The Linacre Quarterly

When the diagnosis of a lethal anomaly has been established, many patients will choose to continue to their pregnancy. Until recently, there has been a lack of medical literature addressing the specific management of the families who find themselves in this unique situation. Since 1996, we have proposed a model of care that involves the strength of prenatal diagnosis, perinatal grief management, and hospice care to address the needs of these families. This article describes how to identify patients who benefit from this care; the multidisciplinary team approach; and the aspects of antepartum, intrapartum, and postpartum care. The literature to date is discussed, and barriers to implementation described.

Since 1968, vital organs, necessary for life, have been removed from patients for transplantation into patients in whom corresponding organs have ceased to function. Since then this has been morally justified by the claim that the donor is “brain dead” or has suffered “cardiac death.” Brain death is defined as complete and irreversible loss of all brain function, and cardiac death is declared two to five minutes after cessation of the heartbeat.

The moral problem is that the criteria used to declare that brain death or cardiac death has occurred are arbitrary, open to serious world-wide debate, variable in definition and application, and, more seriously, do not necessarily provide moral certainty that real death has occurred and that such organ retrieval does not actually cause the death of the donor.

This problem has been debated over the years at the Pontifical Academy of Sciences and remains a subject of legitimate debate to this day. The declaration of brain death or cardiac death also does not appear to be consistent with the teaching of Pope Benedict XVI that the definition of death receive the consensus of the entire scientific community and does not give everyone certainty that the primary criterion is respect for the life of the donor and that the organs are removed from a dead body, a cadaver.

On December 4, 2009, the American Nurses Association (ANA) issued a call for public comment on a revised position statement, “Registered Nurses' Roles and Responsibilities in Providing Expert Care and Counseling at the End of Life.” The intent of this new statement is to replace the 1994 position statements on assisted suicide and active euthanasia, which clearly prohibit nurse participation in those activities. The revised position statement subtly endorses assisted suicide. Four main problems in the revised statement are addressed in this essay: a misunderstanding of the principle of double effect, the misuse of sole intent in the ANA Code of Ethics for Nurses, confusion about the meaning of conscience, and failure to recognize the primacy of human dignity. To date, the ANA's final decision on the revised statement has not been released.

Catholic health care has, as one of its essential components, the spiritual or pastoral aspects of the care of sick patients. In an effort to assess this aspect of care, the Catholic Physicians' Guild of Chicago sent a questionnaire to the pastoral-care directors of the twenty-one Catholic hospitals in the Archdiocese of Chicago. This questionnaire addressed various topics, such as 1) Catholic identity, 2) Mass, 3) Sacraments, 4) ethics, and 5) natural family planning. In general, the responses indicated that the Chicago archdiocesan hospitals demonstrated strong pastoral-care programs. Health-care counseling appears to be gaining prominence. It is recommended that the sacramental ministry aspect of Catholic care—Mass, the Eucharist, reconciliation, and the anointing of the sick—be reinforced and emphasized.

The immune system distinguishes self from nonself permitting protection from invading microorganisms and cancer, but also causing rejection of foreign cells as in allogeneic organ transplantation. However, in sexual reproduction, the man's sperm are not rejected by the woman's immune system. This is based on the presence of a mild immunosuppressant in the seminal fluid, making possible the “two-in-one-flesh” intimacy that results in procreation. The biological consequences of natural sexual intercourse are completely distinct from the unnatural act of anal intercourse, as occurs in homosexual unions. The capacity of spermatozoa to penetrate into the nuclei of cells, coupled with the immunosuppressant in seminal fluid, greatly increases the risk of development of anal cancer. Science, which is immune to political or fashionable trends, thus bears witness to the unique nature of the conjugal bond between a man and a woman.

Attacks on the conscience rights of health-care professionals are increasing. This stems from the seven stages of liberal legal activism which begins with the assertion that a specific (immoral) activity should not be illegal and ends with the condemnation as criminals of those who disagree with the immoral activity. The history of legal activism in the United States with regard to abortion is traced, including attempts to force Catholic hospitals to perform abortions and sterilizations. These include challenges on the national and state levels with conscience-protection legislation enacted both in Congress and in state legislatures. However, these laws provide no explicit means by which a medical professional or institution may seek redress for a violation of their conscience. This has led to recent failures of conscience protection, such as when Catholic Charities in New York was forced to provide insurance coverage for contraceptives and a Catholic nurse was forced to assist in a twenty-two-week-old dismemberment abortion. The conscience protection regulations issued near the end of President Bush's second term would be helpful in ensuring greater education about and adherence to the laws and respect for conscience rights, but the Obama Administration has proposed rescinding the Bush Administration regulations. Catholic Medical Association members must stand and defend their conscience rights in this time or risk the loss of those rights in the near future. The Alliance Defense Fund and its allies are ready to assist medical students, professionals, and institutions who are willing to stand in this gap and refuse to sacrifice their consciences to the anti-choice agenda being promoted by those who call themselves “pro-choice.”

Today there is a growing crisis in politics and economics, as well as health care and more specifically Catholic health care. We have inherited a great legacy in Catholic health care in America; and despite modern challenges to it, we must protect this ministry. Three areas are proposed in which we must respond to the particular medical-ethical challenges we are facing, and these areas are the following: protection of conscience and religious freedom, freedom to develop positive alternatives, and recapturing the vision of Catholic health care. Ultimately love of Christ and fidelity to his teaching and example must undergird our efforts in preserving the delivery of Catholic health care in America.

The Church's teachings are often very challenging. Those who are involved in the health-care professions and who conduct their practices in accord with Church teaching can expect misunderstanding and even rejection from their colleagues and patients. One of the most difficult teachings of the Church is its condemnation of contraception. In 1968 Pope Paul VI issued the encyclical Humanae vitae, which hit the world like a bomb. In it he affirmed the Church's long-standing teaching on human sexuality and condemned contraception in particular. Today scientific advances such as in vitro fertilization and embryonic stem-cell research, as well as the challenges in making moral decisions about end-of-life care, make it increasingly difficult for health-care professionals to practice in accord with their deeply held moral convictions. Developing a properly formed conscience, which is the voice of God, is essential in dealing with these contemporary issues and making right choices. This essay outlines the process for properly forming the conscience. It also explains why prescribing contraception is morally wrong.