 |
Volume 3, Issue 08 - October 2000Catholic Health Association of Canada: Health Ethics Guide
The Catholic moral tradition presents a number of theological foundations that guide ethical reflection. These include a belief in the presence of God in human experience; the conviction that all of creation is to be regarded as a gift of God's love; an awareness that we have a responsibility to work to eliminate sickness and suffering; acknowledgement that, at times, there can be growth through suffering and the recognition that the moral dimension of human existence requires that we act from an informed conscience... Since the Christian moral tradition is a living tradition, our formulations of it are necessarily the product of a grasp of reality that is constantly being refined, of historically conditioned attitudes, and of limited philosophical concepts and language. At any given time in history, a particular formulation is only more or less adequate. Continued faithfulness to this living tradition presupposes growth in understanding of moral principles and their implications. It is also important to remember that Catholic teaching maintains a hierarchy of truths values. This means that specific teachings have varying degrees of importance concerning one's faith and moral life. The tradition is not always clear or unanimous concerning all moral issues. In such cases, it is the teaching of the Catholic Church that obligations are not to be imposed unless they are certain. Thus, in moral questions debated by moral theologians in the church, Catholic tradition upholds a person's liberty to follow those opinions that seem to be consistent with the wishes of the person receiving care and with the best standards of good care. Christian Moral ValuesChristian ethical reasoning is based upon a world view contained in the gospel as interpreted by the church. This world view gives rise to values and principles that direct ethical decision-making and that enable us to respond to the call to respect dignity, promote justice and foster trust. Two fundamental values underlie the discussion of values in this guide. 1. Dignity of every human person-All persons possess an intrinsic dignity and worth that is independent of what any other person thinks or says about them1. The basis for this dignity, in the Judeo-Christian tradition, is the belief that every human being is made in the image of God. 2. The interconnectedness of every human being-Human persons are social beings and cannot live or develop their potential outside of human relationships and community2. This fundamental value affirms the interconnectedness of every human being with all persons, with all of creation, and with God. From these two fundamental values flow a number of related values. 3. Stewardship and creativity-The scriptures present a view of creation as both gift and responsibility. We share a responsibility to respect, protect and care for all of creation and for ourselves. We are to use our own free and intelligent creativity to fashion better world while respecting its true nature, appreciating its benefits and accepting its limitations. 4. Respect for human life-Human life is sacred and inviolable in all of its phases and in every situation3. Human life is a I God's love and the basis for all other human goods. Nevertheless human bodily life is not an absolute good but is subordinated to the good of the whole person. 5. The common good-Every individual has a duty to share in promoting the well-being of the community as well as a right to benefit from being a member of the community. Respect for human freedom necessitates that society seeks to enable men and women to assume responsibility for their own lives, and to encourage them to cooperate with each other in pursuit of common good - the building of a just and compassionate order in which true human growth for all persons is encouraged. By extension, the common good includes environmental concerns that have a direct relationship to the good of individuals and society. 6. Charity or solidarity-Charity is the Christian virtue urging us to respond to the needs of others. Solidarity (which includes empathy and compassion for others) is a contemporary way to express our interconnectedness to all human beings and our obligation to respond with love to their needs. This response is even more explicitly articulated in church teaching which exhorts individuals, organizations and those who develop public policy to a preferential option for the poor and marginalized. Christian Moral Principles1. Totality and integrity-All our physical and psychological functions are to be developed, used, and cared for to protect our human dignity. Therefore, no human function can ever be sacrificed except for the saving or better functioning of the whole person. Basic human capacities may not be sacrificed if more harm than good would result to that person. 2. Double effect-When an action may have both beneficial and harmful consequences, such as pain relief treatment for a terminally ill person - treatment that might shorten life - the action may be pursued if the following conditions are fulfilled: (i) the directly intended object of the act must not be intrinsically evil, i.e. contrary to one's fundamental commitment to God, neighbour or oneself; (ii) the intention of the agent must be to achieve the beneficial effects and to avoid the harmful effects as far as possible (i.e. the harmful effects should not be wanted, but only allowed); (iii) the foreseen beneficial effects are not achieved by means of the foreseen harmful effects; rather, the beneficial effects are inextricably and unavoidably linked to the harmful effects; (iv) the foreseen beneficial effects must be equal to or greater than the foreseen harmful effects. 3. Legitimate cooperation-This principle applies to situations where an action involves more than one person, and sometimes when the persons have different intentions. It is unethical to cooperate formally with an immoral act, i.e. directly to intend the evil act itself. But sometimes it may be an ethical duty to cooperate materially with an immoral act, i.e. one does not intend the evil effects, but only the good effects, when only in this way can a greater harm be prevented. Two provisions must be considered namely, (1) the cooperation is not immediate and, (2) the degree of cooperation and the danger of scandal is taken into account. to Appendix II, "The Principle of Legitimate Cooperation". 4. Subsidiarity-According to this principle, decisions should be taken as close to the grass roots as possible. As applied to health needs, the principle suggests that the first responsibility for meeting these needs resides with the free and competent individual. Individuals, however, are not self-sufficient. They can achieve health and obtain health care only with the help of the community The responsibility of fulfilling those needs that the individual cannot achieve alone must be assumed by larger or more complex groups, e.g. community organizations and different levels of government. (Refer to John Paul II, Centesimus Annus, no. 12) 5. Free and informed decision-making-The person receiving is the primary decision-maker. No service or treatment is to be provided without his or her free and informed consent. For those not capable of making an informed decision, a proxy4 shall act for the person in accordance with their personal care directives. If an advance health care directive is inapplicable or unavailable, a proxy shall act for the person in accordance with their known needs, values and wishes. In emergency situations where the person receiving care is not capable of making an informed decision and a proxy is unavailable, the care provider may act in the proxy's stead. 6. Confidentiality-Respect for the dignity of persons insists that the persons receiving care be treated with trust, honesty and confidentiality. This includes privacy of personal information and freedom from unnecessary intrusions by others. In this introductory section of the guide, we have highlighted the values and ethical principles of the Christian tradition that direct our efforts to enter into relationships that respect dignity, promote justice and foster truth. In the remainder of the guide we apply these values and ethical principles to seven key areas related to care in the fields of health and social services. 1. Pastoral Constitution of the Church in the Modern World, Vatican Council II: Constitutions Decrees, Declarations, Austin Flannery (ed.), New York, American Press 1996, nos. 27, 29. 2. Ibid., nos. 12, 25. 3. Pontificia Academia Pro Vita, Final Declaration, 5th General Assembly (February24-27) 1999, no. 1. 4. The term proxy is used in this guide to identify those people who are entitled to make a care and treatment decision for an incompetent person. This may or may not be a family member. In some provinces or territories the definition of proxy is provided in legislation. Views offered in this article are those of the author and do not necessarily reflect the position of the Provincial Health Ethics Network.
Announcements
Views offered in this article are those of the author and do not necessarily reflect the position of the Provincial Health Ethics Network.
|
|
|
Search our resources
(Books, articles, videos)
Updated February 9, 2012
In Touch
The
Catholic Health Association of Canada recently released the latest
edition of its Health Ethics Guide (September 2000). The following
is an excerpt from the introductory section of that document. For
copies of the full publication, fax the CHAC at (613) 731-7797 or
order on-line at