Health Care Ethics, Fifth Edition: Health Care Ethics: A Catholic Theological Analysis

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Health Care Ethics is a comprehensive study of significant issues affecting health care and the ethics of health care from the perspective of Catholic theology. It aims to help Christian, and especially Catholic, health care professionals solve concrete problems in terms of principles rooted in scripture and tested by individual experience; however, its basis in real medical experience makes this book a valuable resource for anyone with a general interest in health care ethics.

This fifth edition, which includes important contributions by Jean deBlois, C.S.J., considers everyday ethical questions and dilemmas in clinical care and deals more deeply with issues of women's health, mental health, sexual orientation, artificial reproduction, and the new social issues in health care. The authors devote special attention to the various ethical theories currently in use in the United States while clearly presenting a method of ethical decision making based in the Catholic tradition. They discuss the needs of the human person, outlining what it means to be human, both as an individual and as part of a community.

This volume has been significantly updated to include new discussions of recent clinical innovations and theoretical issues that have arisen in the field:

� the Human Genome Project• efforts to control sexual selection of infants• efforts to genetically modify the human genotype and phenotype � the development of palliative care as a medical specialty• the acceptance of non-heart beating persons as organ donors• embryo development and stem cell research reconstructive and cosmetic surgery �� nutrition and obesity• medical mistakes � the negative effects of managed care on the patient-physician relationship � recent papal allocution regarding care of patients in a persistent vegetative state and palliative care for dying patients

Health Care Ethics, Fifth Edition: Health Care Ethics: A Catholic Theological Analysis Review

When one observes that a book has gone through five editions in a period of approximately thirty years, the question arises as to the need or usefulness of yet another re-presentation by the same authors on identical topics. (N. B. These authors also have published three editions of a similar but simpler work, Ethics of Health Care, directed more toward a student or non-specialized readership.) The need for this book is made evident by the ever-increasing rapidity of developments in biotechnology which call for renewed investigation and application of ethical principles as new interrogatives surface. The usefulness of this edition (for the first time with Sister deBlois as a co-author) derives also from the fact that the level of the discourse is located somewhere between the more sophisticated theological analysis of the four previous editions and the less detailed approach of the simpler introductory handbook. An even greater distinction of this book is its clarity about bioethical matters in a world which often is confused and led about by not much more than the latest politically correct opinion.
The three principal divisions of the book may be described as treating of: ethical theory and its relationship to health care, clinical applications and social-pastoral approaches to health care and the sick.
In Part One, amidst a presentation of a variety of approaches to the foundations of ethics, the authors remain anchored in what they term as prudential personalism. With such a methodology, the good of the person is sought by the prudent application of moral principles. This is described not as a strictly deontological (duty-based) formula but more of a teleological (ends-means) system whereby choices are guided by that which will bring the moral agent to the achievement of the goal of personal existence. It is in this context that the inherent attractiveness of natural law theory is amplified since it corresponds to concepts which seek the fulfillment of the true good of our common human nature. Thus, the role of reason in ethical decision-making also finds a noble place along with a virtuous character in the moral armamentarium of the believer.
The Catholic moral system regarding these matters is described by demonstrating the role of the Magisterium as teacher (also for theologians). On page 25 the following statement is made: "In general it can be said that the moral teaching of the Church for the most part is infallible by reason of the fact that the universal ordinary teaching authority of the bishops has confirmed it as the teaching of the Church." A separate volume would be required to determine further the implications of such a statement. Double effect, cooperation, consent and confidentiality are highlighted as particularly relevant to health care decisions.
In Part Two, the authors succeed admirably in grouping numerous topics into four major categories: sexuality/reproduction, bodily reconstruction/modification, mental health and suffering/death. Valuable reasoning is provided in support of the personhood of the human embryo and the resultant respect it is to be accorded. The link between human sexuality and life issues is evidenced amply in the treatment of such matters as contraception, abortion and artificial generation of human life. Debated topics such as the management of ectopic pregnancies and the treatment of rape victims are discussed; the authors' conclusions are surely subject to further analysis.
With the ongoing development of medical and surgical techniques, interventions on the human body now have taken on a multiplicity of forms. Beginning at the genetic level and stem cells, the body is subject to manipulations such as cosmetic surgery, experimentation, enhancements and organ transplantation from living or dead persons. The authors deal with these topics in the context of therapeutic liceity while excluding attempts at the alteration of human nature itself.
As a result of many factors associated with modern living, more attention is directed these days to the preservation or restoration of mental health. The authors, while recognizing the value of many discoveries of mental therapy, maintain that this "level" of the human person must be considered in the overall context of Christian anthropology. Medical models and pharmacotherapy are evaluated alongside the various approaches in psychotherapy and the contribution of each toward developing the proper functioning of human freedom while respecting ethical boundaries is brought forth.
Our human condition brings along with it the reality of suffering and inescapable death. Both of these must be faced from a spiritual perspective but also require ethical guidance in patient management. It comes as no surprise that euthanasia and physician-assisted suicide are seen as thoroughly illegitimate. Palliative care and hospice are appreciated as moral means of caring for those in the final period of their lives. The general question of which treatments are optional or obligatory is well presented with much attention given to the debate over the provision of artificial nutrition and hydration to those in the so-called persistent vegetative state (PVS). The position outlined by the authors (p. 197) led to a clarification by the National Catholic Bioethics Center of their own position (see [...] More recently, the prolonged debate over related matters also led to a statement from the Vatican Congregation for the Doctrine of the Faith (see [...]
Part Three addresses topics of a different nature. Increasingly, basic health care is seen as an undeniable human right. Consequently, society must align policies in such a way as to include its provision in efforts to promote social justice. This field is an area of intense debate and scrutiny even in the wealthiest countries of the world. Many theories exist as to the most favorable means of implementing such policies and the authors add their recommendations while delineating also the obligations incumbent upon medical professionals and citizens to make their own contribution. In conclusion, the book pinpoints the spiritual/pastoral care of patients as the linchpin of a holistic ethical approach to health care.
Finally, it can be said safely that this is among the best books on Catholic Bioethics available in English. Faith and reason find a marvelous blend within its pages. Each chapter begins with an overview and ends with a conclusion. One could learn much just by reading those brief paragraphs. One could hope for a more careful proofreading if there is yet another revised edition.

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