In 1994, the National Conference of Catholic Bishops revised the "Ethical and Religious Directives for Catholic Health Care Services." A goal of the Directives is to maintain the moral integrity of Catholic health care institutions and to address controversies in bioethics and health care. The Directives represent a shift to an exclusively principle-based approach to moral reason. This shift threatens to undermine the very tradition that (...) the bishops seek to protect. (shrink)

In 1994, the National Conference of Catholic Bishops revised the "Ethical and Religious Directives for Catholic Health Care Services." A goal of the Directives is to maintain the moral integrity of Catholic health care institutions and to address controversies in bioethics and health care. The Directives represent a shift to an exclusively principle-based approach to moral reason. This shift threatens to undermine the very tradition that (...) the bishops seek to protect. (shrink)

Completely updated and revised, the third edition of Catholic Health Care Ethics: A Manual for Practitioners sets the standard for Catholic bioethicists, physicians, nurses, and other health care workers. In thirty-nine chapters (many with subchapters), leading authors in their fields discuss a wide range of topics relevant to medicine and health care. The book has six parts covering foundational principles, health care ethics services, beginning-of-life issues, end-of-life issues, selected clinical (...) issues, and institutional issues. Some highlights from the third edition include new entries on the Ethical and Religious Directives for Catholic Health Care Services, certitude in moral decision-making, the principle of double effect, clinical ethics consultation, natural family planning, prenatal testing and diagnosis, care of fetal remains, challenges to neurological criteria, the use of ventilators, POLST, alkaline hydrolysis, opportunistic salpingectomy, so-called lethal prenatal diagnoses, transgenderism, and new age medicine. The volume continues to provide insightful information on the topics previously covered in the second edition, but with significant updates throughout. (shrink)

We argue that the American Society for Bioethics and Humanities has endorsed a facilitation approach to clinical ethics consultation that asserts that bioethicists can offer moral recommendations that are well-grounded in bioethical consensus. We claim that the closest thing the field currently has to a citable, nationally endorsed bioethical consensus are the 22 Core References used to construct the questions for the Healthcare Ethics Consultant-Certified (HEC-C) exam. We acknowledge that the Core References reflect some important points of bioethical consensus, but (...) note they are unwieldy, repetitive, and sometimes inconsistent on important issues faced by clinical ethicists. In this article, we draw carefully qualified inspiration from the Ethical and Religious Directives for Catholic Health Care Services (ERDs) to argue for the creation of a concise, nationally endorsed bioethical consensus document on moral issues commonly faced in clinical ethics, what we call the Standardized Ethical Guidelines for Secular Health Care Services (SEGs). We observe that such a document would better meet the expectations of stakeholders, clinical ethicists, and their trainees who desire moral recommendations grounded in a clearly articulated bioethical consensus, and we defend the SEGs from some common objections. (shrink)

The Catholic tradition can help to guide patients and practitioners through the complex issues that arise due to the medicalization of death because of contemporary medical technology. The purpose is to illustrate how this religious denomination makes moral decisions in practice. The Catholic tradition moors its moral teachings in the constructive interplay between faith and reason, each of which opens itself to the other for insight and enlightenment. The analysis begins with the theoretical realm to discuss the (...) theological foundations and the meaning of Natural Law that guide the Ethical and Religious Directives for Catholic Health Care Services. This stance is then applied to several practical concerns that ethically engage issues surrounding the medicalization of death, including maternal-fetal conflicts, patients approaching the end of life, and after death dilemmas. The flexibility and range of Catholic morality can offer astute guidance not only to those who follow this tradition but also to those with different faith perspectives when they encounter the heart-wrenching dilemmas that medical technology presents around death and dying. (shrink)

Cochran has argued that Catholic health care occupies a “unique place on the border of public and private life”. Catholic health care is accountable to both its religious and sacramental traditions and its public responsibilities. It is inevitable that “border skirmishes” will arise. Yet there is no single formula for suggesting what public-private collaboration should comprise or how conflicts between values ought to be resolved. It may be, as Cochran suggests, that increasingly bitter (...) conflicts over widely valued services such as sterilization, combined with market pressures to conform to for-profit trends in health care, will make divestiture of faith-based hospitals in favor of other types of church-community partnerships the best course for the future. (shrink)

The first edition of the Ethical Religious Directives for Catholic Health Care Services was published in 1948. Since then, it has undergone two major revisions and several smaller ones. The following essay explores the history of the ERDs and the important aspects of these revisions.

Since their inception in 1948, The Ethical and Religious Directives for Catholic Health Care Services have guided Catholic health care ministries in the United States, aiding in the application of Catholic moral tradition to modern health care delivery. The ERDs have undergone two major revisions in that time, with about twenty years separating each revision. The first came in 1971 and the second came twenty-six years ago, in (...) 1995. As such, a third major revision is due and will likely be undertaken soon. (shrink)

Directive 36 of the Ethical and Religious Directives for Catholic Health Care Services gives guidance to health care professionals on the reactive administration of contraceptives to women in instances of isolated rape. This paper examines the moral permissibility of long-term proactive contraceptive use in instances of repeated marital rape by comparing it to the moral permissibility of reactive contraceptive use in cases of isolated rape found in directive 36.

