Episode 13: Catholic and Religious Directives

Episode 13: Catholic and Religious Directives



hi my name is Marie Roman Yano founder of healthcare professionals for divine mercy I'm so happy to present to you our educational conferences that integrate medicine bioethics and the spirituality of divine mercy in patient care for healthcare professionals because of their importance even if you're not a medical professional we invite you to join us today I wish to summarize a conference presentation by His Excellency Robert McManus Bishop of the Diocese of Worcester Massachusetts and a member of the American bishops Subcommittee on health care who in his talk titled Catholic and religious directives outlines for us the Catholic teaching in regards to beginning and end-of-life issues the Holy Scripture gives witness to Jesus is concerned for the sick and dying He healed a leopard brought back a young girl to life and healed the hemorrhaging of an elderly woman thus the Catholic Church has always considered the fundamental importance of its healing ministry as rooted in Jesus's ministry initially this was done by religious brothers and sisters but is now done primarily by lady one cannot be called the Catholic institution unless approved by the local bishop and this designation may be removed if it does not follow the Church's teachings with regards to life the most fundamental concept is that we are created in the image of God the body is created by the marital act in the soul by God the soul is immortal and not destroyed by death Bishop McManus discusses ethical relativism and noted that there are certainly acts that are intrinsically evil he reviews three forms of relativism pragmatic relativism if it works and is successful we should do it consequential relativism the end justifies the means motive ISM whether it is right or wrong depends on how the person feels about it the Church teaches objective moral truth regarding the beginning of life issues one must recognize the sanctity of human life and that what is technologically feasible is not always morally right the marital act is both unitive and procreative and must not be separated in vitro fertilization and surrogate motherhood separate these two parts another area that he discusses is direct and indirect abortion the former is never permitted as the procedure and intent is to kill the child examples of an indirect abortion include a miscarriage and ectopic pregnancy the ectopic pregnancy will cause the mother's death if untreated if treated the primary intent is to save the mother's life by excision of the fallopian tube the side effect of the embryos death is foreseen but not the primary reason for the procedure and that is morally acceptable Bishop discusses end-of-life issues particularly definitions of ordinary and extraordinary care and proportionate and disproportionate care as it relates to food and hydration he closes with a quote from Saint John Paul the second when speaking to health care professionals in the Jubilee year cure if possible comfort always let us listen to Bishop McManus as he speaks on this very important topic for today's family caring for the most vulnerable among us thank you Thank You Marie good morning everybody I suppose I should apologize at the beginning because I do not have a PowerPoint presentation and that's the state of the art now but I'm in the old school and so I'm just going to do a few random thoughts well the first thing I want to do is so set of theological context or a church context for healthcare professionals like yourself and the ministry that you carry out in the name of the church the first is that if we look at Sacred Scripture it is very very clear that's the miracles of Jesus are indications of his concern for the sick and suffering of his own time he cleansed lepers he restored speech to the mute man he cured of women a woman of chronic hemorrhaging he brought a young girl back to life and he cured this you remember Simon Peters mother of a desperate fever so with his public ministry the public ministry of Christ integral to that ministry was healing and as Catholics obviously we believe that the salvific mission of Christ has been confided to the church that he founded and built it on the rock of Peters faith and so this patna salvific mission of Christ this on in history through the Ministry of the church and an integral part of the church's ministry for centuries has been the healing miss in ministry so we have to realize that in our Catholic health care systems today the what we do as healthcare professionals is rooted in the Ministry of Jesus within the community of the church today historically it was religious women and men sisters and brothers and sometimes what does a priest that they're charism was to heal the sick and they institutionalize this charism of healing in in their own order and it's establishing the what we know today as hospitals and places of care and also within the history of the church it has become the responsibility now especially with the did mission of the number of men and women religious specifically those who are doing a health care many of the auditors who did have hospitals or health care facilities they've passed that on to to laypeople and I'll say brief if I have time is at the end of the my presentation I'll talk what it's being called during a juridic persons that now sort of have assumed the charism that was originally exercised by religious men and women so now fundamentally Catholic health care ministry is fundamentally a lay type of ministry it also it has become a incumbent upon the bishops to take a very active role in the oversight of health care ministry no institution according to church law no institution in any diocese can assume the title Catholic that an institution is can call itself Catholic only when it has the permission of the local bishop so AB in a new institution is set up in a diocese they must petition the bishop to grant them the title of Catholic and if things happen in the life of an institution which comes to the bishops attention that he also has to the right if the situation is not corrected to remove the Reeb remove the turn of Catholic here at sing in the Diocese of Wooster we have one Catholic hospital st. Vincent's here in the city but it's an interesting type of phenomenon because it was it was begun by the sisters of Providence from out in the Diocese of Springfield and for years they ran that hospital but they also had the support of the diocese however at one point the sisters sold the hospital to