Catholic Health Care Facilities Research Articles

Catholic Teaching: A Middle Ground and Guide for End-of-Life Care and Decision-Making and an Antidote for Dying Badly in America.

Dying in the United States is characterized as: medicalized, depersonalized, high technology, fragmented with frequent transitions among care settings, burdensome to patients and families, driven by efficiency and effectiveness, and lacking in key areas, for example, access to palliative care and adequate pain and symptom treatment. Patients and families are often left with a choice of two extremes: vitalism or utilitarian pessimism (utilitarianism). The Catholic Church, however, rejects both of these extremes, and Catholic social teaching (CST) at end of life focuses on ordinary-extraordinary treatments/means, a culture of life and human dignity, accompaniment and community, and caring for whole persons through the end of life. The Catholic tradition of ordinary-extraordinary means is helpful to guide complex end-of-life decisions, regardless of one's religious beliefs, and offers a middle ground between vitalism and utilitarianism that can inform end-of-life care and decision-making for all patients in Catholic health care. While it does not provide answers, it offers guidance and enables conversations that are crucial for the dying and their families to make autonomous, informed decisions about end-of-life care. It provides an opportunity for the dying to let the care team, loved ones, and decision-makers know what a life with meaning, purpose, and passion is for them-and how they want to live and die. This article will summarize the problem, describe end-of-life Catholic teaching, and discuss how it offers a middle-ground. Arguments for and against vitalism and utilitarianism will be explored, including a discussion of CST's response to those receiving care in Catholic health care facilities who are outside the Catholic tradition and do not believe in the teaching. The last section describes a model of collaborative partnership where local parishes and Catholic health care come together to tackle the challenges of caring for and ministering to the seriously ill and those facing death.

Subsidiarity and Participation in an Age of Catholic Mega-Systems.

While the number of Catholic healthcare facilities has held stable over the last several decades, Catholic healthcare has followed the trend of merging facilities and systems into "mega-systems." These consolidations can be beneficial for creating continuums of care, lowering operating costs, ensuring long-term viability, and sharing physical, digital, and human resources. However, with larger systems comes a practical need to be integrated to some degree, and the pressure to standardize policies and practices across regions is present. To address this need and pressure, the Catholic Social Teaching principles of subsidiarity and participation should guide system and local administrators. Subsidiarity and participation encourage all decision making to happen at the most local levels and to include as many of the people those decisions affect as possible. I will review both the pragmatic benefits of keeping decisions as local and rooted as possible as well as the moral benefits of allowing as many administrators and health care professionals to exercise and form their virtues as moral agents. In a time when changes to medical care have created many procedural responsibilities and cut into time spent in moral witness, institutions, even mega-systems, should remain attentive to the ways in which the moral agents of their system are formed and exercised.

How Many Heart Valves Should One Person Receive?

This article argues that Catholic health care facilities should resist the emerging consensus in clinical ethics, which contends that patients suffering from intravenous drug use induced endocarditis should be denied multiple heart valve replacements. The article demonstrates that the Ethical and Religious Directives for Catholic Health Care Services, as well as core concepts in the Christian moral tradition, such as human dignity, the preferential option for the poor, and the common good, reject this emerging consensus. Patients suffering from endocarditis who inject drugs should, in principle, be eligible for second, third, and even fourth valve replacements. While hospitals may protect and promote the common good by limiting access to multiple heart valve surgeries for this patient population, these limitations should emerge from evidence that such surgeries harm the common good of access to primary health care for all members of a community.

Pope Francis and Perinatal Palliative Care: Advancing the Culture of Mercy.

For the last 25 years, the Popes of the Roman Catholic Church have been vocal proponents of palliative care in an effort to promote human dignity, decrease human suffering, and discourage euthanasia and suicide. They have supported efforts to expand the scope and provision of palliative care. Recently, Pope Francis has focused on the need to provide perinatal palliative care. He has emphasized the need to do so as an act of mercy, love, and solidarity. His approach builds on the main pastoral theme of his Papacy, the mercy of God. This article outlines the thought of Pope Francis on the mercy of God and how he wishes to see this mercy motivate and invigorate not only the Church but all people. Perinatal palliative care becomes a further outgrowth of the love and mercy we show one another. It is a pastoral practice encouraged by the Church and consistent with Catholic doctrine and the mission of Catholic health-care facilities.

