Book Review - Testing the Medical Covenant: Active Euthanasia and Health Care Reform

November-December 1997


Testing the Medical Covenant: Active Euthanasia and Health Care Reform
William F. May
Eerdmans Publishing, Grand Rapids, MI
1996, 158 pp., $14

We in Catholic healthcare are acutely aware of both the practical and theoretical dilemmas posed by attempts to provide a just healthcare system within the American context of our regulated, free-market economy, our autonomy-fixated culture, and our own mission to continue the healing ministry of Jesus. This book examines the struggle to propose and develop delivery plans, whether government based or market driven, that balance competing interests and provide for all persons' dignity and well-being while staying fiscally sound and politically acceptable. Deeply immersed in the problems of access, affordability, quality, and selection, we also realize that these issues are intertwined with other social and economic controversies.

In the midst of this struggle, we are simultaneously facing the growing clamor for assisted suicide, often presented as if it were removed from the larger context of society's commitment to providing healthcare and as if it were merely a simple, private matter of individual and family wishes. In this book William F. May demonstrates the interconnections between these two issues in the light of virtue-based ethics and religious covenant.

This work is the second in a series offered by The Institute of Religion to "those in health care who want to understand and undertake their work as a calling, as a form of ministry," and "to members of believing communities who would support, encourage, and admonish one another," including those who are sick, suffering, or dying and their caregivers.

Readers with a firm understanding of the theological basis for the healthcare ministry or those who have thoughtfully compared principle-based ethics with virtue-based ethics may gain few new insights into active euthanasia. This book's primary audience is those healthcare providers with little time to reflect on the relationship between a deeper understanding of their calling and the decisions they face professionally and as citizens. With relative brevity, this text offers new images and categories for thinking about that relationship.

Author May counters the seductive assertions that assisted suicide (or its variants) is the logical and deserved right of citizens in a free and nonsectarian society, a right necessary to protect our most basic liberties and fundamental choices. He makes the explicit connection between the illusion of voluntariness in a "right-to-die" decision and the lack of accessible, affordable, comprehensive, and high-quality healthcare. "A system that denies them treatment cannot smugly claim that it merely allows them to die; it consigns them to death and hardly with mercy" (p. 99).

Arguing from a social covenant that contains the relational commitments of biblical pacts rather than the impersonal duties of a negotiated contract, May focuses on traditional philosophical and theological virtues. He explains the implications of an ethical approach that requires us truly to care for one another, even in the context of earning our livelihood by the provision of care. By avoiding the exclusive use of rights-based arguments and moving beyond them to the concepts of virtue and covenant, May gives a special warmth and richness to the discussions by asking not merely, "What must I do and not do?" but also "What kind of person must I be? What kind of society shall we be?"

In his four discussions on care for the dying, professional behavior, medical futility, and healthcare reform, the author speaks a language that resonates well with the values of faith-based, not-for-profit healthcare. For those who support the Catholic Health Association's positions on healthcare reform and appropriate care for dying patients and who want a quick resource to explain the factual, theological, and philosophical foundations, this book will fulfill their needs.

Rosemary Anton, JD
Vice President for Mission & Ethics
Catholic Health Initiatives, Central Midwest Region
Omaha, NE


Copyright © 1997 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Book Reviews-Testing the Medical Covenant

Copyright © 1997 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.