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Catholic Treatment Ethics and Secular Law: How Can They Cohere? Solidarity: The Journal of Catholic Social Thought and Secular Ethics Volume 6 Issue 1 Bioethics: Multidisciplinary Article 4 Perspectives on Euthanasia 2016 Catholic Treatment Ethics and Secular Law: How Can They Cohere? Thomas J. Balch Robert Powell Center for Medical Ethics, [email protected] Follow this and additional works at: https://researchonline.nd.edu.au/solidarity ISSN: 1839-0366 COMMONWEALTH OF AUSTRALIA Copyright Regulations 1969 WARNING This material has been copied and communicated to you by or on behalf of the University of Notre Dame Australia pursuant to part VB of the Copyright Act 1969 (the Act). The material in this communication may be subject to copyright under the Act. Any further copying or communication of this material by you may be the subject of copyright protection under the Act. Do not remove this notice. Recommended Citation Balch, Thomas J. (2016) "Catholic Treatment Ethics and Secular Law: How Can They Cohere?," Solidarity: The Journal of Catholic Social Thought and Secular Ethics: Vol. 6 : Iss. 1 , Article 4. Available at: https://researchonline.nd.edu.au/solidarity/vol6/iss1/4 This Article is brought to you by ResearchOnline@ND. It has been accepted for inclusion in Solidarity: The Journal of Catholic Social Thought and Secular Ethics by an authorized administrator of ResearchOnline@ND. For more information, please contact [email protected]. Catholic Treatment Ethics and Secular Law: How Can They Cohere? Abstract Central elements of Roman Catholic treatment ethics include: 1) that rejection of treatment with the intent of hastening death (even for a good end) is ethically equivalent to active euthanasia with the same intent; 2) a distinction between morally obligatory “ordinary” treatment and morally optional “extraordinary treatment”; 3) that the quality of the patient’s life is not be a legitimate basis for rejecting treatment; and 4) that extraordinary treatment is not forbidden, but optional, and that it is the patient or the patient’s legal surrogate–not the doctor– who has the right to choose or reject it. Despite these principles, even in a cultural climate fully sympathetic to Catholic treatment ethics, it is appropriate as a legal matter to maintain the doctrine of informed consent under which it is possible for patients or their surrogates to reject life-preserving treatment, including for unethical reasons. It is normally impossible to enforce in practice in the external forum a differentiation between rejection of treatment for ethically acceptable and ethically unacceptable reasons. By contrast, in cases of direct killing, such as assisting suicide, the intent to cause death is unmistakable (as opposed to accepting an increased risk of death as a foreseeable but unintended consequence of pursuing a good end). In a pluralistic society Catholic ethics cannot be legislatively enforced on the ground that they are compelled by Catholic teaching. However, the basic principles of Catholic treatment ethics may be justified based on logic and widely accepted norms of human equality independently of er velation or ecclesiastical authority. Particularly in protecting the right of individuals to choose and obtain life-saving medical treatment regardless of their “quality of life,” and in suicide prevention, secular law can and should be congruent with key aspects of Catholic health care ethics. This article is available in Solidarity: The Journal of Catholic Social Thought and Secular Ethics: https://researchonline.nd.edu.au/solidarity/vol6/iss1/4 Balch: Catholic Treatment Ethics and Secular Law: How Can They Cohere? 1Catholic Treatment Ethics and Secular Law: How Can They Cohere? Thomas J. Balch Introduction Among the most controversial yet common contemporary ethical issues are those concerning the provision or withholding of medical treatment, especially life-preserving health care. What does the Roman Catholic Church have to say about treatment ethics, and how can that ethics appropriately interact with secular law in non-sectarian society? I. Catholic Treatment Ethics A. Intent to Cause Death or Double Effect? The first principle of Catholic treatment ethics rejects “Euthanasia [which] in the strict sense is understood to be an action or omission which of itself and by intention causes death, with the purpose of eliminating all suffering.”1 It deserves emphasis that omission of treatment necessary to preserve life with the intent to cause death is treated as forbidden euthanasia just as much as is direct killing.2 An unethical act or omission may not validly be used as a means to a good end.3 Thus, for example, being with God in heaven might certainly be regarded as good by Christians, and for sinful mortals only through and after death can that end come about. However, it is not ethical to kill oneself or another in the hope and with the intent of hastening entrance into heaven. Therefore, rejecting life-preserving treatment for Grandma with the motivation of ‘letting