The American Society for Bioethics and Humanities poses a chal­lenge in Core Competencies for Healthcare Ethics Consultation: health care ethics consultation services “should be able to demonstrate their value to those who pay for the service, as well as to those whom the service is intended to serve.” To respond to this challenge, this article provides a brief review of the literature on evaluating ethics consultation in its traditional frameworks of quality outcomes. The author follows this discussion (...) with a new methodology to evaluate ethics consultation on the basis of the intrinsic good of the service. He ends with a novel risk-based assessment to complement the evaluation of clinical ethics services grounded in the Ethical and Religious Directives for Catholic Health Care Services. (shrink)

Catholic health care is often viewed as antithetical to secular conceptions of autonomy. This view can engender calls to protect “choice” in Catholic facilities. However, this view is built on a fundamental misunderstanding of the Ethical and Religious Directives for Catholic Health Care Services (ERDs). This commentary, which responds to “Principled Conscientious Provision: Referral Symmetry and Its Implications for Protecting Secular Conscience,” by Abram Brummett et al., seeks to demonstrate (...) the nuance of the ERDs as well as to address some of the challenges various Catholic identities have when interpreting and living out the ERDs so that all patients receive high-quality, compassionate care. By highlighting the Church's desire to protect all people at every stage, I hope to dispel the caricatures that often result from misunderstandings by Catholics and non-Catholics alike. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Rethinking Cooperation with Evil: A Virtue-Based Approach by Ryan ConnorsGary AtkinsonCONNORS, Ryan. Rethinking Cooperation with Evil: A Virtue-Based Approach. Washington, D.C.: The Catholic University of America Press, 2023. xiii + 313 pp. Paper, $34.95The author adheres closely to the recommendation to tell his reader what he intends to do, tell him what he is doing while doing it, and having finished, tell him what he’s done, a (...) recommendation worth following for a work as tightly structured and complex as this one. It is clear, irenic, and shows extensive research: nearly 1,000 footnotes in its 275 pages of text offering many avenues for further exploration including numerous references to “alternative” accounts. It is far more than an analysis of cooperation, for it exposes the reader to a universe of concepts, many of which are seldom introduced in studies on the topic. It is also bracing, an elixir likely to incite (and likely intended to incite) the reader to a deeper commitment to careful moral thought and conscientious moral action. Few readers will close this book with a feeling of time unprofitably spent.The introduction makes clear the book’s two central claims: (i) that an adequate analysis of the topic of cooperation with evil has yet to be provided and (ii) that a virtue-based approach stemming from St. Thomas Aquinas contains the elements for its provision. In support of these claims the book is organized into five chapters, the first three foundational and the last two matters of application.Chapter 1, “The Teaching of St. Thomas Aquinas: Received and Jettisoned,” begins with a presentation of St. Thomas’s treatment of five topics—borrowing money from known usurers, scandal, restitution for [End Page 709] crimes committed by agents working together, exacting oaths from known perjurers, production of objects used for sinful purposes. This first section is followed by an examination of three theologians in the tradition of Thomistic analysis, Jean Capreolus (d. 1444), Giacomo de Vio Cajetan (d. 1534), and John of St. Thomas (d. 1644). Following this section is a third containing an account of the departure from the Thomistic mode of analysis represented by Thomas Sanchez (d. 1610) and St. Alphonsus Liguori (d. 1787). The first chapter provides a nice introduction and solid grounding for what is to come.Chapter 2, “A Broad Sampling of Nineteenth- and Twentieth-Century Casuist Authors,” explores in its first section the manuals of nine figures: Aloysius Sabetti, Thomas Slater, Dominicus Prümmer, Benoit-Henri Merkelbach, Noldin-Schmitt, Jone-Adelman, McHugh-Callan, Henri Davis, and Bernhard Häring. The second and third sections highlight the lack of consensus among the authors and the consequent perplexity encountered by a conscientious moral agent regarding what counts as a “sufficient, proportionate, serious, or grave” reason for cooperation with evil. At several points throughout this book the author acknowledges the good sense of the casuists and the careful articulation of their judgments, but he finds their general approach to be wanting for several reasons, including their tendency to neglect consideration of the moral virtues and the nature of the act of cooperation itself.The extensive historical grounding provided by chapters 1 and 2 prepares the reader for chapter 3, “The Renewal of Theology: A Return to Virtue,” the focal chapter of the book. The first section concerns the thought of Servais Pinckaers, who “initiated a revival of St. Thomas’s moral theory that continues to the present day.” This is followed by a section treating of magisterial documents adopting St. Thomas’s and Pinckaers’s approach: Veritatis splendor, Evangelium vitae, Declaration on Euthanasia (1980), Vademecum for Confessors Concerning Some Aspects of Conjugal Life (1997), Ethical and Religious Directives for Catholic Health Care Services (2009). The third section considers the work of three twenty-first-century moralists who apply Thomistic methods to the topic of cooperation with evil: Steven Long, Archbishop Anthony Fisher, and Andrew McLean Cummings.Chapter 4, “A New Way Forward: the Virtuous Person Faces a Moral Dilemma,” is the first of two chapters showing St. Thomas’s approach at work. The author calls this approach both “object based” and “virtue based,” marking the two features receiving... (shrink)

