MEDICAL ETHICS: THE CATHOLIC PERSPECTIVE
Today, more than ever, the challenges of the health care worker seem to be attracting the notice of everyone and society as a whole. The health care worker has always been a focal point in society; but today the demands on them as well as the development of modern technology have put them seriously in the lime-light. The proverbial admiration that was part and parcel of the health care worker seems to be vanishing; indeed, it seems to be running into serious criticisms and general hatred. What could be the genuine reason for this unfortunate situation? Of course, there are still a number of health care workers who still win the admiration of people, including patients, their relatives, and the general public. But fact remains that the institution, health care, is having very serious challenges in society. I am sure all of us are aware of this situation. You may be the admired one! But what about the rest? What do we do about the situation?
In this discussion we would look first at LIFE and its qualities and see where our call lies in this regard. Fact is, it is the deterioration of life, an attack on life, or a mishap to a person’s good life that calls the attention, the help, the support or some activity of the health care worker.
The Dignity of Life
Life is a gift from God for every individual: a gift that we must all love and preserve. As a gift we have the duty to account for it both in this life and in the life to come – in our eternal home. It is therefore an obligation on the part of all men and women of goodwill to recognize the dignity and the sanctity of human life; to defend it against all attacks launched against it today in our modern world; and to love it as a precious gift from God who is the only source of all lives. It is because of the sanctity and dignity of this life that our Lord was ready to pour out His own life on the Cross so that everyone would have his/her life and have it to the full (cf. Jn. 10:10 ).
In his Encyclical Evangelium Vitae, Pope John Paul II reminds us that in the biblical narrative, the difference between man and other creation is shown above all by the fact that only the creation of man is presented as the result of a special decision on the part of God, and a deliberation to establish a particular and specific bond with the Creator.”Let us make man in our own image after our likeness” (Gn. 1:26). The life which God offers to man is a gift by which God shares something of himself with his creature (EV.34).
Therefore the respect, protection, and care rightly due to human life derive from its singular dignity. “In the whole of visible creation it (human life) has a unique value.” The human being, in fact, is the only creature that God has wanted for its own sake” (John Paul II). Human beings alone, created in the image and likeness of God, are not and cannot be for any other or others but for God alone, and this is why they exist. Human beings alone are persons; they have the dignity of a subject and possess value as an end in themselves (G.S. , 24).
The fact that life belongs to God, and not to the human being, gives it that sacred character which produces an attitude of profound respect. The divine lordship over life is the foundation and guarantee of the right to life, which is not, however, a power over life. Rather, it is the right to live with human dignity, and also to be given guarantees and protection in this fundamental, original, and insuppressible good which is the root and condition of every other good/right of the person. The subject of this right is the human being in every phase of development, from conception to natural death, and in every condition, whether health or sickness, perfection or handicap, wealth or pervert.
Human life must, therefore, be respected and protected absolutely from the moment of conception. From the first moment of his existence, a human being must be recognized as having the rights of a person – among which is the inviolable right of every innocent being to life (cf. CCC 2270, at. 489).
The primary principle that God alone is the Lord of life and death has its foundation in the Christian principle of sanctity of human life. Therefore it should be understood that a person’s life is entirely an ordination, a loan, and a stewardship. His essence is his existence before God and to God, and it is from Him. In this formulation, then, a person must respect his/her own life and the lives of others as well.
