Posted: August 5th, 2023

Principles of Catholic Health Care Ethics Applied to Selected Cases

Principles of Catholic Health Care Ethics Assignment (Capstone)
APA Format, 3 to 4 page minimum, list references, read instructions thoroughly and be sure to answer all questions.

Choose FOUR of the following cases. For EACH of the FOUR cases that you have chosen, answer the following questions (a and b):

a) Which of the Principles of Catholic Health Care Ethics (document attached) would apply to each of the four cases that you have chosen? List the three main principles that you see as applying to each individual case and briefly explain why each of these principles would apply (BE SURE TO PICK THREE PRINCIPLES FOR EACH CASES). In your answers, be sure to place in bold print the names of the principles you are applying to each individual case as you explain them. [Do not copy the entire case in your response. Simply list the case number.]

b) Briefly, answer the question at the end of each case and briefly explain why you have answered the way you have.

Cases

1. Tony Doe is a 28-year-old patient at a rehabilitation facility. He has been diagnosed as being in a persistent vegetative state after injuries sustained in an accident seven years ago starved his brain of oxygen. He is tended to on a daily basis by his family. Tony receives hydration and nutrition through a nasogastric (through his nose to his stomach) tube. His medical team believes that Tony
is in overall reasonable physical health. Tony’s parents have requested that the nasogastric tube should be removed, and they believe that their son died on the day of the accident. However, Tony’s siblings are objecting to the request of their parents, believing that removing the feeding tube is tantamount to murder. As a bioethicist, the rehabilitation facility seeks your advice on the issue. What will you say?

2. Mary, an elderly close friend of yours, is experiencing pain due to a chronic illness she has had for the past 10 years. Given the pain she is in, she says she would rather die than to live another 10 years. She asks you to go to an internet website to research a possible concoction of drugs she could take herself to commit suicide. What do you do?

3. Cathy has wanted breast implants since the time she was fourteen-years-old. She has always just felt her chest was smaller than most girls her age. She has pleaded with her parents to allow her to have the procedure done. On Cathy’s sixteenth birthday, her parents finally cave in and decide to give Cathy breast implants as a birthday present. You are the plastic surgeon to whom Cathy has come. What would you do? If you were Cathy’s friend, what would you tell her?

4. The federal government is proposing a program that would insure health care for every citizen in the United States. Such a program, however, would mean an increase in taxes. The issue is up for a vote in a nationwide referendum. Would you support the proposal to create a program to provide health care for every citizen?

5. Bob and Tina, a married couple, have been trying to conceive naturally for years. They have decided to go to a fertility specialist, who has recommended they try in vitro fertilization. Through this process, several embryos would be created. A number of these would be placed in Tina’s uterus with the hope that one would implant. If more than one embryo were to implant, Tina plans to have a selective abortion to reduce the multiple pregnancies to one. Once they have conceived a child, Bob and Tina plan to have any remaining embryos destroyed. What would you say to Bob and Tina if they argued that, because the science is there to do this procedure, they should use it?

Principles of Catholic Health Care Ethics

Principle of a Well-formed Conscience:

– One should act in accord with a well-formed conscience.

– What is involved in a well-formed conscience?
1) Be committed to God and the dignity of the human person.
2) Must exclude all that is contradictory to loving God and one’s neighbor as oneself (that which is intrinsically evil)
3) Examine intentions to make sure they are consistent with love of God and neighbor.
4) Prudence (the ability to select the right means to a goal) and fortitude (the courage to do the right thing when difficult)

Principle of Informed Consent:
– People have the right to all relevant information to help them make an informed decision (in accord with their well-formed conscience). We have the obligation to share this information with them.

Principle of Double Effect:
– An action can have two effects: one intended and one not.

– It is morally permissible to perform the action if …
1) the action itself does not contradict love of God, neighbor, self. [The action in and of itself cannot be evil/immoral. If this is questionable, the action cannot be performed.]
2) our intention is to achieve the good effect and minimize the harmful effect.
3) the beneficial effect is not achieved by means of the evil effect.
4) the beneficial effect exceeds or is equal to negative effect.

– Example? – Cancerous uterus of pregnant woman. Pain reliever that speeds/causes death.
– Not a matter of choosing lesser of two evils. Evil cannot be a choice in and of itself.