There is controversy in the Catholic medical ethics community surrounding assisted nutrition and hydration (ANH). Recently, the Ethical and Religious Directives for Catholic Health Care Services were amended to make ANH “obligatory.” The persistent vegetative state is cited specifically in the document, and the sentence following its mention states that ANH is “optional” when it cannot be expected to “prolong life” or when it would be “excessively burdensome.” For patients suffering from other (...) medical conditions, such as dementia and frailty, ANH may be excessively burdensome and may not prolong life. For these patients, ANH may be of no real benefit and may even have significant morbidity and mortality. Competent individuals with these conditions can ethically elect to forgo ANH. National Catholic Bioethics Quarterly 10.3 (Autumn 2010): 481–488. (shrink)

The public responsibilities of nonprofit hospitals have been contested since the advent of the 1969 community benefit standard. The distance between the standard's legal language and its implementation has grown so large that the Internal Revenue Service issued a new reporting form for 2008 that is modeled on the Catholic Health Association's guidelines for its member hospitals. This article analyzes the appearance of an emerging moral consensus about community benefits to argue against a strict charity care mandate (...) and in favor of directing efficient care delivery and healthy community initiatives to underserved populations. The analysis turns on three moral conceptions of community benefits, the social contract model of hospital critics and the common good and covenantal models of Catholic and Jewish hospitals. (shrink)

Theological basis -- Religion and health care -- The dignity of human life -- The integrity of the human person -- Implications for health care -- Theological principles in health care ethics -- Method -- The levels and questions of ethics -- Freedom and the moral agent -- Right and wrong -- Metaethics -- Method in Catholic bioethics -- Catholic method and birth control -- The principle of double effect -- Application -- (...) Forgoing treatment, pillar one: ordinary and extraordinary means -- Forgoing treatment, pillar two: killing and allowing to die -- Forgoing treatment, pillar three: decisions by competent patients -- Forgoing treatment, pillar three: decisions for incompetent patients -- Forgoing treatment, pillar three: advance directives -- Hydration and nutrition -- Physician-assisted suicide and euthanasia -- Medical futility -- Pain and pain management -- Ethics committees -- Embryonic stem cells and the beginning of human personhood -- Genetic engineering -- Allocating health care resources -- The use and misuse of the allocation argument. (shrink)

In Roman Catholic Moral Theology, a direct abortion is never permitted. An indirect abortion, in which a life threatening pathology is treated, and the treatment inadvertently leads to the death of the fetus, may be permissible in proportionately grave situations. In situations in which a mother’s life is endangered by the pregnancy before the fetus is viable, there is some debate about whether the termination of the pregnancy is a direct or indirect abortion. In this essay a recent case (...) from a Roman Catholic sponsored hospital in Phoenix is reviewed along with the justifications for and arguments against viewing the pregnancy termination as an indirect abortion. After review of several arguments on both sides of the debate, it is concluded that termination of the pregnancy itself as the means of saving the mother cannot be considered an indirect abortion and that the principle of “double effect” does not justify the termination. In addition, the importance of a breakdown in communication between the local bishop and the administration of the hospital is shown to have contributed to the ultimate loss of Catholic sponsorship of the hospital. (shrink)

This article critically examines, from the perspective of a Roman Catholic Healthcare ethicist, the second edition of the Core Competencies for Healthcare Ethics Consultation report recently published by the American Society for Humanities and Bioethics. The question is posed: can the competencies identified in the report serve as the core competencies for Roman Catholic ethical consultants and consultation services? I answer in the negative. This incongruence stems from divergent concepts of what it means to do ethics (...) consultation, a divergence that is rooted in each perspective's very different visions of autonomy. Furthermore, because of the constitutive elements of Catholic ethics consultation, such as the Ethical and Religious Directives for Health Care Services, the tradition needed to apply those directives, and the Catholic facility’s membership in the institutional Church, the competencies needed for its practice differ in kind from those identified by the report. While there are many practical points of convergence, the competencies identified by the report should not be adopted uncritically by Catholic healthcare institutions as core competencies for ethical consultation services. (shrink)

Hospitals sometimes refuse to provide goods and services or honor patients’ decisions to forgo life-sustaining treatment for reasons that appear to resemble appeals to conscience. For example, based on the Ethical and Religious Directives for Catholic Health Care Services , Catholic hospitals have refused to forgo medically provided nutrition and hydration , and Catholic hospitals have refused to provide emergency contraception and perform abortions or sterilization procedures. I consider whether it (...) is justified to refuse to offer EC to victims of sexual assault who present at the emergency department . A preliminary question, however, is whether a hospital’s refusal to provide services can be conceptualized as conscience based. (shrink)

Roman Catholics have a long tradition of evaluating medical treatment at the end of life to determine if proposed interventions are proportionate and morally obligatory or disproportionate and morally optional. There has been significant debate within the Catholic community about whether artificially delivered nutrition and hydration can be appreciated as a medical intervention that may be optional in some situations, or if it should be treated as essentially obligatory in all circumstances. Recent statements from the teaching authority of the (...) church have attempted to clarify this issue, especially for those with a condition known as the persistent vegetative state. I argue that these recent teachings constitute a “general norm” whereby artificial nutrition and hydration are considered obligatory for most patients, but that these documents allow for exception in cases of complication from the means used to deliver nutrition and hydration, progressive illness, or clear refusal of such treatment by patients. While the recent clarifications do not constitute a major deviation from traditional understanding and will rarely conflict with advance directives or legal statutes, there may be rare instances in which remaining faithful to church teaching may conflict with legally enshrined patient prerogatives. Using the Texas Advance Directives Act as an example, I propose ways in which ethics committees can remain faithful to their Roman Catholic identity while respecting patient autonomy and state law pertaining to end of life health care. (shrink)

