REVIEWED BY FR. MICHAEL R. PRIEUR, STD
Health Care Ethics: A Catholic Theological Analysis, 5th ed.
By Fr. Benedict M. Ashley, OP, Ph.D.; Sr. Jean K. deBlois,CSJ, Ph.D., RN; and Fr. Kevin D. O'Rourke, OP, JCD, STM
Georgetown University Press
Washington, DC, 2006
328 pp., $34.95 (paperback)
This fully revised edition of Frs. Ashley's and O'Rourke's quarter-century-old textbook is worth using. The contents, as described by the chapter titles, are most contemporary: "Bioethics in a Multicultural Age," "Ethics and Needs of the Common Person," "Sexuality and Reproduction," "Reconstructing and Modifying the Human Person: Ethical Perspectives," "Mental Health: Ethical Perspectives," "Suffering and Death: A Theological Perspective," "Social Responsibility," and "Pastoral Care." All these "hot-button" bioethical issues are treated with a theologically balanced, sensitive, and pastoral eye.
This edition has added many new features. Frs. Ashley and O'Rourke have brought on board a valuable new resource in Sr. Jean deBlois, CSJ, PhD, RN, a very reputable bioethics author. They have added the word "Catholic" to their subtitle, thereby specifically indicating this solidly influential approach, which is based on both faith and reason — that is, biblical and ecclesial teachings and theology as well as arguments based on natural law. The authors have tried to make this text more "user-friendly" by limiting some of their previous theoretical considerations in order to engage the reader more in the clinical situations of health care ethics. More references to the views of other faith traditions are in evidence, an especially valuable addition for today's pluralistic and multicultural health care culture.
The text strongly supports the idea that each person has primary responsibility for his or her own health, a responsibility shared with each person's concomitant right to retain respectful control of him- or herself as a creature of God. This belief is coupled with a strong emphasis on everyone's obligation to assist others in their community in achieving personal health. The truly human and Christian "person-in-community" principle predominates throughout the book. The authors have neatly summarized and categorized various ethical systems, so that a novice in ethical thinking can be brought somewhat up to speed in one chapter. Their own "prudential personalism" approach is maintained, with Jesus Christ as the model for human well-being.
The authors raise some new issues, and take a fresh look at some familiar issues: the completion of the Human Genome Project and its enormous potential to control the sexual selection of infants, genetic modification of the human genotype and phenotype, cloning, development of palliative care as a medical specialty, non-heart beating persons as organ donors, embryo development and stem cell research, reconstructive and cosmetic surgery, nutrition and obesity, pharmacology and the treatment of mental illness and awareness, medical mistakes, nutrition and hydration, and the weakening of managed care as a method of controlling costs of medical care.
This edition takes cognizance of two 2004 papal allocutions of great interest for health care: first, one dealing with patients in a persistent vegetative state (Pope John Paul II eschewed this term; I would prefer using the term "merely reflexive response," suggested elsewhere by Fr. Ashley; and, second, considering palliative care for dying patients. The new edition also includes the updates of the 2001 edition of the U.S. Conference of Catholic Bishops' Ethical and Religious Directives for Catholic Health Care Services.
Health Care Ethics has a twofold purpose: "(1) to present a study that would consider the basic principles underlying the Catholic understanding of health care ethics and (2) to assist Christian, and especially Catholic, health care professionals and health care facilities in their task of offering service and witness in the Christian tradition, in a milieu influenced by diverse and conflicting value systems" (p. ix). The authors develop these purposes through a triple template: the nature of the human person seeking to fulfill his or her human needs under the influence of grace, the pertinent principles of Catholic theology, and applicable individual clinical issues in health care.
Current neuralgic issues are treated with theological and pastoral sensitivity, thereby ensuring continuing dialogue. Four such issues are treatments that are morally acceptable for ectopic pregnancies (salpingostomy and methotrexate are still seen as legitimate), pharmacological intervention in rape situations (also still defended as legitimate), presumed consent for organ donations, and the withholding/withdrawing of nutrition and hydration in situations where the person is not imminently dying. Occasionally, the authors present legitimate views that they themselves do not accept, such as the question: Who constitutes implicit formal cooperators? However, the authors have tightened up their views regarding early induction for an anencephalic infant.
These authors breathe the best of what it means to be "Catholic." They are committed to the "Gospel of Life" of Pope John Paul II, allow for legitimate dialogue when a question is not yet definitively settled by the church, and are open to conversation with other Christians and non-Christians in our search for the truth. They often espouse a "both/and" rather than an "either/or" approach, another truly "Catholic" perspective. However, the book generally has an American perspective that will require interpretation for countries with a different health care management system and current health ethic guides (e.g., Canada and Australia).
I have been using Frs. Ashley and O'Rourke ever since they began their wonderful textbooks in 1978. I especially appreciate the setup of their other student series (Ethics of Health Care — An Introductory Textbook, 3rd. ed., 2002), with its introductory overview at the beginning of each chapter and summary, questions, and case studies at the end. It's a pity this could not be included in this text as well. That being said, my students (including many in the medical field), who are quite interested in multicultural and interfaith approaches, find their book most readable, faithful to the Catholic magisterium, sensitive to their own traditions, technically appropriate, and very reasonable. The fundamental distinction of objective and subjective good (without which Karl Rahner, the great German theologian, said you cannot do ethics) runs through the book like a golden thread, concluding with a most helpful key concerning pastoral counseling. The book also handles the current controversy regarding nutrition and hydration with typically careful openness, without being either overly rigid or lax. An excellent glossary and bibliography are most resourceful.
My personal teaching motto of "mercy-in-truth" is quite evident in Health Care Ethics. It is a "must-read" for any teacher of bioethics or health care worker of the 21st century!
Fr. Michael R. Prieur, STD
Professor of Moral and Sacramental Theology
St. Peter's Seminary
Copyright © 2007 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.