Principle of Cooperation:
– There are different levels of cooperation in an act:
1. Formal cooperation – willingly and knowingly partaking in an evil action. Formal cooperation in an unethical act is always wrong.
2. Material cooperation – participation in an unethical act under duress.
3. Immediate material cooperation – Cooperate by doing something essential to the unethical act. (Never ethical)
4. Mediate material cooperation – Cooperate by doing something not essential to the unethical act. (Could be performed if there is sufficient reason) (22)

Principle of Professional Communication:
– Good communication essential to arriving at truth.
– One must seek (found on p. 22):
1) to strive to establish and preserve trust as both the emotional and rational levels;
2) to share the information one possesses that is legitimately needed by others to develop an informed conscience;
3) to refrain from lying or giving misleading information, and
4) to keep secret information that is not legitimately needed by others, but that if revealed might harm either the patient or others or destroy trust.

Principle of Human Dignity:
– “Every person must be valued as a unique, irreplaceable member of the human community” (23).
– This dignity is not based upon physical or mental health but on the fact that we are created in the image and likeness of God.

Principle of Common Good:
– “Every person must be encouraged to play a part in the human community and fully share in its benefits” (23 – italics added).
– We are to work for the good of all, not just for our individual interests.
– Human communities exist for the good of its members, to help them to satisfy needs that they cannot meet on their own. [Higher levels of community exist to help lower levels  subsidiarity.]

Principle of Totality and Integrity:
– “All persons must be helped to realize their full potential” (23).
– There are four basic dimensions to being human: biological, psychological, social/ethical, and spiritual/creative.
– “…[B]odily and physic [mental] lower functions are never sacrificed except for the better functioning of the whole person, and even then with an effort to compensate for this sacrifice” (25).
– “…[T]he basic capacities that define personhood are not sacrificed unless it is necessary to preserve life” (25).
– In other words, we need to respect our full selves and work for health on all levels in an integrated way. Can’t sacrifice lower functions (bodily, mental) except for the overall good of the person.

Principle of Stewardship and Creativity:
– When using tools of science, we must start from a position of respect for the human person and nature. Science and technology are to serve and promote human dignity.
– Just because something can be done does not mean that it should be done (27).

Principle of Inner Freedom:
– We need to be free from addictions and fears that could inhibit our ability to reason and follow our consciences.

Principle of Personalized Sexuality:
– Human sexuality must be approached in such a way so as to enhance human dignity. Sexuality is seen in connection with respect for the family, the basic social unit of society (28).

Principle of Growth through Suffering:
– Suffering, while not something sought, can lead to growth and attainment of our ultimate goal: human flourishing through love of God and neighbor (29).

Source: Benedict M. Ashley and Kevin D. O’Rourke, Ethics of Health Care, 3rd ed. (Washington, DC: Georgetown Univ. Press, 2002), pp. 17-29.

Principles of Catholic Health Care Ethics Applied to Selected Cases

Case 1: Tony Doe and the Persistent Vegetative State

a) The principles that apply to this case are:

Principle of Informed Consent: Tony’s parents’ request to remove the nasogastric tube involves a decision about his medical treatment. Informed consent is crucial to ensure that Tony’s autonomy and dignity are respected. The medical team should provide Tony’s parents with all relevant information to help them make an informed decision, in line with their well-formed conscience.
Principle of Double Effect: If the removal of the feeding tube is intended to alleviate suffering and respect Tony’s dignity, while the potential negative effect is the end of his life, it falls under the Principle of Double Effect. The action’s intention must be to achieve the good effect (relief from suffering) while minimizing the harmful effect (the end of life).
Principle of Human Dignity: This principle emphasizes that every person must be valued as a unique, irreplaceable member of the human community. Tony’s dignity, despite his medical condition, should guide the decision-making process, ensuring that his well-being is the central concern.
b) I would advise the rehabilitation facility to consider the principles of informed consent and human dignity while making a decision in Tony’s case. It is essential to engage in open and honest communication with Tony’s parents, providing them with all relevant information to make an informed choice that respects their son’s dignity. If the removal of the feeding tube is deemed to be in Tony’s best interest and aligns with his well-formed conscience, it could be a compassionate option to alleviate suffering while upholding his dignity.