Profession and Vocation of the Health Care Worker
Unfortunately, however, our lives cannot remain the same from the beginning to the end of our earthly life. Sicknesses, misfortunes, accidents, cross our lives and disturb our God-given sanity. Our disturbed lives, then, must be remodeled by experts who have the gift to do so. These we call Health Care Workers. But because of their relevant training, they are also professionals in their own right. However, the Church also believes that the activity of the health care worker is “a form of Christian witness.” This is because the activity of those engaged in health care is a very valuable service to life. It expresses a profoundly human and Christian commitment, undertaken and carried out not only as technical activity, but also as one of dedication to and love for one’s neighbour. It is a “form of Christian witness” (John Paul II). In which case, “their profession calls for them to be guardians and servants of human life.” (EV, 89). Again, as pointed out already, life is a primary and fundamental good of the human person. Caring for life, then, expresses, first and foremost, a truly human activity in defense of physical life. It is to this that professional or voluntary health care workers devote their activity. These are doctors, nurses, hospital chaplains, men and women religious, administrators, voluntary care givers for those who suffer, those involved in diagnosis, treatment, and the recovery of human health. The principal and symbolic expression of “taking care” is their vigilant and caring presence at the sickbed. It is here that medical and nursing activity expresses its lofty human and Christian value (cf. Charter for Health Care Workers, 1995, p. 9).
Undoubtedly, health care activity is based on an interpersonal relationship of a special kind. It is “a meeting between trust and conscience.” The “trust” of those who are ill and suffering and hence in need, who entrust themselves to the “conscience” of another who can help them in their need and who comes to their assistance to care for them and cure them (ibid, pp. 9-10). Pope John Paul II, in addressing participants at a Surgery Congress put it this way: “In exercising your profession, you are always dealing with the human person, who entrusts his body to you, confidence of your competence as well as your solicitude and concern. It is the mysterious and wonderful reality of the life of a human being, with his suffering and his hope, that you are dealing with” (Feb. 19, 1987; cf. nt. 4, p. 10). And thus, the Church can say that: “Life and physical health are precious gifts from God. We should take reasonable care of them, taking into account the needs of others and the common good” (CCC 2288). In other words, for the health care worker “the sick person is never merely a clinical case” “an anonymous individual on whom to apply the fruit of their knowledge” “but always a ‘sick person,’ towards whom” they show a sincere attitude of sympathy,” in the etymological sense of the term (cf. Charter, p.10). John Paul II would put it even more forcefully: “None of you can be merely a doctor of an organ or an apparatus, but you must look to the whole person” (To the world Congress of Catholic Doctors, Oct. 3, 1982). And this is why you should not consider yourselves merely as men and women of a great Profession, but also of a wonderful Vocation.
The Health Care Worker and Health Needs
A person’s health needs begin when something goes wrong with one’s God-given human life with all its dignity, soundness and sanity. Thus, the person is declared sick, or unhealthy. This is where a sick person needs health care in one form or the other. And this is where the health care worker also begins to extend his/her care to the sick. This is nothing new. If anything, the health care workers all over the world have added a lot of professional touch to their call and so are more ready to render more effective service to their clients than before.
Sickness and suffering affect the whole person adversely; they “are not experiences which affect only the physical substance of human beings, but they affect them in their entirety and in their somatic-spiritual unity”(John Paul II, Dolentium Hominum, Feb. 11, 1985, in Insegnamenti VIII/1 pp. 473-4). “Illness and suffering have always been among the more serious problems which put human life to the test. In illness the human person experiences his weakness, his limits and his finite nature. All illness can give us an insight into death” (CCC 1500). Sickness is more than a clinical fact, medically controlled. It is always the condition of a human being, the sick person. It is with this holistic human view of sickness that health care workers should relate to the patient. This means that they should have, together with the requisite technical-professional competence, an awareness of values and meanings that make sense of sickness and of their own work, and render every individual clinical case a human encounter (cf. Charter p. 53).
Unfortunately, however, there seems to be a general discomfort from the general public with regards to the attitude of our health care workers towards their clients. All of us need to be concerned because we all know how it feels to be sick. We all want to be treated with love and fairness whenever we are sick. Yet, our patients don’t seem to always experience this from us.
- i. The Aged and the Terminally ill: Who need our love and care most, don’t always get the love and comfort they need and deserve. They are neglected and shouted at.
