A Primer for Health Care Ethics: Essays for a Pluralistic Society
Sr. Jean deBlois, CSJ; Rev. Patrick Norris, OP; and Rev. Kevin D. O'Rourke, OP
Georgetown University Press, 1994, Washington, DC
272 pp., $19.95 (paperback)
This book's title belies its contents. Not intended as a compendium of medical ethics, its scope is nonetheless far beyond the primer level. The authors rightly believe that medical ethics has become the concern of everyone in our society, since decisions about genetic engineering, assisted suicide, reproductive technologies, and AIDS can determine the kind of people we shall be and the type of society we shall create. One of the book's major contributions is making complex ethical principles and cases understandable to the medical professional and layperson alike.
The three authors, each firmly grounded in the Catholic Church's ethical teachings, come to this study with years of cumulative healthcare experience. Catholic Health Association Senior Associate for Ethics Sr. Jean deBlois draws on her years of experience as a cardiac care nurse. Rev. Patrick Norris is a medical ethics instructor in Saint Louis University's Department of Internal Medicine. Rev. Kevin D. O'Rourke is director of Saint Louis University's Center for Health Care Ethics. He served for many years as director of Medico-Moral Affairs at CHA. This book evidences the authors' foundation in ethics and their shared clinical experience, as well as their commitment to compassionate care of the whole patient.
Recognizing the diversity of both healthcare staff and recipients, Sr. deBlois, Fr. Norris, and Fr. O'Rourke, while rooted in Catholic theology, address their essays to a broader, more pluralistic community. They want their material to be as user friendly and accessible as possible because they believe that "health care ethics is too important to be left [only] in the hands of scientists and health care professionals." Their goal is to stimulate critical thinking, promote discussion, foster a reasoned understanding of objective principles, and help those persons actively engaged in healthcare.
The book is divided into two distinct parts. Essays in the first part cite ethical principles and highlight possible discussion points. Essays in the second part begin with a concise and cogent synthesis of a specific case, and then include principles and discussion. Each essay closes with the authors' conclusion or recommendation. Some essays have endnotes that suggest further reading.
Part one presents principles for healthcare ethics, treating such standbys as ethical systems, informed consent, confidentiality, truth telling, and ordinary and extraordinary means. However, the authors push beyond the traditional approach to include essays that focus on the character of the healthcare professional (e.g., the values inherent in medical care, physician competency, and "playing God"). Part one likewise treats some of the American public's questions about healthcare reform, asking directly, "Is there a human right to health care?" Although I would appreciate an even clearer subdivision of part one to facilitate its use as a textbook, such a systematic organization of principles was never the authors' intent and any creative teacher can assign students to read essays according to his or her personal preference.
Part two, in the best tradition of Catholic ethical teaching, examines cases in light of specific principles. Most of the cases are familiar because they have received media attention. This section, possibly the one that physicians and nurses will turn to first, discusses myriad problems, including cardiopulmonary resuscitation and do-not-resuscitate orders, in vitro fertilization, the Cruzan case, anencephaly, and AIDS. The authors are clear that Monday-morning quarterbacking is not their intent. Rather, they provide sound principles that professionals can use when confronted by similar situations. Furthermore, their conclusions demonstrate just how well they understand and communicate Catholic ethical thought at its best. Without lengthy references to each ecclesiastic or theologian who influenced their thinking, they deftly weave solid philosophical and theological grounding into their case studies.
The book does not include explicit ethical analysis of the role managed care does and will play for physicians, providers, and patients. Although the authors' treatment of professional ethos and rationing (through a discussion of the Oregon plan) can be applied to the changing healthcare reality, even clearer direction about the tensions we face in this area would be helpful. Unfortunately, in some managed care plans, decision making is often driven by finances, rather than commitment to patients and patient care.
Institutional ethics committees in acute or long-term care facilities will find this an excellent educative tool. Chapters in part two on ethics committees, the role of an institutional ethics committee, and ethics consultants, in addition to the excellent chapters on both beginning and end-of-life decisions, make this book an invaluable resource. Since most ethics committees have limited discussion time, the length, depth, and breadth of these essays could provide discussion on topics for many months. I would also recommend A Primer for Health Care Ethics as a textbook for either a philosophy or theology course in medical ethics. This book may well be a starting point for a study of medical ethics, but it will also serve as a good foundation, teasing the reader to continue his or her own study of a topic that concerns us all.
Sr. Patricia Talone, RSM, PhD
Ethics Consultant
Mercy Health Corporation of Southern Pennsylvania
Bala Cynwyd
Copyright © 1995 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.