The National Catholic Bioethics Quarterly

The preferential option for the poor is a concept and set of ideas in Catholic social teaching that is highly relevant to bioethics scholarship and practice. The option for the poor is mentioned frequently in the bioethics literature but with little specification of its history and implications for ethical and theological analysis. This article examines the origins and implications of the preferential option; compares it to critical race theory, which dominates current debates about discrimination and oppression; and proposes a set of principles for further application in bioethical scholarship and discussion.

In this paper, the author takes the perspective of the patient who is very ill and facing death and examines the traditional ethical question of whether forgoing medical treatment, including artificial hydration and nutrition, is equivalent to suicide. She approaches this question by way of a discussion of St. Thomas Aquinas and Aristotle and via a critical look at David Hume. At the end, she turns to Elizabeth Anscombe for the light that this twentieth-century philosopher sheds on the question.

This essay criticizes the subjective understanding of “best interests” adopted by the United Kingdom’s Mental Capacity Act 2005 and by the 2018 guidance of the British Medical Association and the Royal College of Physicians on the provision of clinically assisted nutrition and hydration to incapacitous adults. The key criticism is that such an understanding wrongly values people’s preferences above their lives.

Clinical decisions about medically assisted nutrition require practical wisdom: a goal-directed virtue that makes decision-making purpose-oriented rather than intervention-focused. This deliberative process includes seven basic dimensions: diagnosis, prognosis, test or treatment, burdens, probabilities, goals of care, and clarification of diagnosis or prognosis. These must be integrated within a larger framework of meaning constituted by foundational beliefs and values—for example, social, philosophical, or theological perspectives on human identity, dignity, and purpose—that are substantive enough to explain the clinical context and clear enough to guide a reasoned response to it. This framework, which combines goal-oriented reasoning with empirical data, can clarify the assessment regarding the benefits of percutaneous endoscopic gastrostomy for persons with advanced dementia.

This essay claims that one can consistently maintain a sanctity of human life principle that is explicitly grounded in theology, while making a kind of quality-of-life judgment regarding withholding or discontinuing life-sustaining treatments for those with advanced illnesses. For those who embrace them, resources that are specific to the Christian tradition delineate the parameters of responsibility for people dying with advanced illness and those who care for them. Those who embrace the sanctity of human life for the theological reasons provided in this essay are under no moral obligation to continue merely to sustain life at the end of life—that is, when, in view of our best available judgment, the human being (who remains inherently valuable nonetheless) will not ever be able to exemplify other human values that contribute to human flourishing, theologically understood.

In this essay, I discuss the role that vocation plays in assessing the proportion of burdens to benefits in end-of-life options. I then look at the case of patients in a persistent vegetative state. What vocational considerations are relevant for persons considering what care to accept should they ever be in a PVS or for those caring for patients in such a state? Ultimately, I argue that the vocational shape of a patient’s life ought not to be a consideration for a caregiver in favor of removing artificial nutrition and hydration.

New Natural Law Theory and the Catholic medico-moral tradition often lead to similar conclusions in hard cases regarding end-of-life care. Considering the provision of artificial nutrition and hydration to patients suffering from post-coma unresponsive wakefulness, however, brings to light subtle ways in which NNL differs from the centuries-old natural law tradition. In this essay, I formalize the methodology embedded within the casuistry of the medico-moral tradition and show how it differs from NNL with respect to the role played by double-effect reasoning and the perspective for analyzing cases regarding care for those who cannot speak for themselves. Importantly, the ordinary/extraordinary means distinction has never historically been understood as an application of double effect and logically cannot be so understood. Given the outsized role that double effect plays in NNL, the theory leads to conclusions that deviate from the Catholic medico-moral tradition and creates additional burdens and duties for the sick.