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TheEthicalandReligiousDirectivesforCatholicHealthCareServices:ABriefTourN.A.C.C.MeetingNovember4,2021TomNairn,O.F.M.SeniorDirector,EthicsWhyLookattheDirectives?WhatCatholichealthcareisabout—purposeandfundamentalvaluecommitmentsHowCatholichealthcareshouldbedelivered;setssomebasicparametersDocumenttowhichallinCatholichealthcareareaccountableWhyLookattheDirectives?Asleaderswithinthehealthcareministry,CatholicchaplainsHavearesponsibilityforeducatingabouttheDirectivesMaybeaskedtointerpretandapplytheDirectivesShouldbeabletodirectotherstoappropriatesectionsWhatAre

theDirectives?Alimitedattempttoanswertwoquestions:Whoarewe?Whoshouldwebe?(Identity)Whatshouldwedoinlightofthis?(Integrity)And…toprovideguidanceonethicalissues inhealthcaredeliveryPurposeoftheDirectives(Preamble)ToaffirmethicalstandardsandnormsToprovideauthoritativeguidanceToprovideprofessionals,patientsandfamilieswithprinciplesandguidesformakingdecisionsForWhomAretheERDsIntended?(Preamble)Thoseentrusted

withidentityandintegrityoftheministryandtheorganization(sponsorsandtrustees;CEOs)Thoseembodyingthemissioninday-to-dayoperations(administrators,healthcareprofessionals,spiritualcaregivers,etc.)Recipientsofhealthcare(patients,residents,families,andsurrogates)GeneralFormatSixpartscoveringsixmajorareasofconcerninCatholichealthcareEachpartdividedintotwosections:Introduction:narrative,providingabiblicalandtheologicalcontextIndividuallynumbereddirectivesaddressingspecificissuesThePartsGeneralIntroductionPartOne:SocialResponsibilityPartTwo:PastoralResponsibilityPartThree:Patient/ProfessionalRelationshipPartFour:BeginningofLifePartFive:CarefortheDyingPartSix:FormingNewPartnershipsApproachingtheERDsNotananswerbook—usuallyrequiresinterpretationandapplicationtoconcretesituationsNotexhaustiveeither

ofThechurch’smoralteachingIssuesinhealthcareethicsMayneedassistanceDifferentconclusionsarepossibleApproachingtheERDsGeneralIntroduction:WhoShouldWeBe?ThereasonforCatholichealthcare:ContinuingGod’slife-givingandhealingwork(p.7)ByimitatingJesus’servicetothesick,suffering,anddying(pp.4,5)ResponsetoJesus’challengeto“Goanddolikewise〞(p.38)CarryingonJesus’radicalhealing(p.4)GeneralIntroduction:WhoShouldWe

Be?OughttobeChrist’s“healingcompassionintheworld〞(p.38)Oughttorestoreandpreservehealthandserveasasignoffinalhealing(p.38)Asaministryofthechurch(p.6)PARTONE:

SocialResponsibilityVALUETHEOLOGICALREFLECTIONHumanDignityCatholichealthcareisrootedinacommitmenttodefendhumandignityCareofthePoorCatholichealthcareismandatedtocareforthepoor,theuninsuredandtheunderinsuredCommonGoodCatholichealthcarecontributestothecommongood,ensuringprotectionforfundamentalrightsofindividualsandgroupsResponsibleStewardshipCatholichealthcareisconcernedbothwiththequalityofcarefortheindividualandwiththehealthofthecommunityRespectforConscienceTotheextentitisable,Catholichealthcarerespectstheindividual’sconsciencebutalsoaskstheindividualtorespectitsinstitutionalconsciencePartOne:SocialResponsibilityIntroduction(pp.4-5)CommonvaluesthatshoulddistinguishCatholichealthcare:humandignitycareforthepoorcontributiontothecommongoodresponsiblestewardshipofresourcesconsonancewithchurchteachingPartOne:SocialResponsibilityKeyDirectives#1:Weareacommunityofcare

