Thank you to the 70 doctors, nurses, catechists, clergy, and other professionals who participated in our 4-part series on bioethics, health care, and Catholic teaching. It was an informative and blessed experience for all of us! We look forward to welcoming you back at future seminars. In the meantime, if you are interested in reading the Relatio, or official summary and synthesis of our past program, here it is:
Relatio
Presented on April 10, 2010
CONVERGING ROADS:
BIOETHICS, HEALTH CARE, & CATHOLIC TEACHING
An Educational Formation Program for Health Care Professionals, Catechists, Educators, and Clergy
BUILDING AN ETHICAL FOUNDATION
Seminar I: September 25-26, 2009
We began this Converging Roads series with the pastoral guidance of Archbishop José Gomez.
Archbishop told us, “We’re here because Jesus Christ chose to come among us ‘healing every disease and every infirmity among people’ (Matt. 4:23). The Catholic mission in health care is a continuation of the healing ministry of Christ. When we talk about ethics and health care policy, our goal is to ensure that all medical institutions in our society remain places of healing in which the dignity, and the mystery of the human person is respected-as it was respected by Christ.”
As Catholics we are part of a 2,000 year history of pastoral experience. The Church founded the first hospitals and charitable institutions. As a result we have “the oldest, most comprehensive, most coherent and integral body of teaching on health care, bioethics, and medical issues.”
Archbishop rejoiced in what we were beginning with this conference, saying the “Church has earned its place at the table in this debate.” “We must refuse to allow ourselves to be forced into silence and marginalized…”
He then went on to share several principles the U.S. bishops have outlined in regard to any authentic reform legislation:
“First, health care must be regarded as a fundamental right and not a privilege. Second, policy must respect and protect human life and dignity from conception to natural death. Third, because health care is a basic human right, policy must give priority to meeting the needs of the poor and the immigrants in our midst. Finally, in structuring new health-care delivery models, the nation must preserve a pluralism of options, respect freedom of conscience, and must restrain costs and spread their burden across the spectrum of players.”
After hearing Archbishop Gomez we began to build an ethical foundation. Drawing from his expertise in philosophy and knowledge of natural law, Fr. Arnold Ibarra spoke to us about making true moral judgments and good moral choices. He told us:
- We determine ourselves, we make ourselves to be the kind of person we are in and through the actions that we freely choose to do.
- We are not free; however, to make what we choose to do to be good or bad, right or wrong. We can choose badly or well; and if we are to be fully the beings we are meant to be we need to choose well, i.e., in accordance with the truth.
- We are not free to determine what our ultimate end will be. We are naturally inclined to our ultimate end by the demands of our nature. We are free to determine how to direct our actions toward this ultimate end. Thus, the ultimate end is something fixed, but the various means to be used in reaching this end are not fixed. Freedom of choice applies to these means. We may select the means – either good or bad – from the point of view of our ultimate end.
In making good moral choices, we must remain attentive to the sources of morality:
Considering the elements of a human act, we can see that morality depends on three things:
- The object of the act (the act performed)
- The end of the act (the intention of the agent)
- The circumstances in which the act is done
Also foundational in any conversation on ethics is the unique dignity of the human person, which is describe by both philosophers and theologians.
Philosophy tells us a human person has a special dignity
He stands above all things
He is placed above the rest of creation
By human rationality – the intellect and the will – the human person is distinguished from the other creatures
Man’s transcendence: through the intellect, the human person has the power to transcend the sense, grasp the being of things. He is open to all reality and to know the truth. Likewise, his free will – whose end is to attain the good – can be fulfilled only in attaining the infinite good.
The Church also tells us of the dignity of the human person:
That man is created in the image and likeness of God (Gen 1: 26-27).
That man is the only creature on earth that God willed for itself (GS, no. 24)
“The Church believes that human dignity is based on the fact that God has created each person, that we have been redeemed by Christ, and that, according to the divine Plan, we shall rejoice with God forever.” (J. de Torre, Person, Family and State, p. 9)
So, it is through the dignity of the human person that the rights of the person are based on, starting with the right to life.
