The Role of Morality in Health Care and Its Dilemmas

I borrow the expression from Boyle Joseph , “Radical Moral Disagreement in Contemporary Health Care: A Roman Catholic Perspective,” The Journal of Medicine and Philosophy 19 (1994): 183–200.

Cf. Benedict Ashley O.P. , and Kevin O'Rourke O.P. , Health Care Ethics: A Theological Analysis, 4th ed. (Washington, D.C.: Georgetown University Press, 1997), chapter 1.

Cf. Finnis John , and Anthony Fisher O.P. , “Theology and the Four Principles: A Roman Catholic View I,” in (Ed.) Gillon Raanon , Principles of Health Care Ethics (West Sussex, England: John Wiley & Sons, 1994), p. 37.

See the following informative articles on personhood: Patrick Derr, “The Historical Development of the Various Concepts of Personhood,” and Ashley Benedict O.P., “Contemporary Understandings of Personhood,” in (Ed.) Russell E. Smith, The Twenty-Fifth Anniversary of Vatican II: A Look Back and a Look Ahead (Braintree, MA: Pope John Center, 1990), pp. 17–34 and pp. 35-48, respectively.

Cf. Crick Francis , The Astonishing Hypothesis: The Scientific Search for the Soul (Old Tappan, NJ: MacMillan, 1995). Another good description of the materialist view, by a neuroscientist who disagrees with it, is found in the late Sir John C. Eccles, How the Self Controls Its Brain (Berlin and Heidelberg: Springer-Verlag, 1994), chapter 3. Some philosophers will also use the term “physicalism” to describe this view of the human person, especially the relationship between mind and body.

This anthropology is expressed well in the thought of the philosopher Harris John , “The Philosophical Case Against the Philosophical Case Against Euthanasia: A reply to John Finnis”: “[A] person is a unified complex being, but that complexity is part of what it is to possess the radical capacities of intelligence and autonomy - in short, the capacity to value existence. When these are lacking the person has ceased to exist (or has not yet come into being)” in (Ed.) Keown John , Euthanasia Examined: Ethical, Clinical and Legal Perspectives (Cambridge: Cambridge University Press, 1997, revised paperback ed.; originally 1995), p. 41, emphasis added.

Cf. Singer Peter , Rethinking Life and Death: The Collapse of Our Traditional Ethics (New York: St. Martin's Press) pp. 165–183; 201-206, for his case against what he calls “speciesism,” i.e., the denial of rights to nonhuman beings simply because they are not members of the human species. I have responded to Professor Singer in “The Gospel of Life vs. The Culture of Death,” Homelitic & Pastoral Review (April 1997): 20-28.

On the nature of this difference, see Adler Mortimer , The Difference of Man and the Difference it Makes (New York: Fordham University Press, 1993; originally 1967), especially chapters 7 through 14; David Braine, The Human Person: Animal and Spirit (Notre Dame, IN: University of Notre Dame Press, 1992); and Benedict Ashley, O.P., Theologies of the Body: Humanist and Christian (Braintree, MA: Pope John Center, 1995, originally 1985), pp. 307-332. In the Preface to the 1993 edition of his book, Adler writes: “[M]an differs radically in kind [not merely superficially and not merely in degree] by virtue of an intellectual power possessed by no other animal and not seated in the human brain” (ix.) According to Adler, while animals possess merely perceptual thought, man, because of this immaterial power, is equipped with conceptual thought.

Ashley , and O'Rourke , Health Care Ethics, p. 5; see also pp. 3-7.

Cf. Finnis , and Fisher , “Theology and the Four Principles,” p.32.

Cf. Grisez Germain , The Way of the Lord Jesus, Vol. 1: Christian Moral Principles (Chicago: Franciscan Herald Press, 1983), chapter 2. See also Pope John Paul II, Veritatis Splendor (The Splendor of Truth), #71 on the self-determining dimension of free choice.

Cf. Grisez Germain , Boyle Joseph , and Finnis John “Practical Principles, Moral Truth, and Ultimate Ends,” American Journal of Jurisprudence 32 (1987), pp. 131–133.

Cf. William E. May “Bioethics and Human Life,” in (Ed.) David Forte, Natural Law and Contemporary Public Policy (Washington, D.C.: Georgetown University Press, 1998), pp. 7–9.

As an example of this kind of moral reasoning, The Detroit News reported that a presidential panel is going to recommend that the federal government fund research on human embryos because, according to the panel, “the moral cost of destroying embryos in research is outweighed by the social good that would come from the work,” (Federal Embryo Research Endorsed,” May 23, 1999, 5A).

Cf. May , “Bioethics and Human Life,” pp. 7–9.

An insightful discussion of these two “ethics” - the “quality of life” versus the “sanctity of life” - is found in (Ed.) Gormally Luke , Euthanasia, Clinical Practice and the Law (London: The Linacre Center for Health Care Ethics, 1994), pp. 118–126.

Cf. Grisez , Boyle , and Finnis , “Practical Principles, Moral Truth, and Ultimate Ends,” pp. 127–128. Using religious language, the Bible expresses this most fundamental moral principle by saying that you ought to “love God and your neighbor as yourself (see Deuteronomy 6.5, Leviticus 19.18, Matthew 22.37, Mark 12.30-31, and Luke 10.27).

Cf. Grisez , Boyle , and Finnis , “Practical Principles, Moral Truth, and Ultimate Ends,”, pp. 106–108.

Cf. May William E. An Introduction to Moral Theology, revised edition (Huntington, IN: Our Sunday Visitor Press, 1994), p. 78.

Cf. Beauchamp Tom L. , and Childress James F. , Principles of Biomedical Ethics, 4th ed. (New York and Oxford: Oxford University Press, 1994). See also chapters 2-6.

Cf. Finnis , and Fisher , “Theology and the Four Principles,” p. 31, see also pp. 35-42.

The literature on this issue is voluminous. See the interesting exchange in Ethics & Medics between William E. May (“Tube Feeding and the ‘Vegetative’ State,”: December 1998 and January 1999) and Kevin O'Rourke, O.P. (“On the Care of'Vegetative’ Patients,” April and May 1999).

Cf. Finnis , and Fisher , “Theology and the Four Principles,” pp. 38–39. See also (Ed.) Gormally, Euthanasia, Clinical Practice, and the Law, chapters 5 and 6.

Cf. Finnis , and Fisher , “Theology and the Four Principles,” p. 39.

See William E. May's helpful overview of the different positions taken on this issue by Roman Catholic bishops, theologians, and philosophers, “Caring for Persons in the ‘Persistent Vegetative State’,” Anthropotes 13 (1997): 317–331.

Cf. May , “Feeding and Hydrating the Permanently Unconscious and Other Vulnerable Persons,” Issues in Law and Medicine 3 (1987): 203–217.

Cf. May , “Feeding and Hydrating the Permanently Unconscious and Other Vulnerable Persons,” Issues in Law and Medicine 3 (1987)., p. 205.

Cf. May William E. , “People's Needs, Moral Truths and Priests,” in The Catholic Priest as Moral teacher and Guide (A Symposium) (San Francisco: Ignatius Press, 1990), pp. 71–90.

On the importance (and neglect) of happiness as a fundamental principle in (contemporary) Christian ethics, see Pinckaers Servais , The Sources of Christian Ethics (Washington, D.C.: The Catholic University of America Press, 1993), pp. 17–22.