REVIEWED BY FR. JOHN TUOHEY, PhD
Allocating Scarce Medical Resources: Roman Catholic Perspectives
H. Tristram Engelhardt, Jr., and Mark J. Cherry, eds.
Georgetown University Press, Washington, D.C., 2002, 352 pp., $39.95
The names of this book's editors, and the fact that the book itself is
the latest installment of the well-received "Clinical Medical Ethics Series,"
led me to approach Allocating Scarce Medical Resources: Roman Catholic Perspectives
with high expectations, even as I thought twice about reading yet another
collection of essays about allocating scarce resources. My expectations were
not disappointed, however, and my concern was unfounded.
The authors of the book's 17 essays are "a group of academics from
around the [North American, Western European] world including theologians, philosophers,
physicians and a lawyer" (p. 35; reviewer's brackets). Allocating
Scarce Medical Resources is the product of four meetings over the course
of three years, during which the authors read and discussed each other's
papers. As a result, the book is not the edited collections of discreet essays
I feared, but rather "an interlocking set of essays on determining appropriate
critical care" (p. 35), "a heuristic example of the desire to make
an optimal level of care available for all who require it" (p. 19).
Allocating Scarce Medical Resources opens with two excellent opening
essays by the editors. These are followed by six subsequent parts, all of equally
high quality. Parts 3, 4, and 5 offer the thorough discussion of Catholic thought
suggested by the subtitle. Parts 2 and 4 offer contrasting and comparative essays
from Jewish, Orthodox, and Protestant perspectives (although it is not clear
to me why these were not integrated into parts 3 and 7). The book closes with
part 7, which offers a critical commentary.
What I found most valuable in this book, besides its "interlocking essays,"
was the reason this group came together. Its members did not assemble simply
to offer Roman Catholic perspectives on the topic, as the subtitle suggests.
They came together to explore "to what extent, if any, may or indeed should
a Roman Catholic bioethics be substantively different from secular bioethics"
(p. 12). Underlying the discussions is the more fundamental question of the
uniqueness of the Roman Catholic ethic as a theological position, a position
from which one seeks to address ethical issues through the universally normative
grounding of human reason.
Unless one appreciates the importance of this more fundamental discussion,
one may find part 2, which the authors call "A Moral Consensus Statement,"
disappointing. The statement is a remarkable theological achievement. It is
not, as one might expect, a strategy for allocation, but rather an articulation
of principles that are uniquely "catholic," rooted in the natural
law, in biblical imperatives, and in an anthropology that is appreciative of
the role of government. There are, these writers assert, particularly Catholic
convictions, with practical implications "to which Catholic hospitals ought
to give priority and for which secular health care facilities should make room."
These include such ethical norms as:
- The biblical commandment against killing
- Jesus' injunction to love one's neighbor as oneself
- The values of solidarity and subsidiarity (which imply that the first two
ethical norms are duties of communities, not just individuals; and that political
authority should encourage small groups and individuals in the larger community
to fulfill these duties)
- A natural right to health care, as is implied by solidarity and subsidiarity
- The need for a practical wisdom "shaped by the commitments a Christian
makes in response to the particular call of God for his or her life, made
in prayerful discernment of God's will . . . to deal well with issues
caused by the need to limit critical care" (p. 37)
The value of these principles (and their importance to the Roman Catholic worldview)
is perhaps lost on many of us in today's health care, who so often recite
them without appreciating their uniqueness and breadth. Readers of Allocating
Scarce Medical Resources will appreciate the principles, especially if they
wait to read the "Moral Consensus Statement" after first reviewing
the foundational theological viewpoints offered by such able contributors as
Joseph Boyle; Paul T. Schotsmans; M. Cathleen Kaveny; Kevin W. Wildes, SJ; Paulina
Taboada; Corinna Delkeskamp-Hayes; Mary Ann Gardell Cutter; Michael A. Rie;
Bishop Edward Hughes; and Dietrich Rossler.
Every chapter in Allocating Scarce Medical Resources will be a "must
read" — not only for those interested in what Catholic moral thought
has to say about the allocation of health care resources, but also for those
concerned about what makes Catholic health care "Roman Catholic" and
those who seek greater insight into and appreciation for the contribution of
Catholic moral thought to public policy.
Fr. John Tuohey, PhD
Endowed Chair, Applied Health Care Ethics
Providence St. Vincent Medical Center
Portland, OR
Copyright © 2004 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.