Next, Fr. Jaime Robledo helped us make sense of bioethics. He looked at the history of the field of bioethics, models of bioethics, and the Universal Declaration on Bioethics and Human Rights.
Bioethics is a new discipline which combines biological knowledge with the knowledge on human values.
Professional ethics today is being deconstructed as its philosophical substratum is progressively challenged. The Hippocratic Oath, the backbone of traditional professional ethics is in danger of complete dissolution. It is already defunct in the minds of some very creditable ethicists—eroded by the societal pressures to substitute autonomy or social justice for beneficence, to relax the proscriptions against abortion, euthanasia, assisted suicide, breaches of confidentiality and sexual relations with patients. In any gathering of medical ethicists today, it would be difficult to find a commonly accepted set of precepts or virtues that should characterize the “good” physician.
Fr. Robledo went on to present The Four Principles of medical ethics that serve as general guides and that leave considerable room for judgment in specific cases: respect for autonomy, beneficence, non-maleficence, and justice.
These four principles are valid, yet not sufficient.
He went on to describe how a specific model of bioethics, known as Personalist bioethics, offers additional elements that are necessary in medical ethics:
1) The centrality of the human person and his/her dignity.
2) The human person is an integrated unit of body and soul.
3) Life is a fundamental value and we have the obligation to respect it.
4) Freedom comes with responsibility—the responsibility to adhere to values.
5) Principle of Totality
At the first seminar we also welcomed Dr. John Brehany, the Executive Director for the Catholic Medical Association in the United States and Canada. He spoke to us about the mission of the Catholic Medical Association and looked to the future of health care in the United States, paying special attention to recent legislative developments regarding conscience rights for health care workers. He reminded us that we must work together in order to protect our rights and our profession.
HUMAN SEXUALITY & THE BEGINNING OF LIFE
Converging Roads Seminar II
November 6-7, 2009
In the second seminar we presented a theology of human sexuality and marriage. Mr. Nichols explained a theology of marriage based in the scriptures, the writings of St. Augustine and St. Thomas Aquinas, and Church documents. As Pope Paul VI stated in Humanae Vitae, “Marriage…is in reality the wise and provident institution of God the Creator, whose purpose was to effect in man His loving design. As a consequence, husband and wife, through that mutual gift of themselves, develop that union of two persons in which they perfect one another, cooperating with God in the generation and rearing of new lives. The marriage of those who have been baptized is, in addition, invested with the dignity of a sacramental sign of grace, for it represents the union of Christ and His Church” (n. 8).
Inherent in sexual union are both the procreative and unitive meanings. Natural law dictates that each and every marital act must remain open to life, for we cannot separate through our own initiative these two intrinsic meanings.
Mr. Stravitsch then went on to discuss a proper understanding of eros and agape within the marital relationship. Appealing to the writings of John Paul II he proposed a partial remedy to today’s breakdown in human sexuality: a re-education in love and the inherent responsibilities that come with love.
It is only within this theological context that we can begin to evaluate the ethics of issues closely related to human sexuality. The couple and society suffers rather than flourishes when the teachings of the Church and the natural law are not followed. We live in a society that is suffering from this breakdown.
We learned that contraception and direct sterilization are against natural law because they deliberately separate the procreative and unitive meanings of the marital act. The object of the action is immoral. On the other hand, indirect sterilization can be morally licit when the object chosen and the direct intent is the removal or treatment of a diseased organ. Physicians and couples must carefully apply the principle of double effect in such cases.
We also examined the most up-to-date science around natural family planning, which is a moral method couples can use to space their children while still embracing the full meaning of their human sexuality.
Our seminar then moved into an evaluation of reproductive technologies. Referencing Donum Vitae and Dignitas Personae, Mr. Nichols told us reproductive technologies must respect two essential goods:
1) The “conjugal love between spouses expressed in and through specific conjugal acts must be respected”, and
2) we must also respect “the dignity of the child” who is “to be the fruit of the conjugal union between mother and father.”
Therefore, a physician may “assist” the conjugal act but may not substitute for or replace it. “If the technical means facilitates the conjugal act or helps it to reach its natural objectives, it can be morally acceptable. If, on the other hand, the procedure were to replace the conjugal act, it is morally illicit” (DV).