Abstract:Recently the scope of protections afforded those healthcare professionals and institutions that refuse to provide certain interventions on the grounds of conscience have expanded, in some instances insulating providers (institutional and individual) from any liability or sanction for harms that patients experience as a result. With the exponential increase in the penetration of Catholic-affiliated healthcare across the country, physicians and nurses who are not practicing Catholics are nevertheless required to execute documents pledging to conform their patient care to (...) the Ethical and Religious Directives for Health Care Services as a condition of employment or medical staff privileges. In some instances, doing so may result in patient morbidity or mortality or violate professional standards for respecting advance directives or surrogate decisionmaking. This article challenges the ethical propriety of such institutional mandates and argues that legal protections for conscientious refusal must provide redress for patients who are harmed by care that falls below the prevailing clinical standards. (shrink)

Some hold that the revision to directive 58 of the Ethical and Religious Directives for Catholic Health Care Services—which sought to incorporate the language of Pope John Paul II’s 2004 statement regarding the obligation to provide patients in a persistent vegetative state—represents a threat to patient’s end-of-life decisions. I argue this position is unfounded. The revision to the directive, and the statements that inspired this linguistic modification, do not represent a substantive change in (...) the Church’s teaching. I support this position based on two claims. First, in his statement, the Holy Father speaks of food and water and care personnel’s obligation to provide them as relative to the patient’s status as a person. That is, relative to the patient’s human nature, food and water represent a per se useful means for preserving life and, as such, should be considered ordinary and obligatory. Second, since his teaching is directed toward care personnel, John Paul II does not discuss the patient’s judgment of the means with the assumption that the Tradition has already clearly established the legitimacy of patients refusing means they judge to be extraordinary. Finally, I argue that one of the effects of the Pope’s statement is that it manages to reaffirm the Church’s teaching on euthanasia and ordinary and extraordinary means without institutionalizing a particular theologian’s vision of anthropology. (shrink)

Part Two of the Ethical and Religious Directives outlines the responsibility to care for the spiritual needs of patients and residents, following the example of Christ who both healed the sick and forgave them their sins. The proposed revisions to the introduction add a more explicit focus on the dignity of the sick, the redemptive value of suffering, and the potential evangelization that takes place through institutional health care. The proposed revisions to the (...) class='Hi'>directives emphasize that patients and residents have a right to receive spiritual and sacramental care. Likewise, Catholic healthcare institutions, medical staff, and pastoral care personnel have an obligation to arrange and provide adequate spiritual and sacramental care. (shrink)

Advertising by health care institutions has increased steadily in recent years. While direct-to-consumer prescription drug advertising is subject to unique oversight by the Federal Drug Administration, advertisements for health care services are regulated by the Federal Trade Commission and treated no differently from advertisements for consumer goods. In this article, we argue that decisions about pursuing health care services are distinguished by informational asymmetries, high stakes, and patient vulnerabilities, grounding fiduciary responsibilities on (...) the part of health care providers and health care institutions. Using examples, we illustrate how common advertising techniques may mislead patients and compromise fiduciary relationships, thereby posing ethical risks to patients, providers, health care institutions, and society. We conclude by proposing that these risks justify new standards for advertising when considered as part of the moral obligation of health care institutions and suggest that mechanisms currently in place to regulate advertising for prescription pharmaceuticals should be applied to advertising for health care services more broadly. (shrink)

Part One of the ERDs addresses the balance Catholic health care institutions must strike between their mission to carry out the healing ministry of Christ and the demands of the US health care system. Divided into two sections, the commentary begins by proposing revisions to the Part One introduction focusing on enhanced application of Catholic social teaching principles and a renewed call for robust conscience and religious liberty protections. It then proposes additions to (...) the Part One directives designed to help Catholic health care respond with integrity to the many contemporarychallenges it faces, and to more full live out its mission and identity. (shrink)

USING QUALITATIVE INTERVIEWS AT CATHOLIC AND JEWISH HOSPITAL organizations, this essay contrasts the market-driven reforms of consumer-directed health care and physician entrepreneurship with the mission-driven structures of religious nonprofits. A structural analysis of values in health care makes a convoluted system more transparent. It also demonstrates the limitations of market reforms to the extent that they erode organizational structures of solidarity, which are needed to pool risks, shift costs, and maintain safety nets in a (...) complex and expensive health economy. (shrink)

At Providence St. Joseph Health in Oregon, many factors contribute to the integration and success of the ethics services. There are three principal lenses through which one can understand the distinct way in which the ethics services are operationalized and integrated: the theological foundations of ethics as a service, the institutional ecology, and the professionalization of the field of health care ethics. The authors review key realities that have shaped their work through these three lenses (...) and then describe the activities of the Providence Center for Health Care Ethics regarding its strategic objectives and clinical and administrative integration. (shrink)

