services to meet identified needs. Ethics committees play an essential role in interpreting the Ethical and Religious Directives and in meeting the requirements of national accrediting organizations, such as the Joint Committee on Accreditation of Healthcare Organizations. Ethics committees increasingly help develop new services, such as palliative care, and may offer advice on the ethics of business decisions. Collaboration with other community organizations, whether Catholic or non-Catholic, around mutually held goals—wider education about advance directives, for example—improves health care for all in the community.3 Ethics committees in Catholic health care should seek to engage the wisdom of other cultures' perspectives on ethics, thus drawing from the field of bioethics as a whole.
Part Three of the manual concentrates on beginning-of-life issues. Along with Magisterial teachings on specific issues—abortion, sterilization, and contraception—these chapters acknowledge and describe the basis for differences of opinion about the use of methotrexate to treat ectopic pregnancies.
Part Four is concerned with issues at the end of life. Catholic health care ethics has had a major influence on bioethics as a whole, and nowhere is this more evident than in the ethics of care at the end of life. The distinction between ordinary and extraordinary means of treatment set forth by Pope Pius XII in The Prolongation of Life: An Address to an International Congress of Anesthesiologists (Appendix I) underlies the President's Commission study Deciding to Forgo Life-Sustaining Treatment.4 Specific chapters in Part Four of the manual discuss advance directives, do-not-resuscitate orders, and pain management. The chapter on medically administered nutrition and hydration acknowledges different opinions about the use of this treatment modality. Some further background on the history and development of ethical-legal cases would be useful in this section.5
The chapters in Parts Five and Six are concerned with selected clinical and institutional issues, including organizational ethics.
Overall, this volume is an excellent resource in the foundations and application of Catholic health care ethics. It will be useful for ethics committees to supplement the material provided here with other resources, according to their needs and interests.
Ellen W. Bernal, PhD
Hospital Ethicist
St. Vincent Mercy Medical Center
Toledo, OH
NOTES
- Society for Health and Human Values–Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation, Core Competencies for Health Care Ethics Consultation, American Society for Bioethics and the Humanities, Glenview, IL, 1998.
- Albert R. Jonsen, Mark Siegler, and William J. Winslade, Clinical Ethics, 4th ed., McGraw-Hill, New York City, 1998.
- Bernard J. Hammes and Brenda L. Rooney, "Death and End-of-Life Planning in One Midwestern Community," Archives of Internal Medicine, February 23, 1998, pp. 383-390.
- President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, ,Deciding to Forgo Life-Sustaining Treatment, Washington, DC, 1983.
- See, for example, Daniel O'Brien, Ethics in Health Care: Ingredients for Effective Committees, Sisters of St. Joseph Health System, Ann Arbor, MI, 1995, and Gregory E. Pence, Classic Cases in Medical Ethics, McGraw-Hill, New York City, 1999.