animatedbytheGospelandrespectfulofthechurch’smoraltradition#2:WeactinamannercharacterizedbymutualrespectamongcaregiversandservingwithcompassionofChrist#6:UsehealthcareresourcesresponsiblyPartOne:SocialResponsibility#7:Treatemployeesrespectfullyandjustly

non-discriminationinhiringemployeeparticipationindecision-makingworkplacethatensuressafetyandwell-beingjustcompensationandbenefitsrecognitionofrighttoorganizePartOne:SocialResponsibility#3:Organizationshoulddistinguishitselfbyservice

toandadvocacyformarginalizedandvulnerablePARTTWO:

PastoralandSpiritualCareVALUETHEOLOGICALREFLECTIONHumanDignityCatholichealthcarehastheresponsibilitytotreatthoseinneedinawaythatrespectsthehumandignityandeternaldestinyofall.HolisticCareCatholichealthcareinstitutionsarecommunitiesofhealingthatembracetreatmentofthephysical,psychological,socialandspiritualdimensionsoftheperson.HealingPresenceCatholichealthcarecombinesmedicalexpertisewithotherformsofcaretopromotehealthandrelievehumansufferingDiverseRolesandCollaborationWithinthehealthcareinstitution,clergy,religiousandlaityexercisediversebutcomplementaryrolesinpastoralcare.Also,morefrequently,thelocalparishassumesgreaterinvolvementinpastoralcarebothbeforeandafterhospitalization.PartTwo:PastoralandSpiritualCareIntroduction(pp.6-7)Catholichealthcaremusttreatallinamannerthatrespectshumandignityandtheireternaldestiny;helpothersexperienceowndignityandvalueCareofferedmustembracewholeperson:physical,psychological,social,spiritualPartTwo:PastoralandSpiritualCarePastoralcareisanintegralpartofCatholichealthcarePastoralcareencompassesfullrangeofspiritualserviceslisteningpresencehelpindealingwithpowerlessness,pain,etc.assistanceinrespondingtoGod’swillEstablishgoodrelationshipsbetweenpastoralcareandparishclergyandministersofcarePartTwo:PastoralandSpiritualCareKeyDirectives#15:Addressesholisticneedsofpersons#10:Maintainappropriateprofessionalpreparationandcredentialsforstaff#10-14,#20-22:RespectproperauthoritiesineachreligionorChristiandenominationregardingappointmentsPartTwo:PastoralandSpiritualCare#10:Addressestheparticularreligiousneedsofpatients#11,#22:Maintainanecumenicalstafformakeappropriatereferrals#10,12-20:AddressthesacramentalneedsofCatholicsPARTTHREE:

Patient/ProfessionalRelationshipVALUETHEOLOGICALREFLECTIONRespectforPersonsRelationshiprequiresmutualrespect,honestyandappropriateconfidentiality;avoidsmanipulation,intimidationorcondescensionInterdependenceNeitherprofessionalorpatientactsindependently;bothparticipateinhealingprocessCommitmentFactthatthereisateamofprovidersdoesnotalterthepersonalcharacteroftheinteractionProfessionalEthicalResponsibilityProfessionalstakeintoaccountthepatient’sconvictionsandspiritualneedsandthemoralresponsibilitiesofallconcerned,includingtheinstitutionPartThree:Patient/ProfessionalRelationshipIntroduction

