Medical Ethics I: the Beginning Medical Ethics I: the Beginning of Lifeof Life

Moral decision making Moral decision making related to medical related to medical research and practiceresearch and practice

Important PrinciplesImportant Principles

1. Life is a gift of inestimable value1. Life is a gift of inestimable value• All uses of technology must respect All uses of technology must respect

human lifehuman life

2. Science and technology are 2. Science and technology are valuable resourcesvaluable resources

• Can have positive effects on lifeCan have positive effects on life• Must be used to support human Must be used to support human

dignity and lifedignity and life

3. Humans are a unity of body and spirit3. Humans are a unity of body and spirit• We are more than the sum total of our partsWe are more than the sum total of our parts

4. What is technically possible is not for 4. What is technically possible is not for that very reason morally admissiblethat very reason morally admissible

• Not every potential medical “breakthrough” Not every potential medical “breakthrough” necessarily serves humanitynecessarily serves humanity

• Advances must be measured in terms of Advances must be measured in terms of respect for liferespect for life

TermsTerms DNA:DNA:

The intricate interlocking chain of genetic The intricate interlocking chain of genetic material that makes up all living cellsmaterial that makes up all living cells

Artificial insemination:Artificial insemination: Mechanically introducing a sperm to a Mechanically introducing a sperm to a

uterus to facilitate fertilizationuterus to facilitate fertilization Embryo:Embryo:

A fertilized egg possessing a unique A fertilized egg possessing a unique genetic makeupgenetic makeup

In Vitro:In Vitro: Literally, “in a glass”Literally, “in a glass” An embryo that is placed in a woman’s An embryo that is placed in a woman’s

uterusuterus

In Vitro Fertilization and In Vitro Fertilization and MarriageMarriage

Catholic view of marriage:Catholic view of marriage: Unitive (love, connection) and procreative Unitive (love, connection) and procreative

(creating life)(creating life)

Problems with IVF:Problems with IVF: Separates the unitive and procreative Separates the unitive and procreative

characteristics of marriage;characteristics of marriage;

Destruction of unused embryos - eDestruction of unused embryos - ending of human lifending of human life

Children understood as being gifts from God.Children understood as being gifts from God.

Genetic EngineeringGenetic Engineering Changing inherited characteristics by Changing inherited characteristics by

changing the makeup of a plant, animal, changing the makeup of a plant, animal, or person – limiting to and prefering or person – limiting to and prefering specific desirable physical or specific desirable physical or psychological traits. psychological traits.

Eugenics – (from Greek – “well born” – a Eugenics – (from Greek – “well born” – a program that tries to steer human program that tries to steer human reproduction in a specific direction. reproduction in a specific direction. Restricting immigration from places Restricting immigration from places other than Europe (1907-1937) – in fear other than Europe (1907-1937) – in fear of contaminating the American gene of contaminating the American gene pool. Climax – Holocaust.pool. Climax – Holocaust.

CloningCloning

Cloning - creating a plant, animal, or Cloning - creating a plant, animal, or person asexually. They is genetically person asexually. They is genetically identical with a donor plant, animal, identical with a donor plant, animal, or person.or person.

There are two major types of cloning – There are two major types of cloning – reproductive and therapeutic:reproductive and therapeutic:

Reproductive/ therapeutic cloningReproductive/ therapeutic cloning

Reproductive – Reproductive –

1) Genetic material transferred from a donor 1) Genetic material transferred from a donor adult cell to an egg whose nucleus has been adult cell to an egg whose nucleus has been removed;removed;

2) The reconstructed egg which contains the DNA 2) The reconstructed egg which contains the DNA must be treated with chemicals in order to must be treated with chemicals in order to stimulate cell division;stimulate cell division;

3) Then it is transferred to the uterus of a female 3) Then it is transferred to the uterus of a female host where it develops until birth (Dolly).host where it develops until birth (Dolly).

Therapeutic - is the production of a human Therapeutic - is the production of a human embryo for the use in stem cell research. embryo for the use in stem cell research.

AbortionAbortion

Abortion:Abortion: The spontaneous or induced expulsion The spontaneous or induced expulsion

of a fetus from the womb.of a fetus from the womb. Dealing with those that are caused / not Dealing with those that are caused / not

miscarriagesmiscarriages

Roe vs. Wade (1973)Roe vs. Wade (1973) Supreme Court allows women to choose Supreme Court allows women to choose

whether or not to have an abortionwhether or not to have an abortion Rights of woman over rights of unborn Rights of woman over rights of unborn

childchild

Church TeachingChurch Teaching

Human life must be respected and Human life must be respected and protected protected absolutely absolutely from conception.from conception.

