REVIEWED BY SR. ANGELITA MYERSCOUGH, ASC
Making Moral Choices: An Introduction
Rev. Mark Miller, CSsR
Twenty-Third Publications, Mystic, CT
87 pp., $9.95 (paperback)
As healthcare becomes ever more complex in both its organization and its delivery of direct patient care, so too do the attendant moral and ethical issues. To deal with this growing complexity, healthcare institutions everywhere have established ethics committees, while professional caregivers attend seminars and courses to increase their knowledge of ethical decision making. Yet it is the average citizen, ultimately, who actually makes healthcare decisions.
Rev. Mark Miller, CSsR, has written Making Moral Choices to help average people, especially young adults, make sound moral decisions. Yet the book can also be used by professionals and others who work in a healthcare setting. Through the six chapters of this short book, Fr. Miller provides theory in clear, simple language and then illustrates his point with examples from everyday life, especially from healthcare.
The first chapter introduces ethics and morality, including a discussion of ends and means and the factors and process involved in human choice. Natural law and human freedom are covered in the second chapter, along with civil and Church laws and regulations. The third chapter defines conscience and relates it to personal choice. Most of this chapter describes the formation of conscience through the acquisition of appropriate knowledge and development of character. Chapter 3 also includes a section on human feelings and their impact on conscience.
In chapter 4, Fr. Miller discusses six parallel patterns that people use in moral reasoning (moral arguments, case studies, stories, analysis of motives, example, and the voice of authority), noting that each can be useful but none is absolute.
Particularly valuable is chapter 5, on the social context in which individual choices are made. Here Fr. Miller reflects on the deep, often subliminal, influence of the dominant culture of our society. The sections on social justice and social sin are especially thought provoking, but topics often neglected in medical ethics discussions.
The final chapter considers the faith dimension of moral decision making. Fr. Miller emphasizes that efforts to exclude religion and faith from the public debate on morality are themselves based on a kind of faith, even if that "faith" is atheism.
Although it is intended for the general reader, this book could be useful for members of healthcare ethics committees who need to step away from exclusive concern about particular ethical issues. Fr. Miller's book offers a means for committee members to reflect on their own moral decision-making approach and that of the patients and families whom they serve. The questions for reflection and some of the exercises that follow each chapter will stimulate dialogue in ethics committee (despite occasional references to "your school").
The book could also be a useful tool in values education among healthcare facility staff, including nonprofessionals, who are often aware of decisions being made, but puzzled as to their rightness or wrongness. Pastoral caregivers will want to have extra copies of this book on hand for patients, residents, or family members who want to reflect more deeply on the choices facing them.
The author's ecumenical outlook makes the book appropriate for persons of any faith. The briefly annotated reading lists that follow each chapter offer guidance for further education in moral decision making.
One unfortunate aspect is the way Fr. Miller formulates the principle on withholding or withdrawing medical treatment. His use of the phrase "when a person is dying" could easily cause confusion in this otherwise clear discussion of a key ethical issue.
On the whole, however, Making Moral Choices is a straightforward, simply expressed, beautifully designed, and well-organized book. It is inexpensive and adaptable to a wide audience--both healthcare professionals and the general public.
Sr. Angelita Myerscough, ASC
Copyright © 1997 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.