Bishop's Blog

Making Ethical Decisions

A farmer hired a man to work for him. He told him his first task would be to paint the barn and said it should take him about three days to complete. But the hired man was finished in one day.

The farmer set him to cutting wood, telling him it would require about 4 days. The hired man finished in a day and a half, to the farmer's amazement.

The next task was to sort out a large pile of potatoes. He was to arrange them into three piles: seed potatoes, food for the hogs, and potatoes that were good enough to sell. The farmer said it was a small job and shouldn't take long at all. At the end of the day the farmer came back and found the hired man had barely started.

"What's the matter here?" the farmer asked. "I can work hard, but I can't make decisions!" replied the hired man.

All of us are called to make decisions. One of the existentialist philosophers even said that "we are condemned to choose." Some people hope and pray that if they delay or stall long enough that either the problem will get resolved on its own or mysteriously disappear. Experience would seem to suggest that this rarely works. Most of us need to discern and it's hard to improve upon the old discernent process of SEE, JUDGE, and ACT and to do so in prayer and quiet reflection.

SEE - identify the problem, name it clearly, where is the conflict. What are my "gut" reactions, biases, and loyalties?

JUDGE - consider the alternatives, examine the values, evaluate the alternatives, what principles are involved, what consequences?

ACT - articulate the decision and implement the plan.

Our Catholic tradition has always respected the role of both faith and reason in ethical discernment. The teachings of the faith are not contrary to reason, nor is the use of reason a denial of the need of faith for deeper spiritual insight and significance. The magisterium or teaching authority of the church provides the authoritative interpretation of the moral law, based upon Sacred Scripture, natural law and tradition. In this way, the individual's conscience, with its limitations, avails itself of the accumulated wisdom of the Church.

The Catholic Health Alliance of Canada in the 2012 Health Ethics Guide summarized some important interpretive principles that aid in interpreting particular kinds of moral situations.

1. Burden and benefit - This principle states that we are not obliged to begin or continue treatments that offer no reasonable hope of benefit, or that may constitute a grave burden, excessive pain, suffering, expense or other serious inconvenience to the person or to those who are responsible for their care. The principle is often expressed in terms of treatment being ordinary/extraordinary, proportionate/disproportionate, beneficial/non-beneficial, etc.

2. Double effect reasoning - Some human actions have both a beneficial and a harmful result, e.g., some pain treatment for a terminally ill person might carry a possibility of shortening life, even though it is given to relieve pain and is not intended to kill the person.

Five conditions are cited for trying to decide if such actions would be morally permissible:

  1. The action of the person must be morally good or at least neutral in itself.
  2. There are two anticipated outcomes for the action of the person, one intended and good, the other an unintended but foreseen evil.
  3. The evil effect is not the means to the good effect.
  4. There must be a proportionate reason to accept the evil effect.
  5. There must be no less-negative alternative.

3. Totality and integrity - A part of the body may be sacrificed to save the whole. For example, an organ may be sacrificed if it is the only way to prevent the death of the person. The moral tradition of the Church provides safeguards to protect against causing unjustified harm. The principle of totality points to a safe exception to the principle that one may not cause harm. Because the good of the whole is greater than the good of the part, it is justifiable to sacrifice the part for the whole. The Catholic tradition has limited the application of this principle to cases where the only function of the part is to serve the whole. For example, the eye has no function apart from being part of a living body. The tradition does not allow the principle of totality to be applied indiscriminately when the part has a proper function apart from the whole, as is the case of persons, who besides serving the state of which they are a part also have a value as individuals.

4. Subsidiarity - Decisions and functions ought to be handled by the smallest, lowest or least centralized competent authority.... As applied to health care needs, the principle suggests that the first responsibility for meeting these needs resides with the free and competent individual. Individuals, however, are not completely self-sufficient. Usually, they can achieve health and obtain health care only with the help of their family members, their caregivers and the community. The responsibility of fulfilling those needs that the individual cannot achieve alone must be assumed by larger or more complex groups, e.g., community organizations and different levels of government, without resorting to "micro-managing," which is contrary to the principle of subsidiarity.