Challenges Facing The Performance of Catholic Healthcare Facilities in Tanzania: Insights From Turiani and Mikumi Hospitals in Morogoro

Challenges Facing The Performance of Catholic Healthcare Facilities in Tanzania: Insights From Turiani and Mikumi Hospitals in Morogoro

Referrals for Services Prohibited In Catholic Health Care Facilities.

Catholic hospitals control a growing share of health care in the United States and prohibit many common reproductive services, including ones related to sterilization, contraception, abortion and fertility. Professional ethics guidelines recommend that clinicians who deny patients reproductive services for moral or religious reasons provide a timely referral to prevent patient harm. Referral practices in Catholic hospitals, however, have not been explored. Twenty-seven obstetrician-gynecologists who were currently working or had worked in Catholic facilities participated in semistructured interviews in 2011-2012. Interviews explored their experiences with and perspectives on referral practices at Catholic hospitals. The sample was religiously and geographically diverse. Referral-related themes were identified in interview transcripts using qualitative analysis. Obstetrician-gynecologists reported a range of practices and attitudes in regard to referrals for prohibited services. In some Catholic hospitals, physicians reported that administrators and ethicists encouraged or tolerated the provision of referrals. In others, hospital authorities actively discouraged referrals, or physicians kept referrals hidden. Patients in need of referrals for abortion were given less support than those seeking referrals for other prohibited services. Physicians received mixed messages when hospital leaders wished to retain services for financial reasons, rather than have staff refer patients elsewhere. Respondents felt referrals were not always sufficient to meet the needs of low-income patients or those with urgent medical conditions. Some Catholic hospitals make it difficult for obstetrician-gynecologists to provide referrals for comprehensive reproductive services.

Catholic Bioethics for a New Millennium by Anthony Fisher

500 BOOK REVIEWS Catholic Bioethics for a New Millennium. By ANTHONY FISHER. Cambridge: Cambridge University Press, 2012. Pp. 346. $30.00 (paper). ISBN: 978-0-521-25324-6. Anthony Fisher’s first book brings together a collection of previously published essays and conference presentations on a variety of hotly debated topics in Catholic medical ethics. It was probably no easy task for Fisher to decide what to include, since he has published extensively on bioethics over the last twenty-five years. While Fisher begins the book with three chapters on methodological questions (culture, conscience, and cooperation), the heart of the book consists of six chapters on controversial issues that preoccupied much of bioethics, especially Catholic medical ethics, at the turn of the millennium. Chapters 4-6 focus on aspects of the abortion debate (e.g., “when human life begins,” embryo experimentation, and pre-natal testing), and chapters 7-9 take up questions “at the other end of life” (8) (e.g., transplantation, medically assisted nutrition and hydration, and euthanasia). The final two chapters employ the case-study method to examine two types of Catholic participation in the public square, namely, how Catholic healthcare facilities and Catholic politicians may serve the authentic common good of contemporary Western societies. Fisher argues his views vigorously and at times polemically, not unexpectedly for a work in bioethics with a strong constructive approach on a variety of neuralgic issues. He is most nuanced and generous on the issues (e.g., in the chapters on transplantation and Catholic political participation) where the disputed viewpoints within the Catholic tradition tend to be less rancorous, or where he takes a more exegetical and pastoral approach (as in the chapter on euthanasia). However, most noteworthy about the book is not its arguments about the controversial issues. For the most part Fisher does not aspire to novel takes on the issues, but stakes out in an intelligent, sophisticated, and at times pithy way—ground well-trodden by the kinds of Catholic bioethicists typically associated with Catholic Church-sponsored bioethics centers (e.g., Anscombe/Linacre Bioethics Centre, Pontifical Academy for Life). What makes this book noteworthy—and very difficult to review—is that it seeks to be “all things to all people.” Anthony Fisher plays many roles: he is a Dominican, a lawyer, a philosopher, a bishop, and a pastor. The book is an amalgam of genres: at times he argues as a philosopher, at other times he writes as a bishop offering guidance to his flock, at times he speaks as a casuist, at times as a public intellectual proffering pithy slogans, at times as a biblical exegete, at times as a lawyer, and at times as a pastor. And at times he integrates many of those roles in a masterful way. However, if the reader does not appreciate that different chapters of the book have rather different audiences and approach issues in diverse way, the book may well seem somewhat disjointed. The unity of the book does not lie in a particular genre or mode of argumentation. BOOK REVIEWS 501 What unites Catholic Bioethics for a New Millennium is Fisher’s reference to himself as one of the “John Paul II generation” (1). This is no mere pious reference. Every chapter in the book seems to draw as extensively as possible on the thought of Pope St. John Paul II. The index has at least five times as many references to the works of John Paul as any other thinker. The encyclical Evangelium vitae (The Gospel of Life) receives far more citations than any other document, and Fisher dubs it John Paul’s “bioethical charter” (4). Back in 1995 when Evangelium vitae first appeared, Fisher appraised it as “undoubtedly the most authoritative statement of Christian bioethics to date” (“Theological Aspects of Euthanasia,” in Euthanasia Examined: Ethical, Clinical and Legal Perspectives, ed. John Keown [Cambridge: Cambridge University Press, 1995], 330 n. 22). In addition, Fisher displays the influence of John Paul in his strong integration of issues of sexuality and the family (and John Paul’s Theology of the Body) with biomedical issues. Even the title of the book is an allusion to a work of John Paul, namely his...

