CATHOLIC CONNECTIONS

By Sandra Kary

Technology today: handling health care dilemmas

Technology (in health care) provides us with the luxury of medical options that often require us to make decisions we’d rather not.
Many of us can recall when we first heard of organ transplants — cutting-edge medicine that was capable of saving and extending life! And yet, it raised many questions.

Born from this advancement of technology in health care is an area of study and practice called bioethics (bios= life; ethos = behaviour), a term coined in the 1970s to define the emergence of this academic discipline that contended with dilemmas and controversial situations.

In the last 40 years, the scope of ethical dilemmas has only expanded.

Consider what your thoughts are regarding reproductive technologies (such as in vitro fertilization), genetic engineering or stem cell research. Or how about advanced life support, physician-assisted suicide or euthanasia? A few years ago there was considerable concern regarding the spread of the avian (bird) flu and the availability of vaccine. This compelled many of our health region officials to review the policies and protocols for pandemic planning.

Ultimately the question becomes, “who has the right to comment on these dilemmas and issues, and in what form?” states Joy Mendel, ethicist for St. Paul’s Hospital in Saskatoon. What framework is used to help discern these complex situations?

Mendel comments that her job as an ethicist is not to provide final decisions, but rather articulate and advocate for the full spectrum of relationships and information that need to be considered. These include clearly set out treatment options, the individual’s choice, substitute decision-making if someone loses the capacity to decide, policies and values of the health care institution/region, standards and codes of ethics for medical professionals, provincial and federal legislation, and the teachings of the church.

Bringing it all together — navigating technology, understanding relationships, promoting policies and advocating for rights — is the essence of what an ethicist or ethics committee captures to create a lens for decision-making.

Furthermore, in the field of health care ethics, there is a Catholic or Christian lens that gives a guide for how ethical issues and dilemmas are resolved. As outlined in the Health Ethics Guide (Catholic Health Association of Canada, 2000), those who serve in Catholic facilities, who promote the healing ministry of Christ, do so by committing to two fundamental values — upholding the dignity of every human person and understanding the interconnectedness of every human being.

Although broad concepts, these two values provide the foundation of our compassionate care — believing that each person possesses intrinsic worth and that, as social beings, we need relationships and community to protect and develop our full potential. These values pave the way for us to conscientiously and creatively steward our resources, to uphold human freedoms while maintaining the common good and to foster a preferential option for the poor and marginalized.

How then does one live by these values while swimming in the technologically induced health dilemmas we ourselves create?
Capturing an entire field of study (in Catholic bioethics) to answer this question is daunting. However, there are six Christian moral principles that help us navigate the brackish waters (which I outline briefly and somewhat simplistically):

Totality and integrity: all of our functions are to be developed, used and cared for to protect our human dignity, and not to be sacrificed unless for the saving or better functioning of the whole person (for example, amputation to save one’s life).

Double effect: if an action has both good and bad consequences, this principle provides criteria for sometimes permitting an important good while tolerating the evil that is produced (for example, cutting a person open to provide needed surgery).

Co-operation: as groups who provide health care services, there should be no formal co-operation with (or intent for) an immoral act.

Subsidiarity: decisions should be taken as close to the grassroots as possible, which gives a voice to those in need to help determine how best to meet their need.

Free and informed decision-making: the person receiving care is the primary decision-maker, with no service or treatment to be provided without free and informed consent.

Confidentiality: those who receive care must be treated with trust, honesty and respect for privacy.

I have often heard it said that the backbone of Catholic health care is our mission to the sick and our ethics. It is evident that the caregiving in our institutions is weighted upon our values and principles, established to navigate the times (and technology) we create. From the beginning and through to the end of life, without our ethics to guide us, we certainly could not “walk our talk.”

Do you ever wonder what our world would be like without Catholic health care or Christian ethics? It’s not hard. These real-life dilemmas and complex situations have become the story lines of many books, TV shows and movies, which often demonstrate a slippery slope down which society could easily slide.

Kary is executive director for the Catholic Health Association of Saskatchewan