Many years ago, while being interviewed by Bishop Sherlock as part of his search for a new Seminary Rector, he asked me - "Can you think of any quality that you have that these other priests might not have?" I said "No, they are all smarter than I am." But then, I added: "All I know is that I can make tough decisions and sleep well at night, but I don't want the job." I got it anyway!  

☩ Frederick Henry
Bishop Emeritus

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Supreme Surrealism

The "Supreme" Court has ruled the nation's law against assisted suicide is unconstitutional, and gave Parliament one year to craft a legislative response. The "Supreme" Court decision regarding assisted suicide is extremely disappointing and more than a bit surreal. It has the disorienting, hallucinatory quality of a dream, unreal and fanciful.

I, obviously mistakenly, thought that there would have to be some incontrovertible or almost divine-like intervention to reverse its earlier position in Rodriguez v. B.C. (Rodriguez). It is quite a stretch to argue that this was necessary because of a different "matrix of legislative and social facts." The differing matrix needs to be proven, not assumed. It is far from self-evident as it ignores the clear, unchanged Parliamentary consensus opposing assisted suicide.

Between 1991 and 2012, nine private member's bills were introduced in the House of Commons seeking to amend the Criminal Code to decriminalize assisted suicide or euthanasia. Six were voted on and all failed to pass. When considering the "matrix" of legislative facts, the Court gave weight to legislative developments in Belgium, Switzerland, Oregon, Washington and the Netherlands, but ignored the legislative record of Canada's Parliament.

While insisting that the "matrix of legislative and social facts" has changed since the last ruling on this issue, the "Supreme" Court acknowledged that "physician assisted dying remains a criminal offence in most Western countries." Nevertheless, the Court chose to align itself with the minority of jurisdictions which allow physician assisted suicide.

If you have read this far, you will have noted that I have put quotation marks around the word "Supreme." Nothing has changed morally despite the recent decision of the Court! There is no right to physician assisted suicide.

Assisted suicide or helping some one to take his or her own life, usually a sick person who wishes to commit suicide but is physically unable to do so is never morally permissible, for it violates the prohibitions of taking innocent human life [cf. Catechism of the Catholic Church, n. 2281-2282].

The noble arts of medicine must be employed in the service of life. The medical community has traditionally refused to participate in any act of physician-assisted suicide or euthanasia. The Oath of Hippocrates, dating from the fourth century, BC, states "I will neither give a deadly drug to anybody who asks for it, nor will I make a suggestion to that effect." Physician assisted suicide is fundamentally incompatible with the physician's role as a healer.

There can be no question that advanced technologies have enabled physicians to preserve human life beyond what is morally obligatory, and the abuse of technology has led some to embrace physician assisted suicide and euthanasia.

The prospect of a prolonged and painful illness, under the dominance of technological devices that only extend the dying process, rightly alarms all who wish to die a peaceful and natural death.

Catholic moral teaching recognizes that there is a definite limit to the medical treatment that a patient is morally bound to accept. The governing principle is that "no moral obligation to have recourse to extraordinary measures exists; and that, incidentally, a doctor must follow the wishes of the sick person who refuses such measures" [Cor Unum, Questions of Ethics regarding the Fatally Ill and the Dying, 1981].

As a rule, extraordinary means of preserving life may be abandoned at any time (whether one is dying or not), and the use of comfort measures that unintentionally hasten death may sometimes be permissible.

The Congregation for the Doctrine of the Faith in 1980 issued a Declaration on Euthanasia that presented four points that can serve as a thumbnail sketch of the proper grounds for refusal of burdensome treatment:

  • If other alternatives are not available, one may make use of the most advanced, even if still experimental, medical procedures.
  • One may also refuse or cease to use extraordinary means if the benefits they provide fall short of expectations.
  • One may make do with the ordinary means available and refuse all extraordinary means. "Such a refusal is not the equivalent of suicide; on the contrary, it should be considered as an acceptance of the human condition, or a wish to avoid the application of a medical procedure disproportionate to the results that can be expected, or a desire not to impose excessive expense on the family or the community."
  • When death is imminent one may "refuse forms of treatment that would only secure a precarious and burdensome prolongation of life."

☩ Frederick Henry
Bishop Emeritus

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