Cultural competency, autonomy, and spiritual conflicts related to Reiki/CAM therapies: Should patients be informed?

The use of complementary and alternative medicines (CAM) such as Reiki is on the rise in healthcare centers. Reiki is associated with a spirituality that conflicts with some belief systems. Catholic healthcare facilities are restricted from offering this therapy because it conflicts with the teachings of the Catholic Church. However, hospitals are offering it without disclosing the spiritual aspects of it to patients. This article will address the ethical concerns and possible legal implications associated with the present process of offering Reiki. It will address these concerns based on the Joint Commission's Standard of Cultural Competency and the ethical principles of autonomy and informed consent. A proposal will also be introduced identifying specific information which Reiki/CAM practitioners should offer to their patients out of respect of their autonomy as well as their cultural, spiritual, and religious beliefs.

Emergency contraception policy: how moral commitments affect risk evaluation

Based on the beliefs that human life and pregnancy begin at conception, that human life has equal moral value regardless of its development stage or form, and that emergency contraception (EC) has mechanisms of action that may induce abortion, Catholic health care facilities are not permitted to provide EC to rape victims if any possibility exists that a woman may have conceived due to her rape, even if that possibility is unverifiable. The Catholic Church claims that the mechanism of action of EC is uncertain and that some studies have concluded that disruption of implantation, which the Church considers to be abortion, may occur. Drawing on insights from feminist epistemology (e.g. work by Helen Longino) and arguments at the intersection of bioethics and philosophy of science (including work by Robert Veatch and Grant Gillett), we argue that the Church's position on this matter is based on uncertain (and misinterpreted) scientific claims and that particular normative (moral and theological) commitments on the part of those wielding power over Church Law lead to a weighing of probabilities in a manner consonant with the preservation of that power. In this paper, we examine how normative commitments infuse or infect the assessment of probability and influence ethical policy. We also examine how probabilism, a moral method that operates within the constraints of Catholic normative commitments, offers an alternative approach which respects, acknowledges, and maximizes an individual's ability to determine probable reason for moral action in the face of irreducible uncertainty.

Needed, an Ethics Audit of Catholic Sterilization Policies

The author proposes an ethics audit of Catholic sterilization policies as a way to correct the disparity between the regnant moral directive prohibiting direct sterilization in Catholic health-care facilities and the policy and practice of allowing tubal ligations for “medical” or “therapeutic” purposes. The proposed four-step plan for the ethics audit involves dialogue and collaboration between U.S. bishops who have Catholic health-care facilities in their dioceses and the respective hospitals’ administration, sponsors, and medical staff. First, bishops clarify for Catholic hospital administrators, sponsors, and system leadership the moral distinction between a direct sterilization and one that is therapeutic or indirect. Second, bishops instruct hospital CEOs to abide by directive 53 of the Ethical and Religious Directives for Catholic Health Care Services by providing only indirect sterilizations. Third, bishops encourage hospital leadership and medical/nursing staff to promote directive 53 in tandem with directive 52 and its call for providing natural family planning services within the hospital. And, fourth, bishops collaborate with the hospital or system leadership in conducting ongoing oversight of sterilization policy/procedures to insure that their Catholic health-care institutions practice durable compliance with directives 52 and 53.

Roman Catholic Doctrine Guiding End-of-Life Care: A Summary of the Recent Discourse

Recent statements emanating from high-level church authorities have reignited discussion over the traditional Roman Catholic doctrine guiding end-of-life care. Although these statements concerned the specific issue of artificial nutrition and hydration for patients in a persistent vegetative state, they contain principles that might be applied to other life-prolonging interventions. This paper examines the origins of the Catholic moral tradition that guides end-of-life care. Included is a discussion of the "ordinary-extraordinary" distinction, as well as the Catholic definition of "euthanasia by omission." Further discussion focuses on those recent statements that have reaffirmed the Church's teaching regarding life-sustaining interventions. Although a source of some consternation, these statements should spark healthy discussion within Catholic health care facilities and among patients seeking advice about advance care planning within a Catholic framework. Moreover, the statements rightly reaffirm the Church's unwavering commitment to delivering compassionate palliative care.