for-profit institutions and as sort of they've been sold and resold and sold again so right now st. Vincent's is a typical in terms of Catholic health care institutions because it's a for-profit in reality but the hospital is run like a Catholic hospital and there's where we have a covenant agreement between the Diocese of was in the hospital and if it comes to my attention thanks be to God it hasn't I've been 14 years in the diocese Wooster this month but if something were being done in the hospital that was contravened Church's moral teaching specifically of Catholic biomedical ethics that I would notify the hospital and they would have 30 days to respond to my notification to correct the situation that that has been judged immoral if they do not change it that I would withdraw the Catholic title from the hospital and they would no longer be representing the church in any way so the bishop it especially adds these and I'll say a little bit at the end as I mentioned as we as Catholic institution Catholic medical institutions are partnering with non Catholic institutions they become very the Coast merges and those partnerships become very complicated morally and the bishop has to be very attentive to make sure that even if the partnership is deemed morally justifiable at its beginning the bishop has to be attentive because sometimes these agreements are not lived out as it's supposed to be so the point is the present Catholic health care professionals work within a church context and are carrying out the work of the church in the work of Jesus what I like to say the next that's point number one point number two is to point out to you some of the theological and moral principles that are interwoven throughout of the ethical religious directives these directives that now are operative in the church the United States this is this booklet is in its fifth edition and as a matter of fact in the I'm in the processor for the last 19 years as long as I've been a bishop I have been on the doctrine Committee of the USCCB the National Bishops Conference for the last four years and I'm also the chair of the Subcommittee on health care issues for the last four years we have been reviving revising section six of this document which has to do with merges of Catholic and non-catholic institutions it's taken that long consultation with professionals care institutions with the Holy See the Congregation for the doctrine of faith so finally where my subcommittee is submitting to the body of Bishops in June we have a meeting in Florida for approval of that revision so what there's six parts to this particular document the ER DS we'll call them just for brevity's sake but I'm only going to look at sections four and five section four is a cure for innocent life at the beginning of its gestation and also look at end-of-life issues so those basically the two areas of my reflection so what I'd like to do for the rest of this presentation is to point out to you some fundamental theological and moral theological positions so first of all that the most fun most fundamental theological insight in terms of Catholic medical profession is that the human person created in the image and likeness of God is the being that is once corporal in spiritual in the unity of the body that the soul and body relationship is so profound that one has to consider the soul to be the fairy form the vivifying principle of the body and we must remember also according to Catholic doctrine that although the act of creation is a partnership between God in the human married couple that the god that the soul is not produced obviously by the marital act of the couple the soul is created by God and at the moment of fertilization that soul is individually embodies and Souls the the developing body of the child which will vilify the whole human enterprise from birth of concession to natural death so it was a very interesting if you followed pope francis supposedly had in common well did have a conversation with a italian atheist named safari and according to Scalf re the pope said that there is no hell because souls that have done evil just disappear well obviously the Pope cannot say that because the image immortality of the soul is a fundamental dogmatic truth the Catholic faith so the soul produced through death and then as we celebrate today in the Ascension that Christ has taken a humanity into the life of the Trinity and that at the moment of final judgment our souls in our bodies which have decayed will for those of our saves will be United and we will enjoy the glorified life in heaven that Christ in our Blessed Mother does at the present time so those are some fundamental theological theological principles however the church's ministry of healing the sick curing of the ill is carried on at any particular moment in history within a particular context and one of the great challenges to Catholic health care ministry nowadays is the ethical climate in which we find ourselves and fundamentally the ethical climate in Western culture and specifically in the United States is what is called ethical relativism if you remember that pope benedict xvi i think it was the homily right before the he was elected successor of st. Peter and Bishop of Rome he talked about a dictatorship of relativism and if you talk to people you talk to mr. and mrs. American Catholic they have fundamentally ethical relatives which creates a huge pastoral problem for the church because in our moral theology we treat certain things that are called that we teach objective moral truth and that is sort of enshrined in that we we stay very clearly that there are certain human acts that are intrinsically evil which means to say the act is so vitiated 'add in its content that it breaks our relationship with God and sort of detours us on a pilgrimage home to our father's house in heaven and mmin act that is you know immoral and illicit the intention of the actor and the circumstances within which the actor performs human act intention and circumstances cannot turn an immoral act into a good act but in the type of error ethical relativism that we face here in the United States in a Western culture of the following one instance is pragmatism which says if it works in a successful it should be done the second type of quality relativism is consequentialism the end justifies the means the third type of ethical relativism is emotivism which is to say right or wrong is determined by how deeply I feel it that if I if I'm very worked up about something that the correctness of the moral argument is