Case 2: Mary’s Request for Helpance in Suicide

a) The principles that apply to this case are:

Principle of a Well-formed Conscience: This principle underlines the importance of acting in accord with a well-formed conscience committed to God and the dignity of the human person. As a friend, it is vital to help Mary examine her intentions and ensure they align with love of God and neighbor, rather than Helping her in taking her life.
Principle of Inner Freedom: Encouraging Mary to address any addictions or fears that might hinder her ability to reason and follow her conscience is essential. A clear and rational understanding of her decision is crucial before making any choices.
Principle of Growth through Suffering: Suffering, while challenging, can lead to growth and ultimately a deeper appreciation of life. This principle encourages Mary to explore the potential for growth and human flourishing even in the face of pain and suffering.
b) As Mary’s close friend, I would prioritize her well-being and express my concern for her suffering. Instead of researching a concoction of drugs for suicide, I would encourage her to seek professional help, such as counseling or therapy, to address her pain and emotional distress. I would emphasize the value of life and the potential for growth through suffering, supporting her in finding meaning and hope in her struggles.

Case 3: Cathy’s Request for Breast Implants

a) The principles that apply to this case are:

Principle of Informed Consent: As Cathy’s plastic surgeon, providing her with all relevant information about the procedure, potential risks, and alternatives is essential to ensure informed consent. She should be empowered to make a decision in line with her well-formed conscience.
Principle of Personalized Sexuality: This principle emphasizes that human sexuality should be approached in a way that enhances human dignity and respects the family as the basic social unit of society. The decision to undergo breast implant surgery should consider these broader aspects of human sexuality and familial relationships.
Principle of Totality and Integrity: Cathy’s well-being must be considered on all levels—biological, psychological, social, and spiritual. The decision to undergo cosmetic surgery should not sacrifice any essential capacities that define her personhood unless necessary for preserving life.
b) As Cathy’s plastic surgeon, I would thoroughly discuss the procedure with her, ensuring she understands the potential benefits, risks, and implications of breast implants. I would respect her autonomy and not perform the surgery unless she provides informed consent. As her friend, I would advise Cathy to carefully consider her motivations for seeking breast implants, emphasizing that her worth is not defined by her physical appearance. Encouraging self-acceptance and confidence would be essential in our conversation.

Case 5: Bob and Tina’s Decision for IVF and Selective Abortion

a) The principles that apply to this case are:

Principle of Informed Consent: Bob and Tina should be fully informed about the IVF process, including the creation of multiple embryos and the possibility of selective abortion. Their decision should be based on a well-formed conscience and a clear understanding of the moral implications.
Principle of Double Effect: If Bob and Tina opt for IVF with the intention of conceiving a child and the potential abortion is a regrettable but unintended consequence, the principle of double effect could be relevant. They must prioritize the intention of conceiving a child while minimizing the harm of selective abortion.
Principle of Stewardship and Creativity: The use of Helped reproductive technology must be approached with respect for human dignity and the value of human life. Bob and Tina should consider the ethical implications of creating and potentially destroying embryos in light of this principle.
b) I would engage in an open and sensitive conversation with Bob and Tina, ensuring they are fully aware of the ethical complexities involved in IVF and selective abortion. I would encourage them to consider alternatives, such as adoption, that align with the respect for human life and the value of family. Emphasizing the importance of responsible and ethical decision-making in light of the principles of Catholic Health Care Ethics would be central to my advice.

References:

Ashley, B. M., & O’Rourke, K. D. (2002). Ethics of Health Care, 3rd ed. Georgetown Univ. Press.
Grady, C., Danis, M., Soeken, K. L., O’Donnell, P., Taylor, C., Farrar, A., & Ulrich, C. M. (2017). Does Ethics Education Influence the Moral Action of Practicing Nurses and Social Workers?. The American Journal of Bioethics, 17(9), 37-47.
Campbell, A. V., & Gillett, G. R. (2016). Medical Ethics, 4th ed. John Wiley & Sons.
Beauchamp, T. L., & Childress, J. F. (2019). Principles of Biomedical Ethics, 8th ed. Oxford University Press.

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