Ethics & Medics

The COVID-19 pandemic has resulted in discussion on how to allocate scarce medical resources such as ventilators. Some bioethicists have suggested that difficult determinations about withholding or withdrawing treatment should be made by triage officers or committees to alleviate the psychological strain on frontline clinicians. However, this raises concerns about shifting important personal medical decisions away from physicians and their patients. According to the principle of subsidiarity, frontline clinicians, together with their patients, should be making these decisions, with ethics committees or triage committees serving only in an advisory capacity. Several ethical principles can help health care professionals allocate scarce resources. These include basing exclusion criteria on clinical status rather than nonmedical characteristics; randomizing treatment for clinically similar patients; obtaining free and informed consent when considering the withdrawal of treatment, even in situations where treatment is possibly futile; and emphasizing quality palliative care for all patients.

Palliative care and hospice can be confusing subjects. Many people misunderstand the meaning of both and often consider the two terms synonymous. There are, however, important differences between palliative care and hospice. Palliative care is designed to anticipate, prevent, and manage physical, psychological, social, and spiritual suffering. It is primarily concerned with the symptoms that result from an illness or from the interventions used to treat said illness. It includes both the terminally ill and those with chronic, life-limiting conditions. Hospice is a type of palliative care provided to individuals with a life expectancy of six months or less. Patients are generally admitted to hospice when their condition no longer responds to aggressive interventions or they have chosen to discontinue medical intervention for ethically appropriate reasons. It is necessary to approach enrolling in hospice with caution, and important questions must be considered before doing so.

The appearance of COVID-19 has brought renewed attention to the practice of triage. This is an important means of best utilizing limited available resources during periods of medical crisis, whatever its source. The ethicists of The National Catholic Bioethics Center offer a set of ethical considerations for triage and rationing founded on long-standing principles of Catholic moral teaching. These include the dignity of human life, the objective criterion of justice, the duty to care, and the needs of human stewardship. The authors also offer observations on the process of implementing triage protocols, which must be consistent, accountable, and transparent and undergo regular review. The human dimension of illness and suffering requires prayer and patient support, sound prudential judgment, and the regular exercise of the virtue of charity.

It is the right of the Catholic faithful to receive the sacraments when appropriate. The COVID-19 pandemic has presented new challenges in dispensing the sacraments, particularly to the sick who often need them most. Canon law dictates who can dispense the sacraments as well as where this can happen. Many dioceses have sought to find creative ways to reach those in need of the sacraments while keeping to the guidelines laid out by Canon law and public health authorities. Anointing of the Sick presents particular challenges while also being vitally important to Catholics who suffer from a life-threatening illness. Special precautions must be taken to ensure that communicable diseases are not spread during the administering of this sacrament, but it is essential that it be administered at the appropriate time.

As one of the primary resources for Catholics concerned about moral issues in health care, the ethicists of The National Catholic Bioethics Center have received many questions regarding triage protocols in place during the COVID-19 pandemic. Many protocols emphasize utilitarian principles that are incompatible with a principled approach to Catholic health care. Others expressly discourage appeals to ethical principles that are religious in nature or connected to systems of religious belief. This exclusion is arbitrary given the long history of Catholic health care. The ethicists also have concerns about patient priority scores that include disqualifying criteria based on age, disability, or medical condition. These criteria constitute unjust forms of discrimination. Finally, the withdrawal of care should occur only after consultation with the family, and in no case should physicians unilaterally assign do-not-resuscitate status to critically ill patients with COVID-19.

People can certainly attempt to create new words, convince others that certain words have taken on new meanings, or advocate that new meanings should supplant the older, more common ones. However, the introduction of a new definition does not invalidate a word’s older meaning. Today, many have begun using the word gender in a novel way because they claim that gender is a social construct. This article questions the coherence of that usage with other popularly accepted views about the reality of persons who identify as transgender.