determined by how passionately I argue the case you hear that all the time in a matter of fact in a society that's becoming more and more what is the word I'm searching for is more and more crude in its discourse the level of emotivism has reached a crescendo pitch so it's in that type of moral relativistic culture that the church is trying to carry out its mission to cure and to heal so let's go right now to part 4 of the ER DS which is entitled issues in care for the beginning of life and again this particular section if you if any of you familiar with these AR DS they're very very important and the form is that each section has an introductory narrative and then that narrative is followed by a set of new directives which sort of implemented a very pithy way what the narrative is talking about so in the section 4 which has to do with issues at the beginning of life the following principles moral principles are repeated in the directors first is the sanctity of human life at its beginning the dignity of marriage in the Marriage Act by which human life is transmitted and another very important insight in the section on into the beginnings of human life is what is technologically possible is not always morally right in the literature sometimes called the technological paradise if it can be done technologically it should be done making the decision at the using technologies at the beginning of life is very complex and it takes a lot of serious more reflection to decide whether this technology should be used or this technology should not be used so first of all one of the biggest technological interventions at the beginning of life as I'm sure you know is for in vitro fertilization very very common very very expensive and our Catholic hospitals often are under tremendous pressure to carry out that technology but unfortunately in vitro fertilization is an intrinsically immoral act why because the marriage acts according to the church are more reflection is that the Marriage Act has two related meanings it has the unitive meaning which is the sharing of the life and love between the married woman and the married man that's the units of dimension of the marital act and the second dimension the marital act is the procreative which this act engenders the gift of human life those two meanings cannot be deliberately separated and if they are literally separated through example artificial means of contraception it vitiates the moral act and it becomes an immoral act now and obviously in vitro fertilization that technology sort of usurps the integrity of the marital act and it can do so in at least two ways and the ethical directives talk about hetero hetero legis artificial fertilization which is reproductive technology that involves using the gametes for one or more donors and that is prohibitive because the act of conception the active and fertilization is brought about out of the body of the people who want to have a baby and not only is it outside of the body but the very gametes the sperm in the ovum that are used to bring about new life come from people out different people and not the mother and the mother and father of the child so heterologous in vitro fertilization is wrong because it undercuts the unity of the the Marriage Act and also there is another type of infeed troffer ttle ization which is close homologous artificial procreation and this DMA this technology uses at least one of the gametes of the couple so for example it's either the the oven comes from the woman or the sperm comes from the man who were in this relationship but one of the other gametes comes from a donut so again the integrity of the marriage act is undercut because of one of the Gammy's coming from someone outside of the love relationship we are celebrating in this July July in 19 of 2018 it's the 50th anniversary of Pope Paul the sixth prophetic document loom on TV tape under on the regulation of birth if you remember in 1968 when that document was produced and promulgated a firestorm broke out in the Catholic Church and it was especially intense here in the United States actually some bishop conferences made public statements that sort of soft pedaled the document the American bishops made a good statements months after the the the document money vitae but if you read that document it is in fact prophetic and Pope Paul the sixth said when the unitive and procreative acts are deliberately set separated either before during or after the married act if that happens that a flood of other types of immorality would come upon us and that if you look at the state of in Western culture the state of sexual marital realities that it's it's written it's the document proved prophetic that it has led to alter in matter of fact this me too movement that's going on among women who are coming forward to tell the horrific stories about being sexually abused by powerful men that I would dare say that this type of disrespect for women by men who feel that they have the sexual prowess to do what they want to do I could that's definitely in my mind and I'm not the only one who saying this but I could see the relationship when when people can express their sexuality without respect for a loving reunion between a man and a woman then the repercussions of the use of sexuality is very very dangerous and we're living with this advent just of the among young people this hookup culture it is astounding on college campus campuses is just astounding the number of casual hookup relationships that happen in a college campus even sad to say on our Catholic college campuses so so so in vitro fertilization which is very common and is a matter of fact in our Catholic institutions for sample the diocese Worcester when Obamacare was was promulgated we had we had we spent thousands of dollars with legal fees in making sure that we could have insurance policies for for our lay people that did not cover types of these types of medical technologies that are deemed by the church as immoral another technology that is immoral is surrogate motherhood when a woman the child is is is conceived fertilized in vitro and the fertilized ovum is placed in the room of someone who has come forward to bring the open to gestation again that is although the there's two more evils of valium one it's in vitro fertilisation that's how the child is conceived and then it is breaking the unity of dimension of the marriage acts at Li the prefer that to either go before or follow the birth of the child so surrogate motherhood is is prohibited now there's another distinction that