Part Five is in considerable need of revision. There have been many developments in medicine and health care that present serious moral challenges to the teachings of the Church. The recommendations below include new emphasis on palliative care and hospice, the right of Catholics to receive the sacraments and visits from the family during illness, further safeguards to protect those in a persistent vegetative state, the immorality of voluntary stopping of eating and drinking (VSED), the permissibility of (...) do not resuscitate (DNR) orders, the limited use of palliative sedation, and the requirement that the standards for determining death be rigorously applied by medical professionals. Other minor recommendations seek to bring greater clarity to the existing directives. (shrink)

We suggest edits to Part Four of the Ethical and Religious Directives (ERDs) to help the US bishops address and clarify essential Church teachings on specific beginning-of-life issues facing Catholic health care today. As a teaching tool, Part Four must be updated so that Catholic health care professionals and the lay faithful can understand and apply Church teachings to new ethical challenges. Further, more direction and clarity from the ERDs is (...) needed in applying general principles to assisted procreative technologies, pre- and post-viability induction of labor, ectopic pregnancies, genetic screening and diagnosis, and contraception. Catholic health care clinicians and administrators also need to receive ongoing instruction on the ERDs’ teachings as well as the theological and philosophical rationales that undergird them. (shrink)

The intensive care unit, with its structural complexity and the exposure of critically ill patients to various disparities, presents a significant setting for health disparities. This critical ethnographic study sought to uncover cultural knowledge and ethical practices for reducing health disparities in providing care services within the intensive care unit. The focus was on understanding how ethical considerations and cultural competence can address and mitigate these disparities effectively. This critical ethnographic study was (...) conducted in 2022–2023 at intensive care units in western Iran. Three interrelated phases were used to collect and analyze the data. More than 300 h of observation were done during the first phase. A horizon analysis was carried out in the next phase. To further enhance the dataset, 18 informants participated in semi-structured interviews and informal conversations. Following that, the analysis procedure was conducted to identify a culture of health disparities and factors that reduce it, as it had been in the prior stage. Trustworthiness data collection methods were implemented to ensure the validity and reliability of the study. Two key themes emerged from the study: (A) Improved cultural competence, which encompassed empathy towards patients and their families, effective communication, prioritization of continuous learning, appropriate knowledge and awareness, sensitivity to cultural and religious beliefs, staff attitude and personality, and the delivery of customized care tailored to each patient’s needs. (B) Supporting role and compensating for disparities involved recommendations for upholding ethical standards, compensatory actions, maintaining professional behavior despite external factors, addressing gaps and deficiencies, and actively defending and supporting patients. The findings indicate that staff with high cultural competence can ethically mitigate health disparities through their supportive roles. Managers and health policymakers should create barriers to health disparity by improving staff cultural competence and knowledge about health disparities. (shrink)

The central concern of this article is whether early induction of labor for an anencephalic fetus can ever be morally justified, particularly by a Catholic healthcare ethics committee. By revisiting and refining arguments in articles by Drane (1992) and Bole (1992) published in this journal, a revised argument – consistent with the Catholic moral tradition – can seemingly be constructed that a Catholic healthcare ethics committee might use to justify early induction of labor in some pregnancies involving (...) an anencephalic fetus. Such a revised argument depends upon two central claims; first, that the anencephalic fetus in question is necessarily in the process of dying when early induction of labor occurs, and second, that the fetus is judged to be undergoing extraordinary or disproportionate means of preserving their life as a result of receiving ongoing maternal support of a mother’s womb. The revised argument developed in this article aims to utilize the doctrine of double effect in conjunction with these two central claims to justify early induction of labor for anencephalic fetal persons in some circumstances. Unfortunately, the revised argument – if successful – would be at odds with a stance taken in the United States Conference of Catholic Bishops (USCCB) 1996 statement “Moral Principles Concerning Infants with Anencephaly.” However, there is reason to believe the revised argument offered in this article is well aligned with other guidance from the USCCB, contained in the publication _Ethical and Religious Directives for Catholic Healthcare Services_ (2018). This article concludes by noting some important limitations of the argument and offering hope that consideration of the argument ultimately helps to strengthen the Catholic moral tradition. (shrink)

Geographical variations are documented for a wide range of health care services. As many such variations cannot be explained by demographical or epidemiological differences, they are problematic with respect to distributive justice, quality of care, and health policy. Despite much attention, geographical variations prevail. One reason for this can be that the ethical issues of geographical variations are rarely addressed explicitly. Accordingly, the objective of this article is to analyse the ethical aspects of (...) geographical variations in the provision of health services. Applying a principlist approach the article identifies and addresses four specific ethical issues: injustice, harm, lack of beneficence, and paternalism. Then it investigates the normative leap from the description of geographical variations to the prescription of right care. Lastly, the article argues that professional approaches such as developing guidelines, checklists, appropriateness criteria, and standards of care are important measures when addressing geographical variations, but that such efforts should be accompanied and supported by ethical analysis. Hence, geographical variations are not only a healthcare provision, management, or a policy making problem, but an ethical one. Addressing the ethical issues with geographical variations is key for handling this crucial problem in the provision of health services. (shrink)

