The Morality Of Modern Medicine

 It seems like an eternity ago, yet I remember it like it was yesterday. My mother had been diagnosed with stage four cancer and was given about three months to live. My father had died from cancer nearly fifteen years earlier, and all those horrible memories came back vividly. I knew this would be rough because my mother had been sickly most of her life. Those illnesses, compounded by her advanced age, didn't leave her much strength to fight that most evil and dreadful cancer. She began declining rapidly. Soon, she was in the hospital unable to eat by mouth, and needed a peg placed in her stomach, and an IV in her arm so that nutrition and hydration could continue. The end couldn't be that far off, and I made sure before she lost her mental faculties, a Traditionalist priest gave her the Last Rites of Holy Mother Church.

 I had just come from seeing my mom, when her attending physician (whom I'll call "Dr. B"), saw me in the hallway of the hospital and asked if he could have a word with me in his office. "Your mother will not live much longer," he said. "I can see that, " I replied. "Many things she needs are not covered by Medicare. It's costing you lots of cash." "So what? She's my mother," was my firm response. He looked at me, quite matter-of-fact, and said, "Her quality of life is non-existent. Why don't you just sign a release as her Health Care Proxy, allowing us to remove her feeding and hydration tubes." I couldn't believe what I had just heard. I could feel the rage building inside me. "I wouldn't starve a dog or a cat, and you're asking me to starve and dehydrate my mother?" "Don't be upset," he continued. "It will only take a few days, and it doesn't cause any pain. It's less expensive than hospice." My blood pressure must have been so high at that point, it would be off the scale. I had to suppress the urge to reach across the desk, grab him by the lapels, drag him across the room, and send him head first out the window.

"Human beings are made in the image of God. You don't simply discard them, and you certainly don't starve them to death," I said with my voice trembling in anger. Dr. B didn't know when to stop. "Look, it doesn't hurt. I don't know how they know this, but the medical researchers know this to be true." I had enough. "You don't know how they know. Yeah, that makes sense. I'll make a deal with you. Since you claim it doesn't hurt, I'll lock you up in a room with nothing to eat or drink for a week. If you come out and tell me it didn't hurt, I'll let you do the same to my mother." "You don't understand," protested Dr. B. "No, you don't understand, " my raised voice cutting him off. "As far as I'm concerned, the only place you're qualified to practice medicine is Nazi Germany. You are no longer my mother's doctor. You are not allowed to see her or attend to her in any way, effective immediately. If you even think of going near her, I'm going to sue both the hospital and you. I'll make it my life's work to see to it that you never practice medicine again. Am I clear?" I was now shouting. He shook his head "yes" and I abruptly left.

I immediately went to hospital administration, to let my decisions be known. On the way there, I saw a doctor I had helped with a legal issue a couple of years back. He recognized me, and saw how upset I looked. "Tell them to put your mother under my care," he said. "I promise to treat her as my own mother." I knew "Mike" (not his real name) to be an ethical and kind physician, so I immediately felt better. I also decided to get my mother out of the hospital as soon as possible. Even with Mike taking care of her, just the thought of Dr. B being in the same building made me uneasy. I was going to ask for about a month off work to let my mother die at my home where I could personally care for her. With all the paperwork signed the following Friday, I was all set to have her transported to my house on Monday. I would request the time off Saturday morning. When I awoke, I received a phone call making it all moot. My mom had just passed away from a massive coronary.

All of us will (unfortunately) have to deal--to one degree or another-- with such life and death issues involving medical care for both the people we love, as well as ourselves. What's scary is not having a pope to decide certain issues. While Catholic principles don't change, the circumstances surrounding them do. Without someone to make authoritatively binding decisions, how can we be sure those principles were correctly applied? In 2005 we had the unfortunate situation of having some Traditionalist clergy defend the murder of Terri Schiavo by her adulterous husband. The Schiavo case demonstrates the need to examine the issue of modern medicine in the light of timelessly true principles of the Faith, so that we are prepared to make well-formed moral choices when needed. This post will examine the general principles and guidelines of the approved pre-Vatican II theologians, and some practical guidelines to which I adhere. I'm not a theologian or a canonist, and I have no Magisterial authority. It is not my intent to "bind" anyone (I can't), but at least you can be better informed and seek the counsel of a Traditionalist clergyman you trust.