Third-party reproduction uses ovum donors, sperm donors, embryo donors, and gestational surrogates in various combinations to create a child for heterosexual couples, same-sex couples, and individuals to raise. Its use is increasing in the United States and around the world, and it is increasingly the subject of legislation. But third-party reproduction tells the individuals who provide the ovum, sperm, and gestation required to create a child that they are reproductive mechanisms, not reproductive persons. By contrast, multiple stories in the Bible involving third-party reproduction recognize the motherhood and fatherhood, and thus the reproductive personhood, of those whose sexual union brings forth a new child. This is an important point for people of faith and the public to be mindful of.

Genetic engineering is a rapidly evolving field of research with potentially powerful therapeutic applications. The technology CRISPR-Cas9 not only has improved the accuracy and overall feasibility of genome editing but also has increased access to users by lowering cost and increasing usability and speed. However, recent applications of genetic engineering technology have raised ethical concerns in the scientific community. An investigator in China announced the birth of twins whose genome had been edited as embryos to increase resistance to HIV. These germline genetic modifications were illicit because they both posed potential risks to the children and future progeny and used in vitro fertilization. In addition, a team of US and Spanish researchers travelled to China to perform human–animal chimera research. In light of these events, health care institutions should consider what steps can be taken to prevent or slow rogue science.

This article examines a common misconception regarding the scope of free speech in the context of abortion counseling. Specifically, a recent critique of pro-life legislation identifies an apparent contradiction between (1) requiring doctors to show an ultrasound and play a fetal heartbeat to a mother before providing her with an abortion and (2) not requiring crisis pregnancy centers to give women information on where they can procure an abortion. Giving a patient comprehensive information about the effects of a medical procedure (i.e., the death of the fetus) is a necessary element of obtaining informed consent. A pro-life intention behind such regulation neither invalidates the scientific relevance of the information nor forces a physician to provide medical advice with which he or she disagrees. In contrast, requiring a crisis pregnancy center to provide information on abortion resources changes the organization’s message to advertise practices it morally opposes.

Ethics education is an essential obligation of a robust health care ethics service. Although there is no one-size-fits all approach, all ethics education should be proactive and therefore should avoid portraying ethics as mere compliance with moral norms or as an esoteric activity that applies only in cases of moral conflict. Such a negative approach can lead to an ethics of minimums and to the disempowerment of moral agency. In addition, ethics education should promote ethics competency and virtue for the sake of human flourishing through instruction and habituation. To serve the individuals from diverse backgrounds who work in Catholic health care, ethics education should reflect the Catholic teaching that faith and reason are compatible, and that ethics need not be bound to an exclusively theological approach. This will foster a flourishing moral community where medical staff and associates are united by a common mission and ethical commitments.

The core functions of health care ethics committees are consultation, education, and policy development. In order to better function in these areas, it is necessary for committees to take a proactive approach in relationships with the surrounding community. Local universities provide an opportunity for committee members to teach ethics courses as well as find new members with practical experience through internships and mentorships. Reaching out to local health care organizations regarding ethics consultations for patients and physicians is also beneficial. Community organizations may be interested in classes or consultations and can give ethics organizations an opportunity to learn more about recurring problems and concerns of the surrounding community. Finally, working with the local diocese builds lasting relationships that can increase understanding and respect between the committee, clergy, and lay people in the community.

Recent research indicates that lethal language such as fatal fetal anomaly, lethal or terminal prenatal diagnosis, and incompatible with life is used so that parents have an easier time coming to terms with the decision to abort their child, not because doctors can predict with any certainty whether a baby will die at birth. Once lethal language is attached to a baby, care at birth may also be limited. To this extent, lethal language has potential ethical implications, as it may trigger different obstetric management for women who carry to term. This essay asserts the moral and medical necessity of treating babies with so-called lethal prenatal diagnoses just like every other baby. Case studies and research demonstrate the different outcomes experienced by babies who are labeled as lethal, compared with those who are stabilized and evaluated at birth, enabling their parents to make informed decisions about medical care.

