Friday, 18 April 2014
A Few Moral Questions In Modern Health Care Practice
Ever since the case of the Catholic Midwives in Scotland (LINK) I have become concerned that devout Catholics might have to exclude themselves from the core Health Care professions (medicine, nursing and pharmacy) if conscience rights are not upheld. It is already difficult for them to practice as serious Catholics and as medics, nurses and pharmacists because they inevitably meet grave moral matter and must have conscience rights if they are to opt out.
It is right that professionals refuse to prescribe and dispense contraceptives; not only because they have abortifacient actions but because contraception is gravely wrong per se. But while contraceptives can be morally prescribed and dispensed for a woman with menstrual problems the contraceptive property is often an intended second action –can a serious Catholic ever prescribe or dispense chemical contraceptives in such cases? And will our Catholic professionals ever be obliged to do so?
Certainly many sound Catholics refer patients to a colleague, but another question arises: is it morally acceptable to refer patients on for services gravely contrary to the moral law? It seems akin to saying, “I can’t give you a lift home because I don’t drink and drive but N. does, so you might ask him/her”. Cooperation is remote and indirect in referrals, but are we guilt-free simply by passing the prescribing or dispensing responsibility on in this way?
Then there are Care Pathways for the dying. Now it is absolutely right, good and necessary to give opiates in necessary dosages to those suffering intractable, severe pain (please see end note) because the intention is to relieve the pain and anxiety, but are dosages increased precipitously without checking if smaller increases would ease the pain sufficiently for the patient to continue living in a pain-free state without excessive respiratory depression? (This question inevitably arises if we have a high percentage of people dying within 24-48 hours of an infusion being established). I have even seen such Pathways used with a Stroke victim where pain is not an issue –can this be moral at all? Finally, is withdrawing fluids ever morally justified? 500mls of fluid per day is lost simply by breathing to say nothing of the loss via the skin and urinary output, so a 500mls infusion over 24hours will not actually add respiratory or cardiac problems (and removal of fluids will not decrease any such problems), so an infusion of 500mls over 24 hours will only sustain life with comfort, not extend life, while removal of such fluids will not diminish any problems and may increase discomfort.
Those who are not part of the core health care professions must seek to ensure that practitioners in these professions have a right of refusal to cooperate with or facilitate by active referrals any act gravely contrary to the moral law (such as contraception, abortion, IVF., gender reassignment etc). We need as many sound Catholics as possible in these professions and we must make it possible for them to practice by supporting their conscience rights in our everyday conversations; by communicating with the media on pertinent topics and by petitioning Governments to ensure conscientious objection is respected and enshrined in law. We are told that patients must have non-directive counselling in order to preserve their autonomy and conscience, but what about the autonomy and conscience of the practitioner? Non-directive theory (contradictorily) directs them to put their own autonomy and conscience aside.
End Note: I do not want anyone to be troubled over the death of a loved one who had an infusion established, so I must point out that it would be morally wrong to withhold such infusions from those who are dying since it allows for a continuous pain-and-anxiety-free journey towards death. The questions arising with such infusions concern the “when” and “how much” in that journey. Remember it is entirely possible that even a single dose of an opiate may relax the dying person enough that they allow themselves to die; it does not mean their life was ended by a single injection. Many factors have to be taken into account when establishing a Pathway infusion and it is on getting the balance right that this discussion is focused.