Where The Problem Lies

 There are two fundamental principles upon which we have the unanimous consent of the theologians: (1) The refusal of everyday means of sustaining life, such as nutrition, hydration, and rest may never be denied to a sick or terminally ill person because it is a self-destruction which clearly violates the Divine dominion over human life; (2) Humans are not expected to sustain life at all costs, which would be extraordinary. The fate of death since the Fall is also part of nature. These two points are clear. Their application is much less so. The "ordinary vs. extraordinary" dichotomy (or "natural vs. unnatural") will yield different results with  the chronological development of medicine. What was considered "ordinary means" in 1600 AD will be much different from 1955 AD, and 1955 will differ significantly from 2019. 

Having several blood transfusions was impossible in 1600, extraordinary in 1955, but looked upon by physicians in 2019 as not being "extraordinary" any longer. Much of what the great theologians wrote before the Great Apostasy never envisioned the world in which we live, both in terms of not having a pope for an extended period of time to settle specific questions, and the enormity of medical advancement in a relatively short span of time. Medical practice has advanced more in the last 70 years (1949-2019) than in the prior 700 years (literally).

Certain terms have become abused because they are understood less on an intellectual level than on an emotional level. This is in no small measure because of the Modernist heresy that the world has been infected with for over fifty years now. The term "extraordinary means" is subject to no small amount of abuse. Keeping my mother alive with food and water was considered by her (immoral, unethical) doctor to be "extraordinary" because of her age, her other medical conditions, the expense of her treatments, and "quality of life." The crux of the argument seems to be that the surrounding circumstances can justify starvation and dehydration. Imagine if a State were to propose starving and dehydrating a convicted first-degree murderer as a means of execution. The ACLU and every left-wing organization would file a lawsuit claiming that it contravenes the Eighth Amendment's prohibition against cruel and unusual punishment. Yet these same godless humanists see nothing wrong doing it as "an act of mercy" on an innocent elderly woman like my mother.

There are some acts that are always wrong no matter what the surrounding circumstances. In the aftermath of Vatican II, there was a movement by apostate theologians which attempted to discredit any idea of an intrinsically evil moral object and sought to determine the morality of an action only by a simultaneous consideration of the motive of the act and the other circumstances. The Jesuit theologian Fr. Joseph Fuchs was one of the leaders of this movement. Once an approved theologian, he became a raging Modernist, especially after the publication of Montini's Humanae Vitae in 1968. Fuchs erroneously taught that no act could be considered intrinsically evil (malum per se---"evil in itself"). As a result of this teaching, all moral actions that are branded evil, such as theft, adultery, and even murder, may admit of exceptions, given some special set of circumstance and intention.

In 1977, a group of Modernist theologians put out a book published by Paulist Press called Human Sexuality. In the pages of this tome you will find a defense of fornication, adultery, contraception, and homosexuality as morally acceptable if done for the "proper" motives and under "sufficiently fulfilling" circumstances. The Episcopalian "priest" and philosopher, Joseph Fletcher, became the "Father of Situation Ethics" around the same time. Fletcher would allow the direct killing (i.e., murder) of a terminal patient for such reasons as saving money, alleviating family anxiety, and to "put [the patient] out of his misery." Fletcher and the Modernists make murder, one of the Four Sins that Scream to Heaven for Vengeance, a pretty excusable act.

As a result of such a Modernist onslaught, it is now commonplace to hear such emotional appeals for killing someone in the form of such statements as, "How would you feel if you had tubes hooked up to you and couldn't move?" Such statements carry with them two poisonous presuppositions: (1) life, as such, has no intrinsic value, and (2) there is no good purpose in suffering. If you don't think the second presupposition is purely pagan, repeat it while looking at the Crucifix.