Some of the medically sound and morally good approaches to treat infertility include NaPro Technology, which includes cooperation with natural procreative systems; responsible use of fertility drugs which assist the conjugal act; changes in diet, exercise and lifestyle which can increase fertility.
We must remember that children are a gift from God, to be received with joy, but not all are given this precious gift. Adoption can be encouraged as a beautiful gift for couples who cannot conceive in spite of their best efforts and when they have exhausted all moral treatments for infertility.
Dr. Mueller’s presentation on “A Clinician’s Look at Prenatal Diagnosis” showed a practical application of how the ethical principles learned in these seminars could be applied to a clinical scenario. The principles of Autonomy, Beneficence, Non-malfeasance, and Justice were examined in relation to the Object, Ends, and Circumstances of prenatal diagnosis. The Ethical and Religious Directives for Catholic Health Care Services were then reviewed. Through this analysis, we learned that prenatal diagnosis is often used for immoral purposes, but that individual physicians can improve the Circumstances of prenatal diagnosis through thorough patient education and knowledge of the limits of these clinical tests.
We then went into a detailed presentation covering embryonic and adult stem cell research. Obtaining stem cells from a living human embryo invariably causes the death of the embryo and is consequently gravely illicit. There have been no successful treatments from embryonic stem cell research; rather it has only caused danger to the health of women who are exploited for eggs.
On the other hand, research initiatives involving the use of adult stem cells do not present ethical problems and should be encouraged and supported. To date, there are hundreds of treatments in various stages of development with 2000+ clinical trials. Furthermore, there have been countless success stories in humans for treating or alleviating cancer, immune deficiencies, organ repair, autoimmune diseases, heart disease, and spinal cord injuries.
As we concluded our second seminar Dr. Martha Garza, M.D. shared personally about her own conversion and the implications that had on her professional practice as an Ob/Gyn. She shared openly about the struggles, challenges, and successes she has had in developing a private practice that honors the teachings of the Catholic faith. Some of us were left inspired and encouraged to carry on in our work and others of us were left honestly challenged by what God may be asking us to change in our own medical practices.
LIFE, DEATH, & SOCIAL CONCERNS
Seminar III: February 5-6, 2010
In the third seminar we moved into interventions across the lifespan.
Fr. John Leies shared from his many years as a consultant to the National Catholic Bioethics Center and specifically discussed the ethics of rape protocols, ectopic pregnancies, and sexual reassignment.
In the third seminar we also spent a great deal of time on end of life issues.
Mr. Nichols’ presentations were helpful in showing how the Church guides us in discerning between ordinary and extraordinary medical treatment. We, as a faith community, must uphold the value of the person’s life who finds him or herself in dire health conditions. Rich Woodley’s case studies showed the complexity of the situations faced by patients, medical personnel, and families. And the process of the ethics consultation that he described—of sitting with family members, listening to what they understand of the situation, asking what they need, clarifying information, evaluating options, and making a recommendation—demonstrates sensitivity and values the freedom of the persons involved.
We also looked at death in Catholic teaching, criteria for determining death, and how to decide when organ donation is ethically permissible.
Furthermore, Mr. Nichols presented his paper titled, “Physician Assisted Suicide – Can the Culture of Life and Love Prevail?” An intense cultural war is now being waged between the agents of death, like Jack Kevorkian, and those who believe that man is made in the image and likeness of God and has transcendent worth because he is destined for the face-to-face vision of God. Mr. Nichols clearly explained what the agents of death have accomplished in our technological society and what they have planned for you and me. He revealed the goals and strategy of the proponents of “mercy killing” and physician-assisted suicide, which have already succeeded in the states of Oregon, Washington, and Montana.
The proponents of PAS and euthanasia believe that suffering diminishes the dignity of the human person and the value of life, and therefore, should be avoided by any means necessary.
However, we know the true dignity of the person is revealed through his or her response to suffering. Furthermore, those who suffer and approach death demand a response from us. The response we owe them is one of love and compassion. True compassion involves suffering with the sufferer, not ending his life or giving him the means by which to end his own life.
