Christian Medical EthicsChristian Medical EthicsA basic explorationA basic exploration

of fundamental concepts of fundamental concepts

and a problem solving processand a problem solving process

Common approaches to medical ethics

1. Virtue ethics (Existential)1. Good = What a good person would do

2. Look at motives and behaviour

2. Consequence ethics (Teleological/ Utilitarian)1. Good = Aiming at good goal / consequences

2. Look at facts and consequences

3. Duty ethics (Deontological)1. Good = What the law says

2. Look at laws, protocols, standards, creeds, norms

What is Christian medical ethics?

Theological basis: Matthew 22: 37-39

Application: How love our neighbour in healthcare?

As a science: Reverent,

systematic,

analytical and

critical thinking about

how medical professionals ought to behave.

We consider virtues, consequences and duties in loving God and our neighbour

Define moral problem

Develop possible courses of action

Determine preferred course of action

Deploy planned course of action

Deployment evaluated and appropriately handled

Ethics problem-solving flow-chart

Case study: Patient requests euthanasia

Christian nursing home, Christian doctor doing rounds with successor Male patient:

Early sixties, divorced (no contact with ex-wife), three children (no contact with one of them, poor contact with the other two),

Grew up in Christian environment, drifted away as teenager and stayed that way Poor vascular system, upper leg amputations both sides because of this; still

smoking - under supervision because of fire hazard; several large decubitus ulcers

Has requested euthanasia once before. Doctor then explained that it is against the institutional code and against the doctors’ conscience to do so. Patient accepted it at that stage. His family was not informed about his request.

Now complains of severe ongoing pain, feels depressed, sees no future for himself, requests euthanasia again

Doctor reminds patient of earlier conversation; discusses the various complaints with patient; prescribes more potent pain relief protocol; adds that patient will have to move to other nursing home if he persists with euthanasia request; recommends a talk with a pastoral worker

Patient declines pastoral care; promises to think more about the issue

In the groups

1. Appoint persons in following roles:

1. One person = doctor doing ward round

2. One person = patient

3. One person = son who has no contact

4. Rest = ethics committee members of institution

2. Define the problem

3. Develop possible courses of action

4. Determine preferred course of action

1. Define moral problem

1. What are the facts of the situation: medical, nursing, legal, economic, social, organisational?

2. Who is involved? 1. What does each party think about the situation?2. What are their responsibilities in the situation?3. What interests do they have in the situation?

3. What are the underlying world view perspectives?4. Is there a moral dilemma? If so, which? More than

one dilemma? 5. What is the scope of the problem? (Micro, meso, macro?)

6. State the problem as a specific question

2. Develop possible courses of action

1. Which courses of action could be taken? (including those you would not agree with)

2. What virtues / consequences / duties are relevant in each of the possible courses of action?

3. Which virtues / consequences / duties are in danger of being neglected in each of the possible courses of action?

4. What would each possible course of action mean for each of the key persons involved?

5. If different underlying opinions / preferences / world view issues are evident, specify.

2.1a General Virtues and Vices

Seven Vices

1. Pride

2. Envy

3. Gluttony

4. Lust

5. Wrath / Anger

6. Greed

7. Sloth

Seven Virtues

1. Faith

2. Hope

3. Love

4. Fortitude

5. Temperance

6. Justice

7. Prudence

Q: What does my conscience say? How become more Christ-like through grappling with problem?

2.1b Medical Virtues and Vices

Seven Medical Virtues

1. Compassion

2. Mercy

3. Professionalism

4. Integrity

5. Collegiality

6. Justice

7. Prudence

Seven Medical Vices

1. Coldness

2. Cruelty

3. Quackery

4. Corruption

5. Rivalry

6. Injustice

7. Carelessness

2.2 Consequences: A Christian perspective

1. Purpose: promote health interests of patient2. What will consequences be for:

1. Ethical, religious, legal, economical, social and technical aspects? (? also aesthetic, linguistic and cultural aspects)

2. Preventive, curative, palliative + terminal care?3. Health and well-being of involved parties?

3. Consider these rules regarding consequences:1. Proportionality (benefit / burden analysis)2. Subsidiarity (least drastic / burdensome / expensive)