- ii. Critically ill/Accident Victims…. Nurses are used to blood, deaths, etc. and so don’t care less.
iii The Illiterate: Impatience for those who cannot understand one language or the other; or who want explanation for one problem or the other. Take, for instance, a patient asks for a drug which the doctor has not prescribed. The health care worker is paying no attention to the patients’ needs; is not caring enough; or very anxious to explain their policy to patients rather than understanding their problems.
iv. Some doctors (and some nurses too) do not keep to time, and when they come, they don’t even acknowledge the patients, some of whom might have been struggling with pain for hours already. There is no interest shown, no greetings, no interaction with patients; some appear already tired before coming to work. Some come like that and soon start a selective treatment without any explanation. Some leave soon after to their unofficial duties (Locum (?)).
- i. Illegal monies received from patients before attending to them. Sometimes, unfortunately, they are not even attended to after such monies have been collected. Sometimes, it is outright bribery?
- ii. Nurses colluding with people from different departments (a/c, theatre, etc) to dupe and cheat poor patients.
Indifference to Death
- i. One disturbing thing is the general feeling that many health care workers are indifferent to people’s death. This dimension concerns our inability to understand some doctors’ decision in critical matters. The lay man sees his/her relative in a dangerous situation. The doctor is called. He/she downplays the situation and so refuses to administer medicine or declines an appeal for admission. The person dies. Whose fault/negligence?
- Cf. a. The sad death of Mr. Mensah Aggrey who was refused admission and refused a request from the family for action (oxygen).
b. A young nurse (in my own parish) recently who went to the hospital on two occasions to complain about a strange feeling and was sent home with a few tablets and then refused to go back home. When a check was finally conducted on her it was discovered that the baby had died in her womb. She was rushed to the theatre. It was too late. She died!!!
Some Issues in Bioethics
Although there are many major issues in Bioethics that should concern the Health Care Worker, I would like us to look at one very important area that is of great concern in today’s world: Abortion. Today, many heath care centres, including some Catholic health centres, have become abortion centres, openly or otherwise. Abortion, a “direct violation of the fundamental right to life of the human being” and considered “an abominable crime,” has become a widespread phenomenon in many of our health care centres today. Sometimes it is even financed by tax payers’ money and facilitated by permissive legislation claiming to support civil liberties. All of this fatally leads many people to avoid taking responsibility for the expected child and so to trivialize a serious sin. “Unfortunately, this disturbing state of affairs, far from decreasing, is expanding. At the same time anew cultural climate is developing and taking hold which gives crimes against life a new and – if possible—even more sinister character, giving rise to further grave concern: broad sectors of public opinion justifies certain crimes against life in the name of the rights of individual freedom, and on this basis they claim not only exemption from punishment, but even authorization by the state, so that these things can be done with total freedom and indeed with the free assistance of health care systems” (EV, 4).
The Church, like every person who holds life dear, cannot become accustomed to this mentality, and she raises her voice in defense of life, especially that of the defenseless and unknown, which embryonic and fetal life is. She therefore calls health care workers to professional loyalty, which does not tolerate any action which suppresses life, despite “the risk of incomprehension, misunderstanding, and serious discrimination” which this consistency might cause. It is worthy to note that faithfulness to medicine and health care delegitimizes every intervention, whether surgical or pharmaceutical, intended to interrupt pregnancy at any stage (cf. Charter, pp. 111-112).
One thing we must also note is that if health care workers are faced with legislation favourable to abortion, they “must refuse politely but firmly.” For “one can never obey a law that is intrinsically immoral, and this is so in the case of a law which admits, in principle, the licitness of abortion” (cf. Charter, p. 114). As a result, doctors and nurses are obliged to be conscientious objectors. The great, fundamental value of life makes this obligation a grave moral duty for medical personnel encouraged by the law to carry out abortions or to cooperate proximately in direct abortion.
