December 1, 2006

Catholics and Consequences

by PG

Prof. Bainbridge points to his latest TCS article, in which he criticizes the Nuffield Council on Bioethics for its recommendations on critical care in fetal and neo-natal medicine, and describes bishops who agree with the Council as "[breaking] with 2000-plus years of Judeo-Christian ethics." (His sole citation to Jewish law is a Wikipedia entry that devotes a sentence to Jewish practice.) Bainbridge is a Catholic and presumably has much better knowledge of his religion's teachings than I. My knowledge of Catholic doctrine is derived from secular sources -- i.e., non-clergy bioethicists -- but I was under the impression that Catholicism a) distinguishes between ordinary care such as food and water, and extraordinary care such ventilators and surgery; and b) evaluates "extraordinary care" based partly on how much good it is likely to do compared to how much harm. The Catholic Catechism says, "Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of 'over-zealous' treatment." (emphasis added)

The Nuffield Council says, "We conclude that oral nutrition and hydration should only be withheld from a baby when it is clear that providing it causes discomfort and pain, such as when a baby has little functioning bowel due to disease or when death is imminent. The decision should only be taken after careful assessment and as part of a planned programme of palliative care designed to minimise suffering and make the baby as comfortable as possible."

Am I misunderstanding Catholic doctrine, or is there something in the Council's recommendation that violates it as I have stated it above?

Moreover, there is a massive difference between being "left to die" and receiving only palliative care that reduces pain and does not prolong life. Bainbridge claims, "Although most infants allowed to die per the Nuffield Council's recommendations likely will do so in a hospital setting, there is little ethical difference between allowing a child to expire from denial of nourishment or other forms of care, and allowing a child to die of exposure. Indeed, in both cases, hunger or thirst will be the agent of death."

There is a tremendous ethical difference between the two. By Bainbridge's lights, there is no ethical difference between Christian Scientist parents who spend 24 hours a day at their sick child's bedside, praying and keeping her as comfortable as possible, and a father who leaves his sick child at home to suffer while he goes out to get high. Bainbridge is taking an astonishingly consequentialist view for a religious person; non-utilitarian ethics usually give credit for good intentions.

Indeed, even the consequences for the person most concerned, i.e. the baby who dies, are much better under the Council's guidelines than in Bainbridge's exposure comparison. A baby who starves or dehydrates to death -- something that will not occur under the Council guidelines anyway, unless the food or water itself is causing pain -- while being given sedated so she is unconscious of pain, is being treated far more ethically than a baby who is left to feel every twinge of hunger and to cry futilely because of thirst.

December 1, 2006 2:38 PM | TrackBack
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