Key points:Key points: A new and distinct human life begins at the A new and distinct human life begins at the

moment of conceptionmoment of conception Respect for life at all times in all Respect for life at all times in all

situationssituations Even in cases of rape or presumed disordersEven in cases of rape or presumed disorders The right to life outweighs any others “rights”The right to life outweighs any others “rights”

Abortion ArgumentsAbortion ArgumentsPro-lifePro-life

Human beings are Human beings are required to respect their required to respect their bodiesbodies

Life begins at the moment Life begins at the moment of conceptionof conception

All life is sacredAll life is sacred Unborn have a right to be Unborn have a right to be

bornborn It is wrong to kill an It is wrong to kill an

innocent human being and innocent human being and wrong to legalize an wrong to legalize an action that is immoralaction that is immoral

Pro-choicePro-choice Human beings are free to Human beings are free to

do whatever they think is do whatever they think is rightright

It is unclear when life It is unclear when life actually beginsactually begins

Quality of life is more Quality of life is more important than lifeimportant than life

A woman has a right to A woman has a right to determine what happens determine what happens to her bodyto her body

It is wrong to put one’s It is wrong to put one’s moral position into lawmoral position into law

Culture of DeathCulture of Death

The basis of human life is not the The basis of human life is not the sacredness of life and human sacredness of life and human dignity, but is the ability to get dignity, but is the ability to get what we wantwhat we want

People have the right to more People have the right to more than they need, even as poverty than they need, even as poverty causes death for otherscauses death for others

Culture of Death (2)Culture of Death (2)

People who cause a burden to People who cause a burden to others as less worthy of lifeothers as less worthy of life

The quality of a life as the only The quality of a life as the only measure of whether it is worth measure of whether it is worth livingliving Euthanasia Euthanasia the intentional killing the intentional killing

of someone whose life is deemed no of someone whose life is deemed no longer worth livinglonger worth living

Culture of LifeCulture of Life

We are images of God; more than We are images of God; more than our physical bodiesour physical bodies

Being fully alive means reflecting Being fully alive means reflecting God by loving God and one God by loving God and one anotheranother

Calls people to share what they Calls people to share what they have with othershave with others

Culture of Life (2)Culture of Life (2)

Views all people as gifts of God, Views all people as gifts of God, even those who require extra careeven those who require extra care

Sees life as worth living even if it Sees life as worth living even if it involves sufferinginvolves suffering

Respects and fosters the dignity of Respects and fosters the dignity of each person as being created each person as being created imago imago dei.dei.

Medical Ethics II:Medical Ethics II:

Moral Issues Near the End Moral Issues Near the End of Lifeof Life

Pain and SufferingPain and Suffering

One of the great, enduring One of the great, enduring questions: Why do we feel pain questions: Why do we feel pain and suffer? Important question. and suffer? Important question.

Reality: no one is free from Reality: no one is free from either: is widespread and either: is widespread and commoncommon

Jesus and SufferingJesus and Suffering 3 belief statements3 belief statements

Suffering does not separate us from God. Suffering does not separate us from God. God cares about our suffering. God cares about our suffering.

God does not let us face our suffering God does not let us face our suffering alone. God is always with us, lightening alone. God is always with us, lightening our burdens and giving us sufficient our burdens and giving us sufficient strength.strength.

Suffering IS NOT THE END. It need not Suffering IS NOT THE END. It need not destroy us or defeat the possibility of destroy us or defeat the possibility of eternal happiness in God’s kingdom.eternal happiness in God’s kingdom.

EuthanasiaEuthanasia

Deliberately taking steps to Deliberately taking steps to bring about a person’s death bring about a person’s death for the purpose of eliminating for the purpose of eliminating sufferingsuffering

U.S. Bishops’ Statement on U.S. Bishops’ Statement on Euthanasia (1980):Euthanasia (1980):

In modern society, in which even the In modern society, in which even the fundamental values of human life are fundamental values of human life are often called into question, cultural often called into question, cultural change exercises an influence upon change exercises an influence upon the way of looking at suffering and the way of looking at suffering and death; moreover, medicine has death; moreover, medicine has increased its capacity to cure and to increased its capacity to cure and to prolong life in particular prolong life in particular circumstances, which sometime give circumstances, which sometime give rise to moral problems. rise to moral problems.

U.S. Bishops’ Statement on U.S. Bishops’ Statement on Euthanasia (1980):Euthanasia (1980):

Thus people living in this situation Thus people living in this situation experience no little anxiety about the experience no little anxiety about the meaning of advanced old age and meaning of advanced old age and death. They also begin to wonder death. They also begin to wonder whether they have the right to obtain whether they have the right to obtain for themselves or their fellowmen an for themselves or their fellowmen an "easy death," which would shorten "easy death," which would shorten suffering and which seems to them suffering and which seems to them more in harmony with human dignity. more in harmony with human dignity.