Some health care personnel for one reason or the other indulge in Euthanasia, the so-called mercy-killing. This is the situation when it seems to people logical or even “human” to end one’s own life or that of another “peacefully,” when all that is left to it is suffering and serious impairment Some of the reasons for this reasoning are:
(i) a mentality less and less inclined to recognize life as a value in itself, related to God alone, regardless of how it came into being;
(ii) a concept of the quality of life in terms of efficiency and psychophysical satisfaction, incapable of seeing any meaning in suffering and handicap, which are thus to be avoided at any cost and by every means;
(iii) a vision of death as an absurd end to a life still to be enjoyed, or as a liberation from an existence already considered meaningless.
All of this – within a culture which, leaving God aside, makes men responsible to themselves alone and to freely established laws of society – is the soil of the euthanasia culture (cf. Charter, p. 116). Yet, euthanasia is a homicidal act, which no end can justify. By euthanasia is meant an action or omission which by its nature or in someone’s intention causes death, in order that all suffering may be eliminated. Euthanasia’s terms of reference, therefore, are to be found in the intention of the will and in the methods used (ibid.).
The pity aroused by the pain and suffering of terminally ill persons, abnormal babies, the mentally ill, the elderly, and those suffering from incurable diseases does not authorize any form of direct euthanasia, active or passive. This is not a question of helping a sick person, but rather the intentional killing of a person.
Therefore, medical and paramedical personnel “faithful to the task of always being at the service of life and assisting it to the end,” cannot cooperate in any euthanistic practice even at the request of relatives. In fact, individuals do not have the right to euthanasia, because they do not have a right to dispose arbitrarily of their own life. Hence no health care worker can be the executive guardian of a nonexistent right. Thus, there is a radical difference “death dealing” and “consent to dying.” The former is an act suppressing life; the latter means accepting life until death.
It is important to note that “the pleas of gravely ill persons who sometimes ask for death are not to be understood as implying a true desire for euthanasia; in fact, it is almost always a case of an anguished plea for help and love. What a sick person needs, besides medical care, is love, the human and supernatural warmth with which the sick can and ought to be surrounded by those close to them, parents and children, doctors and nurses” (Declaration on Euthanasia, May 5, 1980, in AAS 72 (1980) p. 546.)
The sick person who feels surrounded by a loving human and Christian presence does not give way to depression and anguish, as would be the case if one were left to suffer and die alone and wanting to be done with life. This is why euthanasia is a defeat for the one who proposes it, decides it, and carries it out. Far from being an act of mercy to the patient, euthanasia is a gesture of individual and social self-pity and an escape from an unbearable situation
Some Proposed Solutions to the Problem
Let us look at a few possible Solutions to the Problem
1. Taking our Christian religious training seriously;
2. Holding firm to our moral values;
3. Regarding our training not simply as a profession but also as a vocation;
4. Promotion of strict moral values and practices in our health care institutions;
5. Promoting vigilance and caring presence in our health care personnel;
6. Promoting interpersonal relationship of trust and conscience in our workers;
7. Promoting a positive attitude of sympathy to and a holistic view of the patient;
8. Integrating meeting between profession, vocation and mission;
9. Sharing in the Church’s pastoral activities;
10. Developing and holding to ethical responsibilities;
11. Upholding of the value and dignity of the human person;
12. Organizing refresher courses/updates for health care personnel in our institutions.
In conclusion, I would like to reiterate the importance of the sanity, the sanctity and the dignity of every human being from birth to natural death. Indeed, human life, inescapably bodily in nature, is precious, in itself and to God, at every moment of its existence, even and especially when it is weak, when it suffers, when it draws near to death (cf. Bioethics, nos. 47-48). God’s command “You shall not kill” (Ex. 20:13; Dt. 5:17) is a specific command intended to protect the dignity and sanctity of human life; indeed, the whole of God’s law, his wise and loving plan for human existence, fully protects human life. [p. 25]
Very Rev. Fr. Ted Nelson-Adjakpey
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