There is a difference between effectiveness and efficacy studies involving family planning methods. Efficacy studies determine whether a method works as expected in specified research conditions; effectiveness studies measure how well a method works in real life. The efficacy of a family planning method is usually determined prospectively by studies conducted in a controlled environment. Effectiveness, on the other hand, is based on the unintended-pregnancy rate among a large population of users over time, usually determined retrospectively through chart reviews or surveys. Most studies of NFP are controlled studies—that is, they are efficacy rather than effectiveness studies.

The ethical implications of brain–machine interface (BMI) are mind-boggling. Connecting a person’s brain to a computer or other machine and successfully transmitting thoughts and instructions bidirectionally has enormous potential for therapeutic applications in health care; but great harm can come from meddling with fragile human brains, succumbing to the temptations of cognitive enhancement, and exposing vulnerable individuals to the power relations formed among owners, generators, users, and sellers of what was once considered the private realm of human thoughts.

Given the momentum in favor of legalizing physician-assisted suicide, Diane Rehm’s recent article in the New York Times provides an opportunity to assess the arguments and assumptions used to justify and promote physician-assisted suicide, in light of Church teaching. Supporters often share the impassioned pleas of those who have personally experienced devastating suffering at the end of life. Rehm’s article is no exception, recounting both her husband’s and her close friend’s deaths. These deeply personal and intense emotions cannot be ignored by anyone arguing against physician-assisted suicide.

A recent outbreak of Ebola starting in August 2018 has spread rapidly in North Kivu and Ituri, north-eastern provinces of the Democratic Republic of the Congo (DRC). This is the tenth outbreak in forty years. Nevertheless, Tedros Ghebreyesus, the director-general of the World Health Organization (WHO), recently stated that the outbreak is not yet a “public health emergency of inter- national concern.” Declaring such an emergency would trigger “a response across the United Nations, mobilizing multiple agencies, funding, and personnel . . . the sort of global response that belatedly resolved the [Ebola] epidemics in Liberia, Sierra Leone, and Guinea in 2014 and 2015.” Instead, the WHO and its partners are working with the DRC Ministry of Health to mount a more local response.

The liceity of deactivating pacemakers and implantable cardio-defibrillators at the end of life has been considered only recently. The current discussion divides into two main camps: those who view deactivation as the moral equivalent of the withdrawal of other life-sustaining interventions, and those who hold deactivation as the equivalent of physician-assisted suicide. Some authors contend that similar to a transplanted organ, the pacemaker establishes an organic unity with the human body. Hence, its deactivation is equivalent to the removal or disabling of an organ. On the contrary, the relationship of a pacemaker to the human body is similar to other supportive mechanical devices. There are burdens associated with the presence of these devices. In the face of a terminal diagnosis, the deactivation of a cardio-pacemaker is morally similar to the withdrawal of other extraordinary measures currently accepted within the Catholic moral teachings.

Over the past few years The National Catholic Bioethics Center (NCBC) has received numerous inquiries from Catholic school principals and superintendents asking for guidance on how they can (1) respond to gender ideology in their schools and (2) address the particular challenges that arise when a student (or parent) announces that he or she is transgender. In the absence of specific, practical guidance on these issues from the US bishops or the Church universal, these administrators are confused and often at a loss for what they should—and should not—do. The NCBC reviewed various Catholic school policies concerning transgenderism to identify best practices. The following list is neither complete nor exhaustive. Instead it is presented as a guide or framework for other schools to use in drafting their own policies in response to this powerful, but erroneous, social trend.

Genetic enhancement runs up against several moral issues, perhaps the chief of which is the inevitable eugenic attitude it would foster and the associated inequality it would create between those who have the “proper” enhancements and those who do not. For simplicity’s sake, this analysis leaves aside questions related to genetic enhancement and considers only changes made for therapeutic purposes. Regardless, most of the censure of He Jiankui focuses on the results of human modification and often overlooks the prior question of how gene editing research itself conducted. Germline gene editing in humans is not safe or morally licit under current practices and technology, because of its reliance on technologies such as IVF, the danger to and destruction of the embryos used, and the unknown consequences of changing the germline.