Pope Benedict tells us in Spe Salvi, “A society unable to accept its suffering members and incapable of helping to share their suffering and to bear it inwardly through ‘compassion’ is a cruel and inhuman society …. To suffer with the other and for others; to suffer for the sake of truth and justice; to suffer out of love and in order to become a person who truly loves—these are fundamental elements of humanity, and to abandon them would destroy man himself.”
Finally, Andy Rivas of the Texas Catholic Conference provided an analysis of the USCCB’s influence on health care reform. It was a proud moment for Catholics to hear the good work of the bishops. They have been the only religious body standing united and demanding that legislative policies must adhere to the principles and values that we have been discussing.
BIOETHICS AND THE MAGISTERIUM OF THE CATHOLIC CHURCH
Seminar IV: April 9-10, 2010
And then of course we had the excellent presentations this weekend that have reinforced the dignity of the human person while demonstrating the wisdom and guidance of magisterial teachings.
OTHER IMPORTANT ACCOMPLISHMENTS
Converging Roads succeeded in organizing the first White Mass for the Archdiocese of San Antonio, which brought together a few hundred health care professionals to celebrate our work and ministry and to strengthen our identity with Christ’s mission.
The Converging Roads program also collaborated with local physicians to support the creation of the new Catholic Physicians Guild of San Antonio. This guild will be essential in maintaining a Catholic health care community by providing ongoing education to its members and a spirit of mutual support.
WHERE DO WE GO FROM HERE?
So the question now is where do we go from here?
First, we must do the hard work of examining ourselves. Reflecting on all that we have learned in these seminars each of us must ask the questions: Where do I feel personally challenged by these teachings? How might God be inviting me to grow and to change? Are there areas of my life, my professional work, or my ministry that need to more clearly conform to the moral teachings of the Catholic faith?
If we wish to influence our society and spark renewal in our culture, we must recognize that renewal always begins with ourselves. In St. Paul’s Letter to the Romans he exhorts us, “Do not conform yourself to this age but be transformed by the renewal of your mind, that you may discern what is the will of God, what is good and pleasing and perfect” (Rom. 12:2).
We must let ourselves be transformed by the gospel of life. All that we have learned can help us “discern the will of God, what is good and pleasing and perfect.”
In answering the question “Where do we go from here?” we would also like to echo some of the words from Archbishop Gomez’ opening address in which he said:
“Catholic teaching and ethical decision-making never take place in a vacuum. Today, we are trying to form consciences in a health care environment that’s rapidly changing.
“This new environment demands fresh thinking and new approaches. Not to compromise or water-down our teaching. We need to find new ways and even a new vocabulary to articulate our teaching in this changed environment.
“We can’t divorce our religious beliefs from our public convictions. Our challenge is to advance the Gospel and the teachings of Christ in a ways that are understood to promote the authentic human good in our civil laws and public polices.
“How do we do that? I believe we need to be more creative in articulating our teaching in terms of reason and the natural law. The truth is that our teaching is not a sectarian intolerance. Catholic social teaching reflects what our Declaration of Independence calls ‘the laws of nature’s God.’
“Now, it is up to the lay faithful-in politics, business, the media, the insurance and health care fields-to fill in the technical details of these arguments and to draw the necessary conclusions.
“We need to gain a new hearing for the Church’s teaching by finding new ways to present that teaching on the basis of reason, the natural law, and practical public policy considerations.
“We need to find new ways to proclaim our teaching in a society that increasingly seems to have lost its foundation, a society that often seems to act against its own good and the well-being of its people.
“We need to do that by promoting the Gospel as an integral way of life and a true and attractive answer to our social questions and problems.
“The great truth that we must proclaim as Catholics is that life is not simply biological. Our life is also theological. Our life is conceived and lived in dialogue, in a relationship with God.”
Where we go from here is largely up to you. What role will you have in effecting change in our society? How will you share what you have learned? What gifts, talents, and ideas do you have that can serve the mission of the Church and bless the lives of others?
We hope you will consider getting involved with the Catholic Physicians Guild of San Antonio as we discuss strategic planning for the future and solicit your help for moving forward.
Thank you.