(p.8)Groundedinrespectforhumandignity

Requiresmutualrespect,trust,honesty,andappropriateconfidentialityParticipatoryandcollaborativeBothpartieshaveresponsibilitiesPartThree:Patient/ProfessionalRelationshipKeyDirectives#23:Inherentdignityofhumanpersonmustberespectedandprotectedhonorpatients’righttomaketreatmentdecisions(#s26and27)honorinformedconsent(#s26and27)encourageandrespectadvancedirectives(#24)PartThree:Patient/ProfessionalRelationshiprespectchoicesofsurrogatedecisionmakers(#25)respectprivacyandconfidentiality(#34)considerwholepersonwhendecidingabouttherapeuticinterventions(#33)respectdecisionstoforegotreatment(#32);ordinaryorproportionatemeans(morallyobligatory);extraordinaryordisproportionatemeans(morallyoptional)PartThree:Patient/ProfessionalRelationship#36:Providecompassionateandappropriatecaretovictimsofsexualassaultcooperatewithlawenforcementofficialsofferpsychologicalandspiritualsupportoffer“accuratemedicalinformation〞providetreatmenttopreventconceptionpregnancyapproachovulationapproachPARTFOUR:

CarefortheBeginningofLifeVALUETHEOLOGICALREFLECTIONSanctityoflifeTheChurch’scommitmenttohumandignityinspiresaconcernforthesanctityofhumanlifefromconceptionuntilnaturaldeathRespectforMarriageandFamilyTheChurchcannotapprovepracticesthatunderminethebiological,psychologicalandmoralbondsofmarriageandfamily.RespectfortheProcreativeActTheChurchcannotapproveinterventionsthathavethedirectpurposeofrenderingprocreationimpossible,orseparatingprocreationfromintercourse.AppropriateUseofTechnologyWhatistechnologicallypossibleisnotalwaysmoral.Reproductivetechnologiesthatsubstituteforthemarriageactarenotconsistentwithhumandignity.PartFour:CarefortheBeginningofLifeIntroduction(pp.10-11)Catholichealthcareministrywitnessestothesanctityofhumanlife“fromthemomentofconceptionuntildeath〞CommitmenttolifeincludescareofwomenandchildrenbeforeandafterpregnancyandaddressingcausesofinadequatecarePartFour:CarefortheBeginningofLifeProfoundregardforthecovenantofmarriageandforthefamilyCannotdoanythingthatseparatestheunitiveandprocreativeaspectsofconjugalactReproductivetechnologiesthatsubstituteformarriageactinconsistentwithhumandignityPartFour:CarefortheBeginningofLifeKeyDirectives

WhattheDirectivesforbid:#45:Directabortions#53:Directsterilization#52:Contraceptivepractices#40:Heterologousfertilization(AID)#41:Homologousfertilization(AIH)PartFour:CarefortheBeginningofLifeWhattheDirectivespermit:#47:Indirectabortions(thoseprocedureswhosesoleimmediatepurposeistosavethemother’slife,wherethedeathofembryoorfetusisforeseenbutunavoidable)#53:Indirectsterilizations#50:Prenataldiagnosis#54:Geneticcounseling#43:InfertilitytreatmentsPARTFIVE:

CarefortheDyingVALUETHEOLOGICALREFLECTIONStewardshipoverHumanLifeWearenottheownersofourlivesandhencedonothaveabsolutepoweroverthem.Wehaveadutytopreservelife.PriorityofCareThetaskofmedicineistocareevenwhenitcannotcure.Suchcaringinvolvesrelieffrompainandthesufferingcausedbyit.CommunityofCareACatholichealthcareinstitutionwillbeacommunityofrespect,loveandsupporttopatientsandtheirfamiliesastheyfacetherealityofdeathRespectfortheDyingTheuseoflife-sustainingtechnologyisjudgedinthelightoftheChristianmeaningoflife,sufferinganddeath.Oneshouldavoidtwoextremes:(1)insistenceonuselessandburdensometechnologyevenwhenapatientlegitimatelywishestoforegoitand(2)withdrawaloftechnologywiththeintentionofcausingdeath.PartFive:CarefortheDyingIntroduction(pp.13-14)Wefacedeathwiththeconfidenceoffaith(ineternallife);basisforourhopeShouldbeacommunityofrespect,love,andsupporttopatientsandfamiliesReliefofpainandsufferingarecriticalMedicinemustcareevenifitcannotcurePartFive:CarefortheDyingStewardshipofanddutytopreservelifethisisalimitedduty.Why?humanlifeissacredandofvalue,butnotabsolutebecauseitisalimitedgood,dutytopreserveitislimitedtowhatisbeneficialandreasonableinviewofpurposesofhumanlifePartFive:CarefortheDyingDecisionsaboutuseoftechnologymadein lightof…h(huán)umandignityChristianmeaningoflife,sufferinganddeathAvoidtwoextremesemployinguselessorburdensomemeanswithdrawingtechnologytocausedeathPartFive:CarefortheDyingKeyDirectives#55:Provideopportunitiestopreparefordeath#56:Moralobligationtouseproportionatemeansofpreservinglife#57:NomoralobligationtoemploydisproportionateortooburdensometreatmentsPartFive:CarefortheDying#59:Respectfreeandinformeddecisionofpatientaboutforgoingtreatment#61:Appropriatenessofgoodpainmanagement,evenwheredeathmaybeindirectlyhastenedthroughuseofanalgesics#60:Euthanasiaandphysician-assistedsuicidearenotpermitted#62-66:Encourageappropriateuseoftissueandorgandonation#58:Presumptioninfavor

