Almost 30 years ago, when the field of medical ethics was still in its youth, the Dominicans Benedict Ashley and Kevin O’Rourke published Health Care Ethics. To see how that professional discipline is now moving into its maturity, one need only inspect Ashley and O’Rourke’s considerably revised fifth edition, now strategically joined in co-authorship by Jean deBlois, C.S.J.
Still deeply rooted in Scripture, the teachings of the Catholic Church and a humanistic natural law tradition, as well as conversant with a variety of value and religious systems, much of Health Care Ethics: A Catholic Theological Analysis could not possibly have been written even 10 years ago, when the fourth edition appeared. The human genome was mapped little more than five years ago. And whereas the only sexual selection options two decades ago were abortion and infanticide, now we have pre-implantation genetic diagnosis and even sperm selection available. Genetic modification has already been successful in somatic gene therapy, while germ line gene tampering (which modifies even reproductive cells and future offspring) beckons. End-of-life issues have become just as complex, to such an extent that there is now argument over the definition of death. Political and economic interests drive our debates over “non-heart beating persons” as well as stem cell research.
In treating all these issues, deBlois, O’Rourke and Ashley are lucid and incisive. While affirming Catholic Church teaching, they address controversies within the Catholic community and challenges from without. Their work, so rich in the most recent bibliographical references, provides a much-needed account of social responsibility and public policy as well as the sacramental and healing dimensions of true care. Most strategically, the book presents a substantial and robust account of what it means to be a human person.
David Kelly’s Medical Care at the End of Life demonstrates tht every particular topic in health care ethics could yield a book. Strong in clinical experience and engagement with patients and families, Kelly offers a Catholic perspective on the hotly contested issues of advance directives (or living will), the distinction between ordinary and extraordinary means and the notion of medical futility.
Kelly’s treatment of the difference between killing and allowing to die, marked by great good common sense, provides convincing counterarguments to Justice Scalia’s unfortunate identification of withdrawal of treatment and intentional killing in the Cruzan case. (The book, by the way, is an excellent introduction to many legal controversies and rulings in the matter of health care.)
The extensive discussion of autonomy, consent and competence in Medical Care at the End of Life is not the last of the book’s strengths. It also suggests why Kelly’s discussion of vitalism and the persistent vegetative state is somewhat unsatisfying. If you count yourself among those who think the purpose or mission of human life is not only the exercise of our higher cognitive and volitional acts but also the humble acceptance and living out of our humanness even in diminishment, you may long for a richer consideration of how to accompany even the least of us in our leaving.
Such a hope is not often met when reading in medical ethics, which so often deals with case studies, legalities or resolution of moral conflicts. A recent happy exception is the collection of essays in Health and Human Flourishing, by Carol Taylor and Roberto Dell’Oro. Themes of this work range from “otherness,” philosophical anthropology, vulnerability and human connectedness to engagement with the latest scientific breakthroughs. The methods and manners of discourse are refreshingly diverse: analytic, historical, hermeneutical and, especially, phenomenological. As a collection it is uneven, not necessarily in quality, but in the context of one’s familiarity with a particular approach or specialized lexicon.
I cherish the thick reflection on patience and the invitation to resacralize the human body offered by the European philosopher William Desmond, the treatments of integrity and virtue, the three essays on vulnerability, the brilliant defense of “Dignity and the Human as a Natural Kind” by Daniel Sulmasy and the efforts to articulate an integrated theological anthropology. But what I found most powerful and sustaining is Alisa Carse’s “Vulnerability, Agency, and Human Flourishing.”
The illusions of monadic autonomy, individualism and self-sufficiency challenged by every offering in the book are unmasked by Carse’s argument that our flourishing itself, although threatened by our fragility, is actually constituted by it. “Allowing ourselves to be vulnerable is necessary to loving and being loved, to caring and being cared for, and to playing, exploring and growing in ways that strengthen and vitalize our effective agency.”
The contributors’ ability to see the healing professions not only in terms of positive outcomes, but also in the context of our interdependence and mutual frailty suggests that the field of medical ethics is indeed reaching into its full human maturity.