We live in a culture where health services are driven by moral relativism, commodification of the human person, the technological imperative, profitability in health services, the creep of utilitarian and impersonal ethical paradigms, escalating costs of health care, and increasing numbers of persons who are uninsured or underinsured. The exercise of a moral conscience both in those who are sick and clinicians who have promised to help and to heal the sick is seriously compromised in this culture. One of the major effects of the current culture is the violation of human dignity, the diminution of the human person of the clinician, and the disregard for the formation of an informed conscience in providing answers to ethical issues in health care.
Further compromising human dignity in health care today is the enactment of legislative mandates that limit or compromise the clinician’s freedom in making decisions and relegates this role to that of a treatment technician. This growing dilemma, founded on moral relativism and unbridled autonomy, prohibits Catholic clinicians and others of good will from applying the principles of the natural law, the findings of the confluence of faith, science and reason, and the process of moral assessment, analysis and judgment that can inform health care decisions. Within this culture human dignity, freedom and the right and duty to form the moral conscience, both of the sick as well as all those who care for them is removed from the person of the clinician and assumed by the state.
What does the Church teach us about the relationship between an informed conscience, the moral teaching of the Church and participating in mandated procedures that are contrary to both the conscience of health care professionals and Church teaching? While we cannot look to the Church to solve every ethical dilemma, we do know that the Church has a centuries-old teaching authority that can be brought to bear on the threat to the freedom and obligation to act only from an informed conscience of clinicians caring for the sick and vulnerable in our world.
Pope John Paul II, in his Encyclical Letter, The Gospel of Life, 1995 (Evangelium Vitae, EV) brings this dilemma to a sharp optic in the obligation of all persons to promote life through every action. Several of these principles have enormous importance in supporting health care professionals who refuse to participate in mandated treatment protocols that are contrary to Church teaching and the development of an informed moral conscience. A brief list of key principles, noted in The Gospel of Life, (though not intended to present a thorough expose?), are listed as follows:
i. It is urgent for the future of society and the development of a sound democracy, to re-discover those essential and innate human and moral values which flow from the very truth of the human being and express and safeguard the dignity of the person: values which no individual, no majority and no state can ever create, modify or destroy, but must only acknowledge, respect and promote.
ii. In no sphere of life can the civil law take the place of conscience or dictate norms concerning things which are outside its competence.
iii. Civil law must ensure that all members of society enjoy respect for certain fundamental rights which innately belong to the person — rights which positive law must recognize and guarantee. First and fundamental among these is the inviolable right to life of every innocent human being.
iv. While public authorities can sometimes choose not to put a stop to something which — were it prohibited — would cause more serious harm, it can never presume to legitimize as a right of individuals — even if they are the majority of the members of society — an offence against other persons caused by the disregard of so fundamental a right as the right to life.
v. Any government which refused to recognize human rights or acted in violation of them would not only fail in its duty; its decrees would be wholly lacking in binding force.
vi. Authority is a postulate of the moral order and derives from God. Consequently, laws and decrees enacted in contravention of the moral order, and hence the divine will, can have no binding force in conscience.
vii. St. Thomas Aquinas teaches: human law is law inasmuch as it is in conformity with right reason and thus derives from eternal law. But when law is contrary to reason, it is called an unjust law; but in this case, it ceases to become a law and instead becomes an act of violence. Every law made by man can be called a law insofar as it derives from the natural law. If it is some how opposed to the natural law, then it is not really a law but rather a corruption of the law.
(© Bro. Ignatius Perkins, O.P.)