This essay attempts to describe contemporary Catholic sponsored health care in the United States and to describe the purpose and structure of these particular Christian charitable organizations within the broader society. As health care has become more complex, critics claim that there is not a need for Catholic sponsored health care any longer. The author attempts to evaluate critically whether Catholic health care has a place in contemporary society. He (...) reviews some salient biblical, ecclesial, and justice teachings of the Church to demonstrate why religious institutional presence is still needed. The author reviews contemporary health care structures to show how this is accomplished. He also uncovers additional issues which need to be addressed in order for these charitable institutions to carry on the ministry of the Church, to shape social structures, and to proclaim the reign of God. (shrink)

Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was (...) inductive. Most participants report positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing. This focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices. (shrink)

Crowdfunding websites allow users to post a public appeal for funding for a range of activities, including adoption, travel, research, participation in sports, and many others. One common form of crowdfunding is for expenses related to medical care. Medical crowdfunding appeals serve as a means of addressing gaps in medical and employment insurance, both in countries without universal health insurance, like the United States, and countries with universal coverage limited to essential medical needs, like Canada. For example, as (...) of 2012, the website Gofundme had been used to raise a total of 8.8 million dollars for seventy-six hundred campaigns, the majority of which were health related. This money can make an important difference in the lives of crowdfunding users, as the costs of unexpected or uninsured medical needs can be staggering. In this article, I offer an overview of the benefits of medical crowdfunding websites and the ethical concerns they raise. I argue that medical crowdfunding is a symptom and cause of, rather than a solution to, health system injustices and that policy-makers should work to address the injustices motivating the use of crowdfunding sites for essential medical services. Despite the sites’ ethical problems, individual users and donors need not refrain from using them, but they bear a political responsibility to address the inequities encouraged by these sites. I conclude by suggesting some responses to these concerns and future directions for research. (shrink)

The Ethical and Religious Directives (ERDs) do not currently address brain death (BD) or medical, professional, and conscience objections. Accordingly, Catholic practitioners, patients, and their families are continually caught in the controversies and confusion surrounding BD and the organ procurement process. Therefore, this essay petitions the US bishops to include a new directive in the next edition of the ERDs that (1) recognizes the moral uncertainty and dubious medical practice surrounding BD and (2) allows families and (...) surrogates and practitioners to object—based on conscience, on medical or professional grounds, and via informed refusal— to the BD tests or (at least) the BD organ procurement process. This essay provides justification for such a directive, proposes potential language, and explores how it could look in practice. (shrink)

In order to care ethically nurses need to care holistically; holistic care includes religious/spiritual care. This research attempted to answer the question: Do nurses have the resources to offer religious care? This article discusses only one aspect - the provision of religious care within the Taiwanese health care system. It is assumed that, if hospitals do not provide enough religious services, nurses working in these hospitals cannot be (...) fully ethical beings or cannot respect patients’ religious needs. The relevant literature was reviewed, followed by a survey study on the provision of religious facilities and services. Aspects considered are: the religions influences in and on Taiwanese society; the religious needs of patients and their families; strategies that patients use to enable them to cope with their health care problems; professional motives for attuning to patients’ religious needs; and hospital provision for meeting the religious and spiritual needs of patients. A survey of nursing executives showed differences between religious service provision in hospitals with and without a hospice ward. The practical implications for hospital management and nursing practice are discussed. (shrink)

Background: In Hospital Emergency Department and Emergency Medical Services professionals experience situations in which they face difficulties or barriers to know patient’s advance directives and implement them. Objectives: To analyse the barriers, facilitators, and ethical conflicts perceived by health professionals derived from the management of advance directives in emergency services. Research design, participants, and context: This is a qualitative phenomenological study conducted with purposive sampling including a population of nursing and medical professionals linked to (...) Hospital Emergency Department and Emergency Medical Services. Three focus groups were formed, totalling 24 participants. We performed an inductive-type thematic discourse analysis. Ethical considerations: This study was approved by ethical committees of Ethical Commitee of Clínic Hospital (Barcelona) and Comittee of Emergency Medical Services (Barcelona). The participants received information about the purpose of the study. Patients’ anonymity and willingness to participate in the study were guaranteed. Findings: There were four types of barriers that hindered the proper management of patients’ advance directives in Hospital Emergency Department and Emergency Medical Services: personal and professional, family members, organisational and structural, and those derived from the health system. These barriers caused ethical conflicts and hindered professionals’ decision-making. Discussion: These results are in line with those of previous studies and indicate that factors such as gender, professional category, and years of experience, in addition to professionals’ beliefs and the opinions of colleagues and family members, can also influence the professionals’ final decisions. Conclusion: The different strategies described in this study can contribute to the development of health policies and action protocols to help reduce both the barriers that hinder the correct management and implementation of advance directives and the ethical conflicts generated. (shrink)

Health care institutions, including Roman Catholic institutions, are in a time of crisis. This crisis may provide an important opportunity to reinvigorate Roman Catholic health care. The current health care crisis offers Roman Catholic health care institutions a special opportunity to rethink their fundamental commitments and to plan for the future. The author argues that what Catholic health care institutions must first do is articulate the nature (...) of their identity and their commitments. By a renewed commitment to the praxis of health care on their own distinctive terms, Roman Catholic health care institutions may reestablish a vision of human nature and human service in an increasingly secular society. Health care could then reclaim its place as a powerful setting for the expression of Roman Catholic faith, life and witness. (shrink)