we have to make in terms of caring for life at its vulnerable beginnings and that is the distinction between a direct abortion in an indirect emotion so let me read very quickly directive 47 which very succinctly and very accurately describes the nature of a direct abortion directive 47 yes director 45 first abortion that is the directly intended termination of pregnancy before by viability or the directly intended destruction of viable fetus is never permitted every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion which in its moral context includes the interval between conception and implantation of the embryo healthcare institutions are not to provide abortion services even based on the principle of material cooperation which is a whole nother lecture in this context Catholic health care institutions need to be concerned about the danger of scandal in any association with abortion providers there was a cause celebra out in a Catholic hospital in Phoenix Arizona we are run by at least the CEO was a sister religious sister of Mercy we're an abortion was performed a woman had some very serious health condition and the Ethics Committee of that Catholic hospital made the faulty decision that it was not a direct abortion and actually it came to the attention of the bishop we should Thomas Olmstead as a fine fine bishop and he said no he's his moral evaluation of the procedure was that it was a directed abortion in the religious systems of Mercer was actually excommunicated because – for someone to participate in the direct abortion even performing it or giving consent for it knowing that it's wrong is his ex Munich atoll obviously the sister was eventually you're not reunited into the church but this is how seriously the church takes the act of direct abortion but there are also instances of indirect abortion the most common of which is the miscarriage that's good innocence that's a real moral sense of miscarriages and indirect abortion but there's also the classical exception or indication of a indirect abortion with the ectopic pregnancy when the fertilized ovum does not attach itself to the uterine wall but on the fallopian tube and that can be it that that reality can be a death-dealing for the for the mother so according to the church teaching is the principle double effects that the intention of the medical procedure is not to kill the child eg an abortion but the intention of the medical procedure is to save the mother's life by by excising the the part of the fallopian tube that has the fertilized ovum that is an indirect abortion because the intention is to save the life of the mother that's the primary retention the side effect which is foreseen we know that the child died when the fallopian tube is looking to his operated upon but the direct that was not the direct intention it's a foreseen side-effect so what fact is in one sense abortion is an indirect abortion and can be morally justified if the principles are properly applied so everybody clear about so the distinction between a direct abortion which is always in every war it's an intrinsically immoral act and in direct abortion then some circumstances can be justified let's see all right so why don't we move on to let me just conclude by this conclusion to my reflections on part 4 of the directives certain directives in this pot four of the document addresses other techniques and technologies that are related to a Catholic institutions commitment to the protection and preservation of innocent human life the provision of genetic and infertility counseling which which is a great contribution that health Catholic health care institution and half Catholic health care professionals can provide to couples who are suffering from infertility the promotion of adoption in a sense that we here in the Massachusetts that when same-sex marriage was legalized according to judicial Fiat here in the Commonwealth that one of the fallouts was our adoption agencies that the Archdiocese of Boston actually surrendered its license because it was going to be forced legally to place children adopted children in every same-sex marriage so the dodge diocese withdrew their they just gave up doing adoptions here in the diocese Worcester I decided to no we're not going to we're not going to give a bad license to carry out adoptions but also we will only do it according to the teaching the church we would not be fair adopted children to same-sex couple guess what happened they stopped sending children to us so we were forced out of the adoption service because of this immoral activity that's going on so however adoption is counseling couples about adoption I think is a great service that Catholic health care ministry can carried out so those are just some reflections on the care of life at its venerable beginnings now let's go to section 5 of the the health care the are DS that deal with death and dying so let me just list view some fundamental moral ethical principles that underpinned the Church's teaching on death and dying the church intramural teaching on the end-of-life issues witnesses to this fact to the belief that God has created each person for eternal life that God has given life and ultimately in a theological context only God can take life from us in his time and in his way another very interesting principle also is this although recognizing the omnipotence of God and sovereignty of God over human life the duty to preserve life is not an absolute duty as interesting I think there's a question here that raised that what does that mean it means that under certain circumstances we can surrender our life for the ultimate good which has got himself in that for example modern a modern dn't is actually a free giving one's own life to witness to ultimate truth Pope Francis just a couple of months ago established another criterion for Sanctum beatification and canonization is that when someone not in a sense of martyrdom in an act of aggression by a person persecutor but if someone gives his or her life in the type of devoted lifelong service to someone else that can be a criterion for sanctity and for canonization so while life is a fundamental good it's not an absolutely good and the task of medicine as you all know as professionals is to care even when it cannot cure the use the use of life-sustaining technology must be judged in light of the Christian meaning of life suffering in death in this way to extremes to extremes that we avoided when we're dealing with issues of death and dying the first is we must talk about the classical distinction