Christian Medical Ethics

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Christian Medical Ethics

• A basic exploration
• of fundamental concepts
• and a problem solving process

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Common approaches to medical ethics

1. Virtue ethics (Existential)
2. Good What a good person would do
3. Look at motives and behaviour
4. Consequence ethics (Teleological/ Utilitarian)
5. Good Aiming at good goal / consequences
6. Look at facts and consequences
7. Duty ethics (Deontological)
8. Good What the law says
9. Look at laws, protocols, standards, creeds, norms

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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

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Ethics problem-solving flow-chart
Define moral problem
Develop possible courses of action
Determine preferred course of action
Deploy planned course of action
Deployment evaluated and appropriately handled
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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

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In the groups

1. Appoint persons in following roles
2. One person doctor doing ward round
3. One person patient
4. One person son who has no contact
5. Rest ethics committee members of institution
6. Define the problem
7. Develop possible courses of action
8. Determine preferred course of action

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1. Define moral problem

1. What are the facts of the situation medical,
   nursing, legal, economic, social, organisational?
2. Who is involved?
3. What does each party think about the situation?
4. What are their responsibilities in the situation?
5. What interests do they have in the situation?
6. What are the underlying world view perspectives?
7. Is there a moral dilemma? If so, which? More than
   one dilemma?
8. What is the scope of the problem? (Micro, meso,
   macro?)
9. State the problem as a specific question

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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.

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2.1a General Virtues and Vices

• Seven Vices
• Pride
• Envy
• Gluttony
• Lust
• Wrath / Anger
• Greed
• Sloth

• Seven Virtues
• Faith
• Hope
• Love
• Fortitude
• Temperance
• Justice
• Prudence

Q What does my conscience say? How become more
Christ-like through grappling with problem?
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2.1b Medical Virtues and Vices

• Seven Medical Virtues
• Compassion
• Mercy
• Professionalism
• Integrity
• Collegiality
• Justice
• Prudence

• Seven Medical Vices
• Coldness
• Cruelty
• Quackery
• Corruption
• Rivalry
• Injustice
• Carelessness

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2.2 Consequences A Christian perspective

1. Purpose promote health interests of patient
2. What will consequences be for
3. Ethical, religious, legal, economical, social and
   technical aspects? (? also aesthetic, linguistic
   and cultural aspects)
4. Preventive, curative, palliative terminal care?
5. Health and well-being of involved parties?
6. Consider these rules regarding consequences
7. Proportionality (benefit / burden analysis)
8. Subsidiarity (least drastic / burdensome /
   expensive)
9. Consider the scope of the consequences
10. Micro (personal), meso (institutional) and macro
    (whole field)
11. Short term, long term, eternal

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2.3 Duties A Christian perspective

1. Christian duties
2. Pro-shalom not kill on purpose
3. Marriage as safe circle for intercourse,
   conception and raising children
4. Respect responsibility and freedom of choice of
   patient
5. Repair of disease as safe circle for genetic
   manipulation
6. Respect property of another
7. Respect created sexual identity
8. The Law What does the Bible say?
9. Ten / two commandments
10. Law suited to humans
11. Love is fulfilment of the law

1. Medical Duties
2. Care
3. Respect for life
4. Beneficence (do good)
5. Non-maleficence (no harm)
6. Justice
7. Confidentiality
8. Trustworthiness
9. Informed consent
10. Hippocratic Oath
11. Medical ethical codes
12. Protocols, standards
13. Professional responsibilities position
    description

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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?

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4. Deploy planned course of action

1. Plan Make a good plan re course of action
2. Consider implications on care plans, treatment
   protocols, institutional plans and procedures
3. Who does what by when?
4. Who is responsible for supervision of which part
   of the planned course of action?
5. How will the implementation of the planned course
   of action be evaluated?
6. What will consequences be of the evaluation?
7. Do Implement the plan

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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

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Overview of the process
Step Virtues Consequences Duties
1
2
3
4
5
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Overlap / different interpretations between
doctor / patient
Virtues
Consequences
Duties
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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

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Faith

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

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Hope

• Desire, expectation, reliance, belief
• Hope certainty of better future based on Gods
  promises

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Love / Charity

• Generosity, benevolence, helpfulness, mercy
• Love desire, choose and act for highest good

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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

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Temperance

• Moderation, restraint, self-mastery, frugality,
  sobriety
• Temperance Self-control

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Justice

• Impartiality, fairness, equity, rightness,
  dispassion
• Justice regard for fulfilment of obligations

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Prudence

• Wisdom, vigilance, carefulness, thoughtfulness,
  discretion
• Prudence due regard for ones own welfare
  habitually careful to avoid error / danger

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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."

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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)

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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)

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Lust

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

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Anger

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

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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)

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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)