Monday, July 20, 2009
Responding to my post on health care rationing, Denise Hunnell writes:
I responded to Peter Singer's article here. The problem with rationing is that it judges the patient, not the treatment. Catholic teaching is that we must determine what is proportionate care and what is disproportionate care. This judgment is made from the perspective of the patient or the patient's surrogate. This teaching of distinguishing proportionate vs disproportionate care has been developed in two Magisterial documents. The first is the Pope Pius XII, Address To members of the "Gregorio Mendel" Italian Institute of Genetics on reanimation and artificial respiration (November 24, 1957) In this document Pope Pius XII states that one is obligated to pursue ordinary or proportionate care.
In the Congregation for the Doctrine of the Faith, Declaration on Euthanasia, (May 5, 1980) n IV, the principles for the determination of what is proportionate care and what is disproportionate care are more clearly stated:
In the final analysis, it pertains to the conscience either of the sick person, or of those qualified to speak in the sick person's name, or of the doctors, to decide, in the light of moral obligations and of the various aspects of the case. Everyone has the duty to care for his or her own health or to seek such care from others. Those whose task it is to care for the sick must do so conscientiously and administer the remedies that seem necessary or useful. However, is it necessary in all circumstances to have recourse to all possible remedies? In the past, moralists replied that one is never obliged to use "extraordinary" means. This reply, which as a principle still holds good, is perhaps less clear today, by reason of the imprecision of the term and the rapid progress made in the treatment of sickness. Thus some people prefer to speak of "proportionate" and "disproportionate" means. In any case, it will be possible to make a correct judgment as to the means by studying the type of treatment to be used, its degree of complexity or risk, its cost and the possibilities of using it, and comparing these elements with the result that can be expected, taking into account the state of the sick person and his or her physical and moral resources
The USCCB ethical and religious directives (ERD) state: “Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community”(ERD 56) and “Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden or impose excessive expense on the family or the community”(ERD 57)
In the case of your 85-year-old, there is the added complication of a limited supply of organs. It is fair to triage an 85-year-old to lower on the transplant list because his risk/benefit analysis may not be as favorable as someone else's. Then it must be determined if the risk of the treatment in this individual patient is worth the anticipated benefit. Cost can be a consideration. You are not obligated to bankrupt your family to pursue care. The point is, it must always be the treatment that is being judged for benefit and burden, not the patient.
Thanks for continuing this discussion.