Nutrition and Hydration: An Analysis of the Recent Papal Statement in the Light of the Roman Catholic Bioethical Tradition

This article discuses the unexpectedly firm stance professed by John Paul II on the provision of artificial nutrition and hydration to patients who are in a persistent vegetative state, and its implications on previously held standards of judging medical treatments. The traditional ordinary/extraordinary care distinction is assessed in light of complexities of the recent allocution as well as its impact on Catholic individuals and in Catholic health care facilities. Shannon concludes that the papal allocution infers that the average Catholic patient is incapable of making proper judgments about their own care. Shannon sees the preservation of life at all costs as at least highly troubling, if not as a radical move against the Catholic medical ethics tradition.

The Impact of Roman Catholic Moral Theology on End-of-Life Care Under the Texas Advance Directives Act

This essay reviews the Roman Catholic moral tradition surrounding treatments at the end of life together with the challenges presented to that tradition by the Texas Advance Directives Act. The impact on Catholic health care facilities and physicians, and the way in which the moral tradition should be applied under this statute, particularly with reference to the provision dealing with conflicts over end-of-life treatments, will be critically assessed. I will argue, based on the traditional treatment of end-of-life issues, that Catholic physicians and institutions should appeal to the conflict resolution process of the Advance Directives Act only under a limited number of circumstances. The implications, under the Texas statute, of varied interpretations of Pope John Paul II's recent allocution on artificial feeding and hydration in the persistent vegetative state will also be considered.

Nutrition and Hydration: An Analysis of the Recent Papal Statement in the Light of the Roman Catholic Bioethical Tradition

This article discusses the unexpectedly firm stance professed by John Paul II on the provision of artificial nutrition and hydration to patients who are in a persistent vegetative state, and it implications on previously held standards of judging medical treatments. The traditional ordinary/extraordinary care distinction is assessed in light of complexities of the recent allocution as well as its impact on Catholic individuals and in Catholic health care facilities. Shannon concludes that the papal allocution infers that the average Catholic patient is incapable of making proper judgments about their own care. Shannon sees the preservation of life at all costs as at least highly troubling, if not as a radical move against the Catholic medical ethics tradition.

Catholic moral teaching, medically assisted nutrition and hydration and the vegetative state

A wide range of medical, legal and ethical opinion regarding withholding or withdrawing medically assisted nutrition and hydration (ANH) from vegetative state (VS) and persistent vegetative state patients (PVS) has been presented in professional journals over the past twenty years. This article concerns the moral aspects of this debate as it has developed within the Catholic Church, especially in the United States. It presents traditional Catholic teaching about the extent and limits of the moral obligation to employ medical means in the preservation of human life, and examines how this teaching applies to the specific question of supplying ANH to PVS patients. It provides a critique of two contradictory views on the morality of discontinuing ANH for PVS patients presented by Catholic theologians. It examines the teaching of Pope John Paul II, who identifies ANH as a natural means of preserving life that must be maintained as long as it preserves the patient's life or alleviates his suffering. Finally, it discusses the practical implications this papal teaching has for the treatment of PVS patients in all Catholic health care facilities.

Appropriation of Evil: Cooperation's Mirror Image

[The author argues that the category of cooperation of evil needs to be supplemented by a new category of appropriation of evil. Cooperation focuses on agents who must decide whether to perform an act that contributes to the morally objectionable action of another. In contrast, appropriation concentrates on the “mirror image” problem faced by agents who must decide whether to make use of the fruits of another agent’s morally objectionable action. She suggests that the new category better illuminates problems involved in research using fetal tissue obtained from elective abortions, the purchase of goods made in sweatshops, and some affiliations between Catholic health care facilities and those that perform procedures prohibited by the Ethical and Religious Directives.]

Foregoing Artificial Nutrition and Hydration: Some Recent Legal and Moral Implications for Catholic Health Care Facilities

Foregoing Artificial Nutrition and Hydration: Some Recent Legal and Moral Implications for Catholic Health Care Facilities

A Model Medical Moral Committee for Catholic Health Care Facilities

A Model Medical Moral Committee for Catholic Health Care Facilities