Book Review — Allocating Scarce Medical Resources: Roman Catholic Perspectives

September-October 2004

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
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