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Volume
3, Issue 08 - October 2000
Catholic Health Association of Canada: Health Ethics
Guide
 The
Catholic Health Association of Canada recently released the latest
edition of its Health Ethics Guide (September 2000). The following
is an excerpt from the introductory section of that document. For
copies of the full publication, fax the CHAC at (613) 731-7797 or
order on-line at www.chac.ca. Reprinted
with permission.
The Catholic moral tradition
presents a number of theological foundations that guide ethical reflection.
These include a belief in the presence of God in human experience;
the conviction that all of creation is to be regarded as a gift of
God's love; an awareness that we have a responsibility to work to
eliminate sickness and suffering; acknowledgement that, at times,
there can be growth through suffering and the recognition that the
moral dimension of human existence requires that we act from an informed
conscience...
Since the Christian moral
tradition is a living tradition, our formulations of it are necessarily
the product of a grasp of reality that is constantly being refined,
of historically conditioned attitudes, and of limited philosophical
concepts and language. At any given time in history, a particular
formulation is only more or less adequate. Continued faithfulness
to this living tradition presupposes growth in understanding of moral
principles and their implications. It is also important to remember
that Catholic teaching maintains a hierarchy of truths values. This
means that specific teachings have varying degrees of importance
concerning one's faith and moral life.
The tradition is not
always clear or unanimous concerning all moral issues. In such cases,
it is the teaching of the Catholic Church that obligations are not
to be imposed unless they are certain. Thus, in moral questions debated
by moral theologians in the church, Catholic tradition upholds a
person's liberty to follow those opinions that seem to be consistent
with the wishes of the person receiving care and with the best standards
of good care.
Christian ethical reasoning
is based upon a world view contained in the gospel as interpreted
by the church. This world view gives rise to values and principles
that direct ethical decision-making and that enable us to respond
to the call to respect dignity, promote justice and foster trust.
1. Dignity of every human
person-All persons possess an intrinsic dignity and worth that is
independent of what any other person thinks or says about them1.
The basis for this dignity, in the Judeo-Christian tradition, is
the belief that every human being is made in the image of God.
2. The interconnectedness
of every human being-Human persons are social beings and cannot live
or develop their potential outside of human relationships and community2.
This fundamental value affirms the interconnectedness of every human
being with all persons, with all of creation, and with God.
From these two fundamental
values flow a number of related values.
3. Stewardship and creativity-The
scriptures present a view of creation as both gift and responsibility.
We share a responsibility to respect, protect and care for all of
creation and for ourselves. We are to use our own free and intelligent
creativity to fashion better world while respecting its true nature,
appreciating its benefits and accepting its limitations.
4. Respect for human
life-Human life is sacred and inviolable in all of its phases and
in every situation3. Human life is a I God's love and the basis for
all other human goods. Nevertheless human bodily life is not an absolute
good but is subordinated to the good of the whole person.
5. The common good-Every
individual has a duty to share in promoting the well-being of the
community as well as a right to benefit from being a member of the
community. Respect for human freedom necessitates that society seeks
to enable men and women to assume responsibility for their own lives,
and to encourage them to cooperate with each other in pursuit of
common good - the building of a just and compassionate order in which
true human growth for all persons is encouraged. By extension, the
common good includes environmental concerns that have a direct relationship
to the good of individuals and society.
6. Charity or solidarity-Charity
is the Christian virtue urging us to respond to the needs of others.
Solidarity (which includes empathy and compassion for others) is
a contemporary way to express our interconnectedness to all human
beings and our obligation to respond with love to their needs. This
response is even more explicitly articulated in church teaching which
exhorts individuals, organizations and those who develop public policy
to a preferential option for the poor and marginalized.
1. Totality and integrity-All
our physical and psychological functions are to be developed, used,
and cared for to protect our human dignity. Therefore, no human function
can ever be sacrificed except for the saving or better functioning
of the whole person. Basic human capacities may not be sacrificed
if more harm than good would result to that person.
2. Double effect-When
an action may have both beneficial and harmful consequences, such
as pain relief treatment for a terminally ill person - treatment
that might shorten life - the action may be pursued if the following
conditions are fulfilled: (i) the directly intended object of the
act must not be intrinsically evil, i.e. contrary to one's fundamental
commitment to God, neighbour or oneself; (ii) the intention of the
agent must be to achieve the beneficial effects and to avoid the
harmful effects as far as possible (i.e. the harmful effects should
not be wanted, but only allowed); (iii) the foreseen beneficial effects
are not achieved by means of the foreseen harmful effects; rather,
the beneficial effects are inextricably and unavoidably linked to
the harmful effects; (iv) the foreseen beneficial effects must be
equal to or greater than the foreseen harmful effects.
