Futile Care Policies and Catholic Health Care
Wesley Smith’s First Things column on the danger of hospital futile care policies sounds an alarm (Proposed Futile Care Hospital Policy Would Allow Committees to Overrule Patient Advance Directives). Smith is rightly concerned that a model Futile Care Protocol is to be promoted in the forthcoming issue of the Journal of Law and Medicine. A key element is to make sure that patients and their families understand that the hospital will always have the last word on medical treatment.
I think it helps to have gone through the experience of the hospitalization and death of an aged parent (or something similar) to gain a better grasp of the issues at stake here. At times we who are pro-life can talk too easily about the hard and fast moral requirements of end-of-life care, acting as if death were an unthinkable alternative. But this should not be the case for a Christian.
At the same time, there can be no question that irreligious people, who in most cases are not pro-life, have a strong tendency to gravitate toward one of two extremes: Either they wish to prolong their own lives at all costs because they really do believe that death is the end of everything; or they wish to take the easiest way out, either for themselves or for others, because they have no sense of the redemptive value of suffering.
If anyone thinks that is too broad a generalization, I’m willing to take the risk. These are both essentially pagan responses, and as the last traces of Christian morality fade away in the West, pagans are rapidly losing whatever Christian cultural conditioning they may have had. That’s why we see such rapid moral change these days. People are reverting to their own resources, and drawing all the logical conclusions. They are acting consistently with their mistaken beliefs.
What Christian patients should want first and foremost is medical care according to Christian principles. Hospitals run by those who accept Catholic teaching about life, death and end-of-life care (insofar as this is subject to clear teaching) will securely place their patients in the proper moral context. This is essential to the peace of mind of Christian patients and their families.
This is even more important precisely because end-of-life issues are so very frequently difficult to address. It is hard enough for a patient to decide how hard he wants to fight a disease (cancer, for example), and it is harder still when the decision is forced upon loved ones because of a patient’s mental disability. It is also increasingly difficult to control costs and to allocate expensive resources. We are conditioned by our affluent society to expect everything, but it seems clear that our medical technology, our high levels of hospital care, and the bureaucratic nature of everything modern are combining to drive the costs of care beyond what even an affluent society can afford, or at least beyond what most citizens are willing and able to spend. So end-of-life care decisions are really not so simple after all.
But where decisions must be made, somebody must make them. So the question becomes, “Who?” In our own culture there seems to be only one claimant to the moral throne Christianity used to hold: Utility. This will never bring peace of mind to anyone, let alone virtue. Instead, if we do not wish it already, we certainly ought to yearn to die within a Christian moral framework, so that the available options are all within the range permitted by God’s law.
Now as far as what forms of care are desired, the patient (within the limits of the Christian model) certainly remains free to decide. If someone else must act on behalf of the patient, generally a family member, it seems clear that the decisions should be made (again, within the limits of the Christian model) according to the patient’s wishes, insofar as these are known.
But as far as the availability and application of medical resources, clearly the patient and his family are not in a position to make the final determination. Once again within the limits of the Christian model, hospital staff cannot escape making those decisions. A particular treatment is available or it is not available; it can be provided or it cannot, or perhaps for only so long. There is no “right” to a certain type of difficult or expensive treatment and, in any case, rights do not produce capabilities.
All of this is simply further evidence of the need for strong Catholic health institutions, institutions which will increasingly distinguish themselves precisely through the moral framework governing their standards of care. In the United States at least, it is very common for hospitals to compete for patients by advertising their superiority in this or that respect, from specialty care to room quality to food service. In the cold future, we may hope that some hospitals will gain an edge by advertising Christian policies for end-of-life care. Make no mistake: As culture becomes more pagan and as the Church reforms her own health institutions, the difference that Christianity makes in health care is going to become readily apparent once again.
Christians need such institutions for their own peace of mind, and when push comes to shove, many non-Christians will choose them, too, rather than put themselves at the mercy of somebody else’s idea of convenience. We can accept that end-of-life decisions may be very difficult, and we ought to be able to accept that every conceivable care option might not, for any number of reasons, be available to ourselves or our loved ones. But though the various decisions may be difficult, we must work to ensure that the available options be limited to those and only those which fit within a Christian moral framework.
Or let me put it another way, to which many who have not yet faced end-of-life decisions can more easily relate. How many young mothers have been pressed to contracept or even to abort by medical staff every time they have been in a hospital giving birth? I do not want morally equivalent treatment for a loved one who is very ill or very old. And when it comes my turn to be old and sick and quite possibly depressed, I do not want to face morally equivalent temptations myself.
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Posted by: brenda22890 -
Mar. 18, 2011 12:33 PM ET USA
First, Dr. Mirus, let me say how much I appreciate your commentary on the culture. As the current article demonstrates, it is often not easy to think clearly about the cultural climate we are faced with. My father and I were pressed by hospital staff 11 years ago about withdrawing care from my mother. We did not relent, and to the best of our knowledge, she died naturally. We will really never know as we were not at the hospital 100% of the time. It is a possibility that haunts.