Euthanasia (cont)Euthanasia (cont)

Two types:Two types: Direct (Active) / Indirect (Passive)Direct (Active) / Indirect (Passive)

Direct Euthanasia:Direct Euthanasia: Involves taking deliberate steps to Involves taking deliberate steps to

end the life of a suffering and end the life of a suffering and incurably ill personincurably ill person

Indirect Euthanasia:Indirect Euthanasia: Deliberately not taking steps to prevent a Deliberately not taking steps to prevent a

sick person’s death, precisely with the sick person’s death, precisely with the desire and intention that this desire and intention that this “withholding” will lead to or cause death“withholding” will lead to or cause death

All forms of Euthanasia are All forms of Euthanasia are immoral:immoral: Violate Human Dignity and the value of Violate Human Dignity and the value of

lifelife

Physician-Assisted SuicidePhysician-Assisted Suicide

Physician-Assisted Suicide:Physician-Assisted Suicide:

Closely related to EuthanasiaClosely related to Euthanasia

A person who is incurably ill killing A person who is incurably ill killing him/herself with the help of a him/herself with the help of a physicianphysician

Seemingly positive motivation:Seemingly positive motivation: Reducing suffering (patient’s and Reducing suffering (patient’s and

family’s) by ending life family’s) by ending life

Immoral action:Immoral action: Violates human dignityViolates human dignity John Paul II “false mercy”John Paul II “false mercy”

Loss of hopeLoss of hope

Allowing Death to OccurAllowing Death to Occur Involves withholding or withdrawing Involves withholding or withdrawing

useless or disproportionately useless or disproportionately burdensome treatment, thus allowing to burdensome treatment, thus allowing to die from the fatal disease or conditiondie from the fatal disease or condition

Key difference from Euthanasia:Key difference from Euthanasia: The intention of the action must be The intention of the action must be

considered – it is not that one wills considered – it is not that one wills death to occur, but that one accepts death to occur, but that one accepts the fact that death can’t be preventedthe fact that death can’t be prevented

Right to Die: PrinciplesRight to Die: Principles

1. Death is imminent;1. Death is imminent;

2. Illness is irreversible;2. Illness is irreversible;

3. All ordinary means are 3. All ordinary means are exhausted; exhausted;

4. The person is at peace with 4. The person is at peace with God;God;

5. Excessive burden on the family.5. Excessive burden on the family.

Ordinary means of life support:Ordinary means of life support: Medical procedures that offer sufficient or Medical procedures that offer sufficient or

reasonable benefits without excessive or reasonable benefits without excessive or undue burdens to the patient or family undue burdens to the patient or family (food, drink, medication, medical (food, drink, medication, medical procedures);procedures);

Extraordinary means of life support:Extraordinary means of life support: Medical procedures that offer little hope of Medical procedures that offer little hope of

benefits or which cause undue or excessive benefits or which cause undue or excessive burdens to the patient or familyburdens to the patient or family

Living WillLiving Will A legal document in which people make A legal document in which people make

known their wishes about what medical or known their wishes about what medical or health care treatment that would or would health care treatment that would or would not want if they became seriously ill.not want if they became seriously ill.

Usually expresses a person’s wish not to Usually expresses a person’s wish not to receive extraordinary means of life supportreceive extraordinary means of life support

Potential problem Potential problem not all situations not all situations addressed and no one named to make addressed and no one named to make decisionsdecisions

Care for the DyingCare for the Dying

How do we, as Christians, care How do we, as Christians, care for the terminally ill, especially for the terminally ill, especially those with intense suffering?those with intense suffering?

Respect for human dignity:Respect for human dignity: Must always reassure the Must always reassure the

individual of their holiness as a individual of their holiness as a child of Godchild of God

Practically face end of life issues:Practically face end of life issues: Living Will:Living Will:

A declaration that a competent adult A declaration that a competent adult makes identifying the medical care makes identifying the medical care desired if s/he becomes incapacitateddesired if s/he becomes incapacitated

Durable Power of Attorney Durable Power of Attorney (Designated Decision Maker):(Designated Decision Maker):

Someone appointed to make medical Someone appointed to make medical decisions for a person who is decisions for a person who is incapacitatedincapacitated

HospiceHospice

Hospice:Hospice:

An intense, multi-faceted, spiritually An intense, multi-faceted, spiritually based approach to assisting people based approach to assisting people through the dying processthrough the dying process

Does not try to either hasten or Does not try to either hasten or postpone deathpostpone death

Attempts to help the patient live last Attempts to help the patient live last days/weeks as comfortably and fully as days/weeks as comfortably and fully as possiblepossible