Book Review - Medicine, Health Care, and Ethics: Catholic Voices

March-April 2008

BY: J. MILBURN THOMPSON, Ph.D.

The Catholic University of America Press, Washington, D.C., 2007,
371 pp., $39.95 (paperback)

Editor John Morris of Medicine, Health Care, and Ethics: Catholic Voices writes that the objective of the book is to "offer a collection of new essays to represent the Catholic perspective in today's pluralistic debates on bioethics" (p. xiii). His goal is to make the book useful as a text in courses in health care ethics and as a resource for members of hospital ethics committees, especially Catholic institutions. The dozen essays in the book by Catholic scholars in philosophy (five), theology (five) and political science (two) are uniformly well-organized and clear, although sometimes abstract and challenging.

Morris is a philosopher, and a philosophical bent exists in this collection. The first part (of five) develops a general approach to the Catholic tradition, which is centered on respect for human dignity. The book then addresses four issues: human reproduction; death and dying; genetics, stem cell research and cloning; and health care reform. Morris writes the preface, an introduction to each of the five sections, and one of the three essays on genetics and stem cell research. Morris did not require the authors to explicitly refer to Catholic teachings; this is one of the roles of his introductions to the sections. Eight of the essays are original. The essays by Frs. John Kavanaugh, Kevin O'Rourke and Michael Place were previously published in Health Progress, and the essay by John Berkman in The Thomist.

Morris may not be correct when he contends in his introduction to Part I that religious voices are being marginalized from the public square today. However, I do agree the Catholic perspective can offer a balanced understanding of the human person to these discussions. Kavanaugh's essay, "Wounded Humanity and Catholic Health Care," argues forcefully for the Catholic vision of the intrinsic value of human life in opposition to the performative value of human life proposed by utilitarian philosopher Peter Singer and others. Kavanaugh also poetically expresses the belief that love expressed concretely in care can heal the wounds of humanity — the vision that motivates the Catholic health care ministry. Philosopher Gregory Beabout's essay, "What Counts as Respect?" argues for the objectivism of Catholic bioethics, which he calls "ordered autonomy," as opposed to the "radical autonomy" or relativism often found in bioethics.

In Part II, theologian William E. May argues the values of the inseparability of life giving and love-making and the dignity of the child — a gift of God who is begotten, not made — are sound bases for the church's condemnation of all forms of new reproductive technologies. He critically engages three theologians (Richard McCormick, Lisa Cahill and Jean Porter), who have disagreed with his position. Finally, he weighs in on the Catholic debate about reproductive techniques that may assist the marital act rather than substitute for it. This is certainly an essay that fulfils the stated purpose of the book.

In "Contraception: 'Did Humanae Vitae' Contradict Itself?" Dominican Benedict Ashley gamely argues in favour of the church's ban on artificial contraception while allowing the use of natural family planning, but it seems to me that he creates an anthropology to fit his conclusion. He brings theology in at the end of his essay, but more as a club that a creative or critical enterprise.

Political theorist Jeanne Hefferman Schindler's essay, "Abortion: A Catholic Analysis," presents a helpful survey of the church's teaching on abortion and makes a clear case for that teaching. She does not engage, however, with the controversy about the absoluteness of the church's prohibition of abortion.

The third part on death and dying is quite helpful, but I will begin by noting a sleight of hand that I find in Morris' introduction and in Brendan Sweetman's "Two Arguments Against Euthanasia." The church has long taught that medical treatment that does not offer a reasonable hope of benefit or that is deemed excessively burdensome is extraordinary or disproportionate and can be morally refused by the patient. Morris and Sweetman, however, forget the reasonable hope of benefit part of this moral criterion and focus only on excessive burden. The result is the reasonable, flexible, compassionate teaching of the church is rendered more rigid and restrictive.

Otherwise, Sweetman's essay against euthanasia is quite good. He presents a principled argument based on the value of human life, then several practical arguments for opposing the legalization of euthanasia and assisted suicide. However, his quality of life arguments in the final section of his essay might be more persuasive than he thinks.

One of the best essays in this collection is by theologian John Berkman on medically assisted nutrition and hydration (MANH). He argues that the withdrawal of MANH should be made on a case-by-case basis but the argument to withdraw MANH bears the burden of proof. He further points out that recent scientific research suggests that MANH may result in increased mortality and thus may be harmful and risky. This scientific evidence may shift the context in which these difficult ethical decisions are made.

The final section of Berkman's essay insightfully reflects on the issue of feeding in light of the Eucharist and the Christian call to hospitality. Berkman observes that tube feeding is often begun, not out of necessity, but for the convenience of the health care providers. The effect, however, of no longer dining or being fed is to rupture the patient's contact with community, a consequence that should trouble Christians committed to Eucharistic hospitality.

Genetics and ethics is Morris' forte, and in the fourth part of the book, he writes the introduction and an essay on "Stem Cells, Cloning, and the Human Person." The strength of these two essays made me wish he had written the section. His introduction is a fine overview of a Catholic position on genetic issues that makes important distinctions. Morris' essay on stem cell research first argues that embryonic stem cell research is scientifically unnecessary because adult stem cell research is more advanced and more promising. He is aware, however, this position has not been fully embraced by the scientific community. (Now, there have been further scientific advances that do not require embryonic stem cells.) Second, Morris builds a clear and convincing ethical case against embryonic stem cell research as destructive of human life and thus contrary to the common good. Morris ably presents the complicated science of stem cell research. In comparison, O'Rourke's "Genetics and Ethics" is somewhat pedestrian. Philosopher Catherine Green offers a fairly convoluted caution that genetic enhancement might have unintended consequences.

In the final part on health care reform, Fr. Place offers a Catholic vision that counters the fragmentation, individualism and commodification that characterizes the American health care system. A consistent ethic of life can create a culture of change that results in a committed, coordinated and just health care system. Political scientist Clarke Cochran complements Place's vision with particular policies that can incrementally move the U.S. health care system toward one that is more just and that better serves the common good and the poor. Cochran is properly concerned, however, by his recognition that the incremental change he promotes, while politically prudent, only takes the United States half way toward to the goal of universal health insurance.

Each part of the book is followed by a selected bibliography, and there is also a general bibliography. These bibliographies (and the book itself), however, exclude some important Catholic voices. Perhaps the most significant American Catholic bioethicist in the post-Vatican II period was the Jesuit Richard A. McCormick, but his work is absent from all these bibliographies. Also, David Kelly of Duquesne University has made especially important contributions to the ethics of death and dying, but his work is likewise missing. Indeed, there seems to be a certain bias here against progressive Catholic voices.

Nevertheless, with some caveats, it seems that Morris has met his objective of developing a collection of essays that bring a Catholic perspective to bioethical debates. This could be a useful text in upper-level undergraduate and graduate courses in health care ethics and a helpful resource to members of ethics committees, especially if they have some philosophical background.

J. Milburn Thompson, Ph.D.
Chairman and Professor of Theology
Bellarmine University
Louisville, Ky.

 

Copyright © 2008 by the Catholic Health Association of the United States.
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