ETHICS MADE REAL
November 26, 2012
The new 2012 Health Ethics Guide is finally here, and Catholic health care institutions across Canada are busy rolling it out. Covenant Health has been busy with their own education to staff and physicians, including sessions with faith communities.
At recent meetings with the priests of the Edmonton Archdiocese and Ukrainian Eparchy, for example, I highlighted the first article in the Health Ethics Guide, on which the rest of the ethics principles hinge: "Since life and health are gifts of God, 'we must take reasonable care of them, taking into account the needs of others and the common good'" (Article 1).
Note we are called to take "reasonable" care of our lives. This means we are entrusted as stewards with a great gift of God which must be cared for graciously, not clung to self-interestedly without regard to the needs of others or the resources of the community.
Unreasonable demands for treatments that force clinicians to compromise their professional judgment and conscience to provide non-medically indicated, burdensome and even futile treatment is morally wrong, and inconsistent with the Health Ethics Guide.
Imagine what it must be like poking and prodding a patient (who may even be trying to push you away) merely because family are demanding care that you feel in good conscience may be a form of battery.
God does not "owe" us a long life or good health, nor can we expect health care professionals to lay aside their clinical and moral judgment and give in, extracting an extra day or week out of a person who is clearly dying by imposing unreasonable, obviously futile treatment.
Our society has difficulty accepting limitations – infirmity, impotence and certainly death. These are not the values enshrined in television ads, so it is no wonder when we bump up against our mortality we find ourselves clinging to therapies purporting miraculous outcomes.
Please do not misinterpret me. Being a good steward of our lives does not mean we throw in the towel, abuse our bodies, forego exercise and a healthy diet, or pursue medical therapies that offer us reasonable hope and realistic outcomes.
It is rather when we set unrealistic expectations, obliging care providers to compromise their professional judgment, or to disregard the common good in absorbing the emotional as well as financial costs of futile care that needs to be questioned.
PEOPLE OF FAITH
Certainly, we are a people of faith, a "resurrection" people as it were, and our faith tradition gives us hope to face death with grace without desperately clinging to life at all costs.
Or are we? The well-publicized article in a 2009 issue of the Journal of the American Medical Association reports a positive correlation between religious coping and use of intensive life-prolonging care like mechanical ventilation or resuscitation among patients with advanced cancer in the last week of life.
If we believe there is life beyond bodily existence why does the evidence suggest we tend to cling to life instead? Are we a resurrection people after all or a resuscitation people?
The article appeared not long after my father died. I remembered his desire to pursue experimental treatment that at best would only extend his life an extra year and a half. He could not tolerate the treatments and had to stop midway through the second treatment.
Granted, he wanted to give it a try which we all supported, coming to his own realization it was no longer realistic or helpful for him to pursue. Other goals besides quantity of days became important, and in the end it was quality palliative care which truly benefited my dad.
When speaking to the priests this month I offered this challenge. Help us be a resurrection people. When breaking open the word of God remind us that the ultimate goal in life is friendship with God, not bodily existence.
Remind us to make a personal directive and talk with family about our needs, wishes and values if the time comes we no longer have capacity to make medical decisions. Help us reclaim the deeper meaning of "pro-life" as different from "life at all costs."
Encourage your parishioners to advocate for quality integrated palliative care services in our country. Use your priestly and prophetic voice to rally against inappropriate attempts to prolong life, with the equal conviction we fight against assisted suicide and euthanasia lobby efforts seeking to hasten death.
Please God, help us to put "reasonability" back into Catholic health care ethics.
(Gordon Self is vice president, mission, ethics and spirituality for Covenant Health and can be reached at firstname.lastname@example.org.)
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