her go to God’ would flatly contradict this principle. There is, however, a critically important distinction between doing or omitting something in order to accomplish an unethical objective, and doing or omitting something in order to accomplish a good objective, while regretfully recognizing and accepting that the act or omission increases the risk of an undesirable consequence. There are courses of action or deliberate omission in which, in the words of the Sacred Congregation for the Doctrine of the Faith’s Declaration on Euthanasia, ‘death is in no way intended or sought, even if the risk of it is reasonably taken’.4 Sometimes known as the principle of double effect, this recognition is really a matter of common sense. Driving an automobile is risky. There were 1207 road deaths in Australia in 2015.5 Anyone who takes to the road in a car risks a fatal accident. Yet driving to the store to get groceries, knowing that involves a certain risk of death, is not ethically equivalent to 1 Pope John Paul II, Encyclical Evangelium Vitae. English translation: The Gospel of Life (25 March 1995) §64 (emphasis in original) (Hereafter, EV). 2 Cf. Sacred Congregation for the Doctrine of the Faith, Declaratio de Euthanasia. English translation: Declaration on Euthanasia (5 May 1980) II http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_c\\hich\\af0\\dbch\\af40\\loch\\f0 on_cfaith_doc_19800505_euthanasia_en.html: ‘By euthanasia is understood an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated.’ 3 Catechism of the Catholic Church, §§1756, 1789. 4 Ibid. III. 5 Australian Government Department of Infrastructure and Regional Development, Bureau of Infrastructure, Transport and Regional Economics, Road Deaths Australia–Monthly Bulletins https://bitre.gov.au/publications/ongoing/road_deaths_australia_monthly_bulletins.aspx. Published by ResearchOnline@ND, 2016 1 Solidarity: The Journal of Catholic Social Thought and Secular Ethics, Vol. 6 [2016], Iss. 1, Art. 4 driving one’s automobile off a steep cliff in order to commit suicide. Indeed, it is hard to imagine any human activity that does not incur some foreseeable risk of death. Even remaining in bed cannot escape the risk of death from fire or earthquake—and if one never rose from it, one would certainly increase the risk of death from starvation and dehydration. Virtually all treatments for a life-threatening illness or injury have side effects and risks, some of which may themselves threaten death. For instance, a surgery that is likely to increase the chance of preserving life in the long term may also be susceptible to complications that could end it in the short term, such as a blood clot or hemorrhage while on the operating table. Treatments for conditions that harm health but are not themselves life- threatening may carry risks of causing or hastening death. Depending on the concrete circumstances, either choosing or foregoing such treatments might be done for reasons that do not amount to intending death, even when a heightened risk of death from the decision is reasonably foreseeable.6 As a committee of bishops from the United States has put it: [W]e are called by our moral tradition to ask ourselves: ... [W]hat am I trying to achieve by doing it? We must be sure that it is not our intent to cause the patient’s death—either for its own sake or as a means to achieving some other goal such as the relief of suffering.7 To phrase it another way, is the action or omission being chosen because of or in spite of the increased risk of death? Whatever the probability that death may result, is the decision- maker sincerely hoping that death will – or will not – be the consequence. B. Is Treatment Mandatory or Optional? A second principle of Catholic treatment ethics is the widely familiar distinction between ‘ordinary’ medical treatment that is ethically mandatory and ‘extraordinary’ medical treatment that is ethically optional. There are two prongs involved in assessing whether particular treatment is ordinary or extraordinary: treatments may ethically be foregone either if ‘they are by now disproportionate to any expected results or because they impose an excessive burden on the patient and his family.’8 It is helpful to characterize these two aspects as separately evaluating 1) what treatment is proportionate and 2) what duty of care for oneself or others is reasonable to expect rather than supererogatory. Far from being idiosyncratic sectarian positions unique to health care decisions, these reflect common sense norms regularly relevant outside the field of health care. 1. Judging Proportionality Regarding the first prong, in the encyclical Evangelium Vitae, § 64, Pope John Paul II wrote: 6 Cf. Marzen, O’Dowd, Crone, & Balch, ‘“Suicide: A Constitutional Right?”– Reflections Eleven Years Later’, Duquesne Law Review, 35, 1996, 268-70. 7 National Conference of Catholic Bishops’ Pro-Life Committee [United States of America], ‘Nutrition and Hydration: Moral and Pastoral Reflections’, Origins, 21:44, 9 April 1992, 705.
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