in Cathal moral theology the difference between ordinary and extraordinary means of medical treatment sometimes in the literature is called proportionate but disproportionate means of medical treatment and then the nutshell is this that the medical technology intervening at the end of life is deemed morally ordinary if the benefit that that technology will provide the dying patient the sick patient if that technology causes more benefit than burden it is an ordinary means of medical treatment and must be used having said that however there's also the reality of disproportionate no external means of medical treatment which is to say if technical technological intervention causes more burden than benefit than a in its judge so some moral grounds a that ordinary intervention extraordinary intervention does not have to be used and if in fact if that technology has been used and it is then later deemed extraordinary it can be removed now that has become very very controversial in the Catholic Church in the last 25 years or so thirty years especially to do with artificial means of nutrition and hydration however right before he died in 2004 and I'll find that eventually that John Paul the second intervened and II in 2000 March 20th 2004 he made following intervention a moral judgement on whether artificial means the nutrition hydration are ordinary or extraordinary it was very very well done a point of view this is what the Holy Father said I should like particularly to underline how the administration of food and water even when provided by artificial means always represents but natural means of preserving life now the medical acts remember that the distinction between ordinary and extraordinary means and medical treatment that reflection focuses on a particular medical actor a particular medical technology the Holy Father goes on its use furthermore should be considered in principle which is key ordinary and proportionate and as such morally obligatory insofar and until it is seen to have attained its proper finality which in the present case consists in providing nourishment to the patient and alleviation of a suffering that is a very dense but very brilliant summation of moral evaluation of nutrition out of facial nutrition hydration and the key is the Holy Father is saying right up front that it is an ordinary means of treatment in principle and that simply means that's a flag to be aware that although in the ordinary cases is to be used there could be there could be some instances where not official means of nutrition hydration could be removed because that as Holy Father the finality of the Act which is to give people nourishment and to avoid suffering if that intervention is not doing either those bring about those finalities then the the intervention can be described morally as extraordinary and this is how we bishops have institutionalized that teaching in our directives of section 5 which is its number 58 this is what we bishops have said in principle we start off with that in principle there is an obligation to provide patients with food and water including medically assisted nutrition and hydration for those who cannot take food orally this obligation extends to patients in chronic and presumably irreversible conditions eg the persistent vegetative state who can reasonably be expected to live indefinitely if such care is given medically assisted nutrition hydration become morally optional when they cannot reasonably reasonably be expected to prolong life or when they would be excessively burdensome for the patient it would cause significant physical discomfort for example result resulting from complications in the means employed for instance as a patient was close to inevitable death from an underlying progressive in fatal condition certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or to provide company it's a very complex situation when I say to my priest is when someone comes to the rectory looking for moral guidance on these types of very complex situations I say to the priest call me first because it's its it can be very complex and what is absolutely key is that in a death and dying issues visa vie Kathryn moral theology what is crucial is that the quality or the correctness of the moral judgment whether something is extraordinary or ordinary the correctness of that moral judgment is rooted in the best medical knowledge and that is why you know an attendant issue for death and dying and the Catholic context a durable powers of attorney that for years with the church has said that the durable power of attorney is the most morally acceptable type of substituted judgment because the person who has this power of attorney obviously when the first consideration is that the patient is no longer medically and most psychologically able to make reasonable decisions about his or her healthcare when that state has reached the person who has the power of attorney is able to speak to the physicians to the nurses to the professionals and have an accurate account of what is this person dying is this has the moment of fatality arrived and within that context you make a best moral decision if you have a living will that you make when you are 55 years old and you don't you don't want this you don't want that you're on you know the following then it's sort of it opens the floodgates of very misinformed decisions at the end of life and what has happened in some cases when the living will is given to the medical professional that he or she in the sense becomes the arbiter of what is going to happen to that person and it's a very very difficult in perplexing situation so well I'm going to conclude this by just reading and if there any questions you can ask them during the question answer the situation that I want to conclude with words that the Holy Father issued to medical professionals during the great Jubilee year and this is the word sometime I make my own distinguished ladies and gentlemen in conclusion I exhort you as men and women of science responsible for the dignity of the medical profession to God jealously the principle according to which the true task of medicine is to cure if possible always to care as a pledge in support of this your authentic humanitarian mission to give comfort and support to your suffering brothers and sisters I remind you of the words of Jesus Amen I say to you whatever you did to one of these least my brothers and sisters you did to me thank you very much [Applause]

Leave a Reply

Your email address will not be published. Required fields are marked *