Life on the Line: Ethics, Aging, Ending Patients' Lives, and Allocating Vital Resources
John F. Kilner
William B. Eerdmans, Grand Rapids, MI
1992, 350 pp., $18.95 (paperback)
Two of the most pressing ethical issues in healthcare deal with the use of life-sustaining measures and the allocation of vital and limited resources. These issues intersect in the lives of patients, their families, and our society as a whole. Rarely has an author attempted to deal with these converging issues in a single work. John F. Kilner has now presented us with such a book.
A fascinating dimension to this work is the Christian perspective out of which Kilner operates. He proposes that Christian ethics has a great deal to offer in the search for a resolution to what is rapidly becoming an ethical quagmire.
When Kilner speaks of the contribution that Scripture and theology can make, he avoids an all-too-common pitfall: a fundamentalist leaning which suggests that the Bible can give simple and direct answers to issues not present when it was written, such as the use of ventilators. But this is not to say that the Bible is not a rich source of guidance, and Kilner deftly helps us find it.
Throughout the book, Kilner describes Christian ethics as God centered, reality bound, and love impelled. God centered means we are to act as God acts, hold to the values of God, and be who God would have us be. The Scriptures are communications from God and can therefore help us discern God's will, which is not an easy task. God has created persons and the world in a certain way, with certain realities, both physical and moral. As St. Paul would express it, who we are in Christ determines how we should live and act. Love of God and neighbor is what should direct our choices.
After a lengthy description of this basic ethical theory, Kilner turns to the first main issue, euthanasia. He does an excellent job of discussing death–which is both enemy and destiny, both cross and resurrection–and suffering, which is certainly not good in itself, but, when accepted as Christ accepted it, can be redemptive for oneself and for others. Euthanasia and suicide are therefore unacceptable because they align us with death instead of with God, who works for good and life in the midst of suffering and death. Recognizing that at some point certain medical interventions are inappropriate is not playing God, but resisting the temptation to claim God's ultimate responsibility over life and death.
Healthcare funding may well remain limited in large part because of misplaced priorities. In his careful analysis of this complex issue, Kilner draws some interesting conclusions, notably:
- Expensive technologies often do not offer as much health benefit for the dollar as many forms of less expensive maintenance and preventive healthcare.
- In setting priorities, we must not slight certain groups of people by allowing them to bear a disproportionately high share of the burden.
- Wise use of resources, such as for palliative care, may help lessen the clarion call to legalized euthanasia and assisted suicide sought by many who fear the pain and alienation associated with the dying process.
Although Life on the Line may at times become ponderous in its detail, it remains an excellent work and tremendous resource for healthcare professionals or anyone else interested in the contribution of a distinctively Christian ethics. The guidance that Kilner offers will be a help to individuals and to the development of a truly just and compassionate public policy.
Rev. Larry Dunklee
Roncalli Newman Parish
La Crosse, WI
Copyright © 1993 by the Catholic Health Association of the United States.
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