In The Medical Right, Remaking Medicine in Their Image (2007) (Medical Right Report or Report), the Religious Coalition for Reproductive Choice (RCRC) applies the term "Medical Right" to refer to religiously influenced medical, bioethics and health policy organizations of the Religious Right. This extremely important, well researched Report examines how the political agenda of the Religious Right, a political force comprised of fundamentalists primarily in the Protestant and Roman Catholic traditions, impacts reproductive health (...) class='Hi'>care. The growing influence of medical associations that apply fundamentalist Christian "biblical values" to research and policy affecting reproductive health care is explored. The Report reveals that many consortiums, think tanks, institutes, and programs apply Religious Right ideology to medical concerns under the mantle of "bioethics" or "biomedical ethics." These groups work with conservative advocacy, outreach, and legal organizations, along with politicians, to advance the policy agendas of the Religious Right. The confluence of conservative politics, fundamentalist religion, and ideologically influenced medicine and science, poses a threat to reproductive health care services, as discussed in detail in the Report. While the Report is comprehensive in its discussion of the Religious Right's involvement in reproductive health issues, it addresses in only a cursory fashion how the Medical Right engages health law and policy governing end-of-life care. The purpose of this paper is to explore this area of concern more thoroughly. (shrink)

Nurses’ religious beliefs influence their motivations and perspectives, including their practice of ethics in nursing care. When the impact of these beliefs is not recognized, great potential for unethical nursing care exists. Thus, this article examines how the theology of one religious tradition, Seventh-day Adventism (SDA), could affect nurses. An overview of SDA history and beliefs is presented, which explains why ‘medical missionary’ work is central to SDAs. Theological foundations that would permeate an SDA nurse’s view (...) of the nursing metaparadigm concepts of person, health, environment (i.e. community), and nursing (i.e. service) are presented. The ethical principles guiding SDA nurses (i.e. principled, case-based, and care ethics) and the implications of these theological foundations for nurses are noted in a case study. (shrink)

The Catholic Church’s reflection on and assessment of the Covid-19 pandemic has developed in several areas. Inspired by the tradition of its social teaching, specifically by the values of the dignity of the human person, justice, solidarity, and the common good, a strong sense of responsibility—on the part of all to prevent the spread of the pandemic and care for the affected sick—was called for. This resulted in a series of interventions and documents on the various medical and (...) spiritual issues involved, particularly concerning the vaccines again Covid-19. In this short article, I draw out these insights from the official and universal reference point of the Catholic Church (i.e., Vatican sources in their various expressions and expertise). Interventions from other religions have also played a significant role during the Covid-19 pandemic as exemplified by the close relationship between certain religious actors and the World Health Organization. However, these alternative viewpoints, while important in and of themselves, do not find a suitable place within this work, which focuses on the Catholic Church’s perspective. (shrink)

This article is the third part in an examination of the Ethical and Religious Directives for Catholic Health Facilities. This installment explores the second section of the most recent edition of the ERDs, discussing what changes were made and why. It also discusses how the ERDs might change in the next edition and what issues will need to be addressed, as well as the best structure in which to present them.

As secular culture exerts pressure on Catholic health care to conform to its standards, there is need for a clear response to those who claim that the body is not constitutive of the person but can be manipulated to suit a subjective view of the self. Patients who suffer from gender dysphoria deserve our compassionate support, but "therapies" that carry out or encourage the destruction of one's natal sexuality are contrary to the Christian tradition and to the (...) teachings of the Catholic Church. This book provides the arguments, evidence, and practical advice needed for Catholic health care to resist this ideology and courageously affirm the biological reality of the person. Through careful analysis, narrative case studies, and policy language, Transgender Issues in Catholic Health Care critiques current interventions for gender dysphoria and provides practical guidance for professionals and institutions committed to providing whole-person care. -- Provided by publisher. (shrink)

The present ethical advice tackles the question as to how caregivers in a Catholic mental health service can take care of psychiatric patients requesting euthanasia because of their unbearable mental suffering. The question arises because the Belgian act on euthanasia allows euthanasia under certain conditions, while the Roman Catholic Church forbids euthanasia in all circumstances. The ethical advice is based on the assessment of fundamental values: the inviolability of life, the patient’s autonomy, and the (...) care relationship between caregivers and patient. To integrate these values, caregivers should in a timely fashion make clear that life is inviolable, attentively respect the patient’s autonomy, and provide the best possible care relationship, including counseling for existential questions. If the request for euthanasia persists, the only sensible option is to refer the patient to another physician, guaranteeing the continuity of the care relationship. In the tension between the inviolability of life and the patient’s autonomy, the care relationship is the binding value. (shrink)

