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Working Papers or "Veniam Pro Laudo Peto"
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More on medical ethics

Sunday, March 05, 2006
+JMJPT+
Praised be Jesus Christ!! Now and Forever!!
I do not really have time right now to write a dedicated posting about anything so I thought to give you all a bit of 'meat' to grab a hold of I would post my moral ethics paper from a couple weeks ago. Hopefully, I can get the footnotes to come through. I will be back with some regular postings later today/ tomorrow.
In His Merciful Love,
Ed




The question was asked "What aspects of decision-making in that [sic. Medical facility] context represent the greatest ethical challenges?" I will attempt to give some of the current challenges that we face today. I will further attempt to answer the question posed "How would alternative ethical systems affect the approach to such challenges? Describe the various dimensions of [how] a Christian ethic would affect work and decision-making in such a facility." For reasons of brevity I have focused this paper primarily upon end of life issues that currently face medical facilities.
Euthanasia and assisted suicide present challenges to the Christian today. While desiring to see the end of suffering in our brother or sister we face the very real possibility that our actions or lack of actions bring about the death of a human being.
Modern medical science has through the Eternal Wisdom of God allowed mankind to bring quality and length to human beings. Many injuries and diseases which brought about death immediately are now treated bringing great consolation to individuals, families and society who just a few hundred years ago would be suffering greatly. Modern man is used to being able through science and technology. Through the infinite Wisdom and Mercy of God mankind is able to alleviate suffering in her children. Yet still, despite her best efforts humankind can only postpone the inedibility of death and suffering. So, it is secular man’s solution to the problem of suffering is to extinguish the life which has been given to the world and to the individual.
To borrow the old axiom "the ends do not justify the means" to which the opposite would be utilitarianism. I feel that the Christian who in their personal life or public life in a medical facility must take due note of the means at which suffering is alleviated. While every effort must be made as a sacred duty to God to relieve the suffering of an individual at no time directly or indirectly must the sacredness of human life be forsaken and destroyed. All available means must be taken to alleviate the pain and suffering of the individual by use of medications, nutrition and hydration, medical treatments, psychosocial care and pastoral care. The family, friends and loved ones need to be involved in the decision making process and in the psychosocial and pastoral care aspect also. Care must be given to respect the differences in cultural and religious aspects of the individual. However none of these important items must ever outweigh the dignity of the life of the individual by shortening the length of life.
Medical facilities must be guided by Natural Law which comes directly from God in their actions and decision making concerning individuals in their care. It should be the primary responsibility of the medical facility to treat and promote the sacred dignity of the individual. The axiom must be reinforced to "first do no harm" in the care of the individual human person. If this sacred dignity is upheld then all staff and their relations and work ethics are affected towards a common good. The rule applies not only to the physicians and nurses involved in direct patient care but also to the social workers, therapists, clerical staff and especially the hospital chaplain who must serve as a constant witness for the Truth and Love of God and as an advocate for the individual and the family.
While the suffering of the individual must be cared for it must be done to preserve the sacred dignity of the patient even in the final hours of life. It is in those final hours (hours that can only be determined by God not mere creatures) that great mercy and grace can flow forth from the suffering individual to countless souls and to the individual soul. Many times those who are unrepentant find Our Lord in those final hours, many times relationships are healed by being brought together in the suffering of a family member or friend, staff of medical facilities have to witnessed those opportunities for God's Mercy and Grace in their lives as the individual faces the waning hours of life. There is also the opportunity in these times for God to work individual miracles of healing in the individual patient and thereby show His Glory through them. Yet when this opportunity is denied through forced (by the individual, the family, the facility or society) death of the patient then the bad yeast develops within others and society.
The Christian is under no obligation to ever end the life through any means of an individual. Neither family pressures, nor employment pressures or societal pressures- even from government- can force the Christian to end the life of another. All manmade law is subject first and foremost to the Divine Natural Law and therefore no law regardless of the source can be just if it violates the Divine Natural Law. Therefore no Christian should ever feel obligated by manmade laws that violate Divine Law. In fact the Christian has the responsibility to ring out with a prophetic voice when the laws and rules of man violate the Divine Law. So, this requires prayerful discernment in every case to insure that the Law of God is not violated by action or lack of action- which would fall under either sin of omission or of commission. We always choose first life and then other decisions will fall into place with some variance of effort.
A brief notation though is required I feel that means to preserve the life of the individual do not have to require "extraordinary measures" which would not add to the eventual progression of an illness nor would increase the quality of the life of an individual. This term "extraordinary means" should never include basic nutrition and hydration as they themselves do add to the quality of life of the individual who is facing death. However individuals who freely choose those "extraordinary means" no impediment should be given for their choice to try one last method and 'hope beyond hope' for that in it self could be the opportunity for God to work through the hands of his instruments of mercy and healing.
In the medical facility it self structure must be established to first educate all providers and patients and family regarding ethical decisions in the light of natural law . Furthermore in that structure at each level constant reevaluation of patient care regarding particularly the ethical treatment of individuals must be established. A system of clear rules and of checks and balances must be established so that the right to life by the individual is not violated even by their self or own family while at the same time guaranteeing the right to choose said treatment is always upheld. This presents a challenge and that is why I feel that while always working under the framework of natural law and Christian ethics medical systems must evaluate each individual case so as not to be exclusionary in practice.
The guiding principles of Divine Natural Law should further be applied to bio-science and medical research. God is the Author of All Life and mankind should never interfere with the Hand of God through the pursuit of scientific knowledge. This further carries over to aspects such as human cloning, selective genetics, bio engineering, abortion, family planning prior to conception and any and all medical experiments. Neither society nor does the individual ever have the right to selectively choose when life is imparted and how. Society, or an individual, does not have the right to create a life just to use that life to aid in scientific research or even in the continuation of life in society or other individuals. Each life has a unique sacred dignity and no life which has been given by God is more or less valuable to society than any other.
Volumes can be written on the implementation of Christian Ethics in the medical facility and with the advancement of science in the world there can be no way to account for what possible dilemmas may occur in the future. However, if the Christian or society facing choices returns to viewing each dilemma within the framework of Divine Law then many problems can be avoided or brought to an ethical conclusion. It is the sacred duty of the Christian to stand up with a prophetic voice and take action when needed when ethical dilemmas arise within society or their own lives for we are alas "our brother's keeper".

"Evangelium Vitae", Pope John Paul II, Rome, 1995; et al.
Romans 2: 14; Job 28: 25; Proverbs 8; Exodus 20; Dt. 5, Matthew 5, 19; et al.

"Primum non nocere", Hippocratic Corpus; also see "Physician and Patient", William Hooker, 1847; et al.
John 15: 14; Col. 1: 24; "Declaration on Euthanasia", Congregation for the Doctrine of the Faith, Rome, 1980; "Salvific Doloris", Pope John Paul II, Rome, 1984; et al.
"Ordinary and Extraordinary Means", "Ethics and Medics", April 1995, Volume 20, Number 4, National Catholic Bioethics Center, Philadelphia; et al.
Romans 4: 20-21; John Henry Newman, Parochial and Plain Sermons, Volume 1, Sermon 15, circa 1890.
Summa Theologica, St. Thomas, 1st part of 2nd Part, Question 94, Article 4; Romans 2: 14; Job 28: 25; Proverbs 8; Exodus 20; Dt. 5, Matthew 5, 19; et al.
Catechism of the Catholic Church (CCC), # 2288- #2296; et al.
CCC, # 2304-2306; et al.
Genesis 4: 9
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