Reflections — Thoughts on the Papal Allocution

July-August 2004

BY: FR. MICHAEL D. PLACE, STD

Fr. Place is president and chief executive officer, Catholic Health Association, St. Louis.

The topic of Health Progress's special section this issue is one that is very important to Catholic health care: providing effective and compassionate palliative care. The reason we are so attentive to this subject is because of our concern for preserving, protecting, and enhancing the dignity of the human person. The alleviation of pain and suffering is an expression of our commitment to eliminate, as fully as possible, obstacles to living that dignity. In some instances, the provision of palliative care also is associated with our care for the terminally ill and the dying. In this instance, our commitment to human dignity is complemented by our belief that this life is a journey to everlasting life. This larger perspective provides both nuance and motivation to our care.

In the instance of care for the terminally ill and dying, we are guided by clinical protocols as well as by a rich tradition of ethical reasoning. Obviously, because such ethical discernment offered is case and fact specific, it requires prudential reasoning in discovering what is morally required or possible. That prudential reasoning is guided by a variety of ethical principles, such as the distinction between ordinary and extraordinary care. Over the years there have been articles in Health Progress about a variety of moral issues associated with the utilization of this principle. Among the most complex and, at times, contentious has been the discussion concerning the parameters of our moral obligations with regard to the provision of artificial nutrition and hydration to dying patients, as well as to persons who are diagnosed to be in a persistent vegetative state. Though the Ethical and Religious Directives provide authoritative guidance on this topic, discussion and debate has continued about what constitutes the morally appropriate range of clinical decisions (see below). That being said, a certain consensus has developed within many parts of Catholic health care about an ethically appropriate range of care and decision making with regard to nutrition and hydration.

The Allocution's Context
It was in this context of consensus and debate that a recent allocution by the Holy Father addressing some aspects of this complex dispute has drawn much attention. As I write these reflections, the text remains the subject of study. The current guidance found in the Ethical and Religious Directives remains normative. In fact, it could be said that many aspects of the allocution are a reaffirmation of current practice. It also could be that further study of the text will reveal that the allocution is more of a theoretical clarification, the application of which will have limited clinical or pastoral significance. In the meantime, the confusion created by media attention remains quite challenging.

In studying any ecclesial document, it is critically important to understand the context in which it is written. Papal and other church documents often are prepared in response to ecclesial, political, or cultural realities. Though only the Holy Father and those who advise him know what their "front-of-mind" context was for this text, it is not difficult to surmise some of the realities that the allocution seeks to address. Allow me to outline those that come to my mind.

Clinical Advances The practice of medicine, especially in the First World, continues to advance. Because of human intervention, life often goes on when previously it would have naturally ended. There are a range of technical and clinical options that previously did not exist. In this evolving and expanding situation, there are several dangers. First, a patient could be perceived or understood merely as a clinical condition, rather than as a human person imbued with inalienable dignity. Second, advances in options could be evaluated from a technological or scientific perspective, rather than from the perspective of the well-being of the human person.

Moral Methodology A consistent concern of the Holy Father has been about affirming the reality of objective moral order. An attitude of relativism, especially in the West, is of grave concern, especially if it were to affect Catholic moral reasoning, and, in particular, if it were to affect the way we in the ministry evaluate ethical issues pertinent to those who are most vulnerable.

Culture of Life Intimately related to the above is the Holy Father's unwavering attention to promoting an authentic culture of life as an antidote to a culture that would evaluate human dignity, not from the perspective of its God-given worth, but, rather, according to a utilitarian calculus that would construe human worth on criteria associated with what one can do or achieve rather than who one is. It is this utilitarian perspective that constitutes the ethical groundwork for considering the taking the life of the unborn via abortion, or assisting in the ending of the life of the terminally ill via assisted suicide, to be morally or ethically acceptable.

Public Order In light of what has already transpired in the United States and in parts of Europe, and being quite concerned about what will become the fundamental law of the European Union — especially with regard to protecting human life from conception to natural death — the Holy Father has been quite insistent on affirming the need to preserve the common good and the well-being of society by resisting the movement to legalize the taking of innocent human life, whether it be by abortion or euthanasia. This conviction is informed, in part, by the belief that civil law is not just a human convention but is itself accountable to the objective moral order. Well aware of the violence done to the human person and the common good that he personally experienced under Nazism and Communism, he is insistent that civil law not institutionalize the absence of regard for life.

Continuing the Dialogue
While, as noted earlier, no one can be certain that these realities were explicitly the context for the recent papal allocution, I believe that they certainly are part of the context for contemporary papal thinking. It is important that they be kept in mind as we continue our study and dialogue.


Nutrtion and Hydration

"There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient."

— Directive 58, Ethical and Religious Directives for Catholic Health Care Services, U.S. Conference of Catholic Bishops, Washington, DC, 2001, p. 31.

 

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