Catholic health care has long been a key place where the Church embodies its social doctrine. However, the moral methodology that shapes Catholic bioethics relies on an act-based approach to decision making, which is rooted in the pre–Vatican II manualist tradition, focusing primarily on clinical issues related to the beginning and end of life. This essay argues that given the doctrinal status of Catholic social thought, Catholic bioethics must revisit its scope and methodology. It (...) proceeds in three steps: a meta-analysis of traditional Catholic bioethics, validating the claim made above; an overview of the limited literature published since 1980 engaging Catholic bioethics and CST; and a map of a Catholic bioethics informed by CST generated from a dual starting point. The essay concludes by focusing on both the places where marginalized persons encounter Catholic health care and the ethical issues presented, including race, health care disparities, immigration status, and gender inequality, as well as the interrelated perspective of the common good, expanding the array of issues to include environmental degradation, unions, health care financing, and more. (shrink)

Background In neonatal intensive care, a child's death is often preceded by a medical decision. Nurses, social workers and pastors, however, are often excluded from ethical case deliberation. If multiprofessional ethical case deliberations do take place, participants may not always know how to perform to the fullest. Setting A level-IIID neonatal intensive care unit of a paediatric teaching hospital in the Netherlands. Methods Structured multiprofessional medical ethical decision-making (MEDM) was implemented to help overcome problems experienced. (...) Important features were: all professionals who are directly involved with the patient contribute to MEDM; a five-step procedure is used: exploration, agreement on the ethical dilemma/investigation of solutions, analysis of solutions, decision-making, planning actions; meetings are chaired by an impartial ethicist. A 15-item questionnaire to survey staff perceptions on this intervention just before and 8 months after implementation was developed. Results Before and after response rates were 91/105 (87%) and 85/113 (75%). Factor analysis on the questionnaire suggested a four-factor structure: participants' role; structure of MEDM; content of ethical deliberation; and documentation of decisions/conclusions. Effect sizes were 1.67 (p<0.001), 0.69 (p<0.001) and 0.40 (p<0.01) for the first three factors respectively, but only 0.07 (p=0.65) for the fourth factor. Nurses' perceptions of improvement did not significantly exceed those of physicians. Conclusion Professionals involved in ethical case deliberation perceived that the process of decision-making had improved; they were more positive about the structure of meetings, their own role and, to some extent, the content of ethical deliberation. Documentation of decisions/conclusions requires further improvement. (shrink)

Little is known about how certain patient characteristics can affect the timing of an ethics consultation, which has been hypothesized to affect patient length of stay. This study assessed how specific patient characteristics affect the timing of an ethics consultation, namely, age (over 65 years), race, Medicaid status, the presence of a living will, the presence of a health care proxy, and the absence of decisional capacity. Moving beyond the typical case-series evaluation of an ethics consultation service, this (...) study used an innovative approach to model how predisposing, enabling, and need factors affect health behavior and subsequently affect health outcomes for patients who received an ethics consultation at a Catholic health care system in Oklahoma. (shrink)

It is nearly 20 years since Tony Hope wrote an editorial in this journal on Empirical Medical Ethics,1 arguing for both a recognition of the increasing amount of work being done in ‘empirical ethics’ and for its importance as a new direction for medical ethics research. Since then empirical ethics has flourished, with debates over the role of ‘empirical’ data in ethical reasoning producing a growing body of literature and the JME and other bioethics journals regularly publishing empirical studies. (...) While bio/medical ethics has grappled with ‘incorporating’ or using more empirical data in ethical analysis, with varying degrees of success, and some criticism, there has not been a corresponding willingness of more empirical disciplines to embrace ethical analysis. This is a particular lack for applied research areas that see their role as predominately influencing policy and practice, such as health services research. Health services research ‘is the integration of epidemiological, sociological, economic, and other analytic sciences in the study of health services.’ Whose ‘main goals … are to identify the most effective ways to organize, manage, finance, and deliver high quality care; reduce medical errors; and improve patient safety’.2 Health services research brings together a wide variety of disciplines and would seem ideally placed to include ethics. However, if you search health services research journals and conference programmes there is very little consideration of ethics as a substantive topic and often scant attention paid to the ethical issues that might be raised by an intervention or policy. Ethics and ethical issues are generally confined to discussions over priority setting, and occasionally health technology assessment, with other areas of health service research seldom engaging in ethical debate. In the Encyclopaedia of Health Services Research,3 ethics …. (shrink)

This paper proposes an ethical framework for rationing publicly financed health care. We begin by classifying alternative rationing criteria according to their ethical basis. We then examine the ethical arguments for four rationing criteria. These alternatives include rationing high technology services, non-basic services, services to patients who receive the least medical benefit, and services that are not equally available to all. We submit that a just health care system will (...) not limit basic health care to persons unable to pay for it. Furthermore, justice in health care requires limiting publicly-financed non-basic health care, striving for equality in access to basic health care, and relying on medical benefit to ration non-basic health care. (shrink)

American health care is in the process of a significant social, institutional, and economic restructuring of the manner in which health services are provided in local communities. The Catholic health care ministry is undergoing the same sort of restructuring. The history of American health care demonstrates that the ministry has experienced at least two similar major restructurings of its institutional framework. The principle of cooperation has been the customary tool to assess (...) the moral propriety of evolving social structures in which the health care ministry has been housed. A process of discernment can lead to the conclusion that the central issue is not moral agency but rather how the ministry engages the secular culture of American society and American medicine. National Catholic Bioethics Quarterly 13.2 (Summer 2013): 263–274. (shrink)