The Teaching of the Church

According to theologian Jone, "For the preservation of life and health, one must employ at least ordinary means. Ordinary means are: proper food, clothing, housing, and physical recreation; likewise medicinal remedies which are not beyond the means of the sick person...Employing extraordinary means of preserving one's life is generally not obligatory." (See Moral Theology, The Newman Press, [1962], pgs. 135-136). 

According to theologian Connell, "A person is obliged to to use ordinary means to preserve his life, but not extraordinary means, such as a very expensive operation, the procuring of an 'iron lung' for permanent need, or the continued and frequent use of blood transfusions." (See Outlines of Moral Theology, [1958], pg. 124; Emphasis mine)

Notice that the terms are not very concrete. What, exactly, constitutes "very expensive"? Is it an absolute dollar amount, or relative to the person's wealth? If the latter, what percentage of money is considered "very expensive"--15% of their money, etc.? What does "continued and frequent" mean? Once a year for life? Four times a year for the foreseeable future? When Jone and Connell wrote (1962 and 1958, respectively), blood transfusions were much more risky and the need for them has abated in many cases due to developments in medicine.

The theologians had developed their principles as time progressed. For example, compare these passages from theologian Noldin in 1922, and then his work as revised by theologian Schmitt nineteen years later in 1941:

Noldin, Summa Theologiae Moralis, 14th Ed. 1922, vol. 2, no. 326: "There is no obligation to undergo a serious surgical operation, or a notable amputation: even though today the pains of many operations are not acute, due to anesthetics, nevertheless, the obligation is not to be imposed, both because many have a great horror of it, and because the success, especially the lasting success, ordinarily is uncertain, and finally, because it is a grave inconvenience to live with a mutilated body."

Noldin-Schmitt, Summa Theologiae Moralis, 27th Ed. 1941, vol. II, no. 328: "Today the suffering is vastly decreased through narcotics, the danger of infection is very remote, and moreover success is more frequent and assured, and even for amputated members, there are artificial limbs--and therefore, at least where certain danger of death would very probably be avoided through an operation, it does not seem that it can be called an extraordinary means, unless there is a great horror of it."

There was a major re-evaluation due to the progress of medicine. The 1941 edition still had its problems: what constitutes a "great horror"? Also, I think had the Great Apostasy not happened, even that would have changed as we now understand that mental imbalance can frequently accompany serious illness, therefore "great horror" (in my opinion) would have been dropped from the text. 

What are the certain principles? 

1. Ordinary means to preserve life must always be used. It seems best defined as those things associated with the basics of life (food, water, rest, clothing, etc.) and what modern medicine can provide. There is never a good reason to starve someone to death. Even in "brain death" or a PVS ("persistent vegetative state"), we cannot know if the person is capable of suffering--suffering we wouldn't want an animal to endure, let alone a human being. 

2. Most of the now commonly available techniques of modern surgery, medicines, and other medicinal practices/devices should be classified as ordinary means of preserving life. 

3. Extraordinary means of preserving life need not be used. Those would seem to include experimental surgery, untested or unproven medicines and the like which cannot be used without prolonged suffering, devastating financial consequences, and offer no substantial chance of recovery.

We must be very careful in what we consider "extraordinary means" of preserving life. In the medical profession, there is the ideal which demands fighting off pain and death until the last possible moment. There is much to be said for that attitude. Many of the great advances in modern medicine, as well as perfection in surgical skill and technique, have been due to what might have frequently been called a "useless prolongation of life/suffering." Modern surgery is only considered an ordinary means of preserving life because of its extensive use in those stages of its development when it was considered an extraordinary means. We must not be too ready to lower that medical ideal, and slow medical progress in the immediate interest of a present case. The future betterment of humanity is also served by attempting "extraordinary means."

Conclusion

I submit all I write to the decisions of Holy Mother Church if and when the papacy is restored. Until such time, I believe that what I've written is a good guideline for end of life decisions. Please make sure you have a Health Care Proxy. This post is not meant to be morbid. It's just a realistic look at the bridge we must someday cross--be it for ourselves, or someone else. Most importantly, keep yourself spiritually healthy.

 "In all thy works remember thy last end, and thou shalt never sin." (Sirach 7:40).