3. Legitimate cooperation-This
principle applies to situations where an action involves more than
one person, and sometimes when the persons have different intentions.
It is unethical to cooperate formally with an immoral act, i.e. directly
to intend the evil act itself. But sometimes it may be an ethical
duty to cooperate materially with an immoral act, i.e. one does not
intend the evil effects, but only the good effects, when only in
this way can a greater harm be prevented. Two provisions must be
considered namely, (1) the cooperation is not immediate and, (2)
the degree of cooperation and the danger of scandal is taken into
account. to Appendix II, "The Principle of Legitimate Cooperation".
4. Subsidiarity-According
to this principle, decisions should be taken as close to the grass
roots as possible. As applied to health needs, the principle suggests
that the first responsibility for meeting these needs resides with
the free and competent individual. Individuals, however, are not
self-sufficient. They can achieve health and obtain health care only
with the help of the community The responsibility of fulfilling those
needs that the individual cannot achieve alone must be assumed by
larger or more complex groups, e.g. community organizations and different
levels of government. (Refer to John Paul II, Centesimus Annus, no.
12)
5. Free and informed
decision-making-The person receiving is the primary decision-maker.
No service or treatment is to be provided without his or her free
and informed consent. For those not capable of making an informed
decision, a proxy4 shall act for the person in accordance with their
personal care directives. If an advance health care directive is
inapplicable or unavailable, a proxy shall act for the person in
accordance with their known needs, values and wishes. In emergency
situations where the person receiving care is not capable of making
an informed decision and a proxy is unavailable, the care provider
may act in the proxy's stead.
6. Confidentiality-Respect
for the dignity of persons insists that the persons receiving care
be treated with trust, honesty and confidentiality. This includes
privacy of personal information and freedom from unnecessary intrusions
by others.
In this introductory
section of the guide, we have highlighted the values and ethical
principles of the Christian tradition that direct our efforts to
enter into relationships that respect dignity, promote justice and
foster truth. In the remainder of the guide we apply these values
and ethical principles to seven key areas related to care in the
fields of health and social services.
1. Pastoral Constitution
of the Church in the Modern World, Vatican Council II: Constitutions
Decrees, Declarations, Austin Flannery (ed.), New York, American
Press 1996, nos. 27, 29.
2. Ibid., nos. 12, 25.
3. Pontificia Academia
Pro Vita, Final Declaration, 5th General Assembly (February24-27)
1999, no. 1.
4. The term proxy is
used in this guide to identify those people who are entitled to make
a care and treatment decision for an incompetent person. This may
or may not be a family member. In some provinces or territories the
definition of proxy is provided in legislation.
Views offered in this article are
those of the author and do not necessarily reflect the position
of the Provincial Health Ethics Network.
Announcements
- The University of Toronto Joint Centre
for Bioethics invites application for 2 clinical fellows in Bioethics.
The fellows will spend one year performing clinical bioethics activities
(case consultation, teaching, organizational/clinical initiatives,
and clinical bioethics research) in various hospitals associated
with the University of Toronto Joint Centre for Bioethics. Through
the Centre, the fellow will have numerous opportunities for multi-disciplinary
bioethics networking, educational opportunities, and access to
a wide range of clinical bioethics expertise. The ideal candidate
will hold a graduate degree in Bioethics, or a professional degree
with significant bioethics training, and have significant experience
in clinical bioethics, including consultation and teaching experience.
Please send a CV, a letter describing your professional background
and clinical bioethics experience, three letters of reference to:
Micheline Cox, (micheline.cox@sickkids.on.ca) The Department of
Bioethics The Hospital for Sick Children 555 University Avenue
Toronto, Ontario M5G 1X8 Phone: 416-813-5000 Fax: 416-813-4967
The selection committee will begin considering applications immediately,
as they are received, and will continue to receive applications
until 2 suitable fellows are selected. Compensation will be commensurate
with qualifications and experience. Start-date will be as soon
as possible and is negotiable.
- Mark your calendars! The 2001 PHEN
Annual Conference will be held on May 25, 2001, in Red Deer. This
year's theme is Seeking Equity in a World of Difference. Stay tuned
for more details...
- Are you interested in facilitating
some discussion on ethical issues in health setting? PHEN is looking
for a volunteer to administer its listserv. The mailing list is
a vehicle for folks to engage important and interesting issues.
Things have been quiet on the list for a while and we are looking
for someone to help ignite some conversation. If you're interested,
please contact the Northern Alberta office.
Views offered in this article are those of the author and do not necessarily
reflect the position of the Provincial Health Ethics Network.
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