4. Consider the scope of the consequences:1. Micro (personal), meso (institutional) and macro (whole

field) 2. Short term, long term, eternal

2.3 Duties: A Christian perspective

1. Christian duties1. Pro-shalom; not kill on purpose

2. Marriage as safe circle for intercourse, conception and raising children

3. Respect responsibility and freedom of choice of patient

4. Repair of disease as safe circle for genetic manipulation

5. Respect property of another

6. Respect created sexual identity

2. The Law: What does the Bible say?1. Ten / two commandments

2. Law suited to humans

3. Love is fulfilment of the law

1. Medical Duties1. Care

2. Respect for life

3. Beneficence (do good)

4. Non-maleficence (no harm)

5. Justice

6. Confidentiality

7. Trustworthiness

8. Informed consent

2. Hippocratic Oath

3. Medical ethical codes

4. Protocols, standards

5. Professional responsibilities + position description

3. Determine preferred course of action Dialogue with relevant parties regarding possible

courses of action; discuss virtues / consequences and duties of each possibility

Use feedback to improve quality of problem solving Develop criteria for evaluating the possible courses of

action: what is acceptable / exemplary / unacceptable Which criteria will count the most? Build convincing argumentation for your choice; refer

to virtues, consequences and duties as well as the criteria for evaluating the courses of action

Seek to reach consensus about the preferred course of action. Use negotiation / mediation if required

What protocol to follow if no consensus is reached?

4. Deploy planned course of action

1. Plan: Make a good plan re course of action:1. Consider implications on care plans, treatment

protocols, institutional plans and procedures

2. Who does what by when?

3. Who is responsible for supervision of which part of the planned course of action?

4. How will the implementation of the planned course of action be evaluated?

5. What will consequences be of the evaluation?

2. Do: Implement the plan

5. Deployment evaluated and appropriately handled

1. Check: Evaluate the course of action as indicated in the plan

2. Act: Use information from evaluation to take appropriate steps towards a better future together

Overview of the process

Step Virtues Consequences Duties

1

2

3

4

5

Overlap / different interpretations between doctor / patient

Virtues Consequences Duties

What happened with the patient who requested euthanasia?

Patient satisfied with adequate pain relief and excellent care; withdrew euthanasia request

Condition later deteriorated seriously; this time took advice from successor doctor to get pastoral help

As a consequence: Reconciliation between patient and God Reconciliation between patient and lost son Gratitude expressed towards successor and staff Patient died in peace just after this

Faith

Belief, trust, fidelity, loyalty, conviction Faith: trust God at His Word

Hope

Desire, expectation, reliance, belief Hope: certainty of better future based on

God’s promises

Love / Charity

Generosity, benevolence, helpfulness, mercy

Love: desire, choose and act for highest good

Fortitude

Strength, courage, endurance, resoluteness

Fortitude: perseverance in integrity; strength of mind to endure adversity steadfastly; perseverance in facing danger for the sake of principle

Temperance

Moderation, restraint, self-mastery, frugality, sobriety

Temperance: Self-control

Justice

Impartiality, fairness, equity, rightness, dispassion

Justice: regard for fulfilment of obligations

Prudence

Wisdom, vigilance, carefulness, thoughtfulness, discretion

Prudence: due regard for one’s own welfare; habitually careful to avoid error / danger

Pride

Pride is excessive belief in one's own abilities, that interferes with the individual's recognition of the grace of God. It has been called the sin from which all others arise.

Thomas Aquinas said of Pride "inordinate self-love is the cause of every sin (1,77) ... the root of pride is found to consist in man not being, in some way, subject to God and His rule."

Envy

Envy is the desire for others' traits, status, abilities, or situation.

Thomas Aquinas said of Envy: "Envy according to the aspect of its object is contrary to charity, whence the soul derives its spiritual life... Charity rejoices in our neighbour's good, while envy grieves over it." (2, 36, ad 3)

Gluttony

Gluttony is an inordinate desire to consume more than that which one requires.

Thomas Aquinas said of Gluttony: "Gluttony denotes, not any desire of eating and drinking, but an inordinate desire..." (2, 148, ad 1)

Lust

Lust is an inordinate craving for the pleasures of the body.

Anger

Anger is manifested in the individual who spurns love and opts instead for fury. It is also known as Wrath.

Greed

Greed is the desire for material wealth or gain, ignoring the realm of the spiritual. It is also called Avarice or Covetousness.

Thomas Aquinas said of Greed: "it is a sin directly against one's neighbour, since one man cannot over-abound in external riches, without another man lacking them... it is a sin against God, just as all mortal sins, inasmuch as man contemns things eternal for the sake of temporal things." (2, 118, ad 1)

Sloth

Sloth is the avoidance of physical or spiritual work.

Thomas Aquinas said Sloth is "sluggishness of the mind which neglects to begin good... [it] is evil in its effect, if it so oppresses man as to draw him away entirely from good deeds." (2,35, ad 1)