ofnutritionandhydrationaslongasitisofsufficientbenefittooutweighburdensPartFive:NutritionandHydration(#58)PARTSIX:

FormingNewPartnershipsVALUETHEOLOGICALREFLECTIONValue-basedCollaborationNewpartnershipscanbeopportunitiesforCatholichealthcareinstitutionsandservicestowitnesstotheirreligiousandethicalcommitmentsandsoinfluencetheChurch’ssocialteaching.EthicalChallengesNewpartnershipscanposeseriouschallengestotheviabilityoftheidentityofCatholichealthcareinstitutionsandservices.ImportanceofMoralAnalysisThesignificantchallengesthatpartnershipsmayposedonotnecessarilyprecludetheirpossibilityonmoralgrounds...butrequirethattheyundergosystematicandobjectivemoralanalysis.FormalandMaterialCooperationReliabletheologicalexpertsshouldbeconsultedininterpretingandapplyingprinciplesgoverningcooperation,withtheprovisothat,asarule,Catholicpartnersshouldavoidenteringintopartnershipsthatinvolvethemincooperationwithwrongdoing.Introduction(pp.15-16)Sectionaddedwiththe1994revisionPrimarilyconcernedwith“outsidethefamily〞arrangementsConcern:somepotentialpartners

engagedinwrongdoingHowdoesCatholicpartymaintain

integrity?PartSix:FormingNewPartnershipsAppendixomitted:ledtomisunderstandingandmisapplicationofprincipleofcooperationConsultreliabletheologicalexpertsCatholichealthcareorganizationsshouldavoidcooperatinginwrongdoingasmuchaspossiblePartSix:FormingNewPartnershipsKeyDirectives#67:ConsultwithdiocesanbishoporliaisonifpartnershipcouldhaveseriousimpactontheCatholicidentityorreputationoftheorganization,orcausescandal#68:Properauthorizationshouldbesought(maintainrespectforchurchteachingandauthorityofdiocesanbishop)PartSix:FormingNewPartnerships#69:Mustlimitpartnershiptowhatisinaccordwiththeprinciplesgoverningcooperation(POC),i.e.:POChelpsdeterminewhetherandhowonemaybepresenttothewrongdoingofanother

Todeterminewhethercooperationismorallypermissible,onemustanalyzethecooperator’s

intentionandactionPartSix:FormingNewPartnershipsIntention:intending,desiringorapprovingthewrongdoingisalwaysmorallywrong(formalcooperation)Action:directlyparticipatinginthewrongdoingorprovidingessentialconditionsfortheeviltooccur(i.e.,theimmoralactcouldnotbeperformedwithoutthiscooperation)ismorallywrong(immediatematerialcooperation)PartSix:TheP