It must first be acknowledged that the medical profession has a long and honorable record of caring for the sick. In recent years, however, that record has become tarnished. Under the influence of society marinated in materialism, physicians have lowered their moral standards and failed, in many ways, to practice the virtue of justice.
St. Thomas Aquinas states that the natural law commands that we are to be temperate, prudent, courageous and just, and that what is right is the object of every act which that law commands. There is, however, an aspect of "right" which applies only to justice, insofar as it concerns the ordering of each person to others1 "Justice", St. Thomas says, is "the habit whereby a man renders to each one his due by a constant and perpetual will."2
How, one may ask, have physicians offended against justice? In many ways.
They not only recommend, refer for, and carry out many unethical procedures, but often misinform their patients about the true nature of these procedures by calling them by names other than their real names. For example, abortion is called 'termination of pregnancy', the embryo is called a 'pre-embryo', drugs which frequently cause abortion are referred to as contraceptive, euthanasia is sometimes misrepresented as palliative care and 'brain death' is often regarded as equivalent to the real death of a person.
Ever since abortion was introduced in the late 1960's, some abortions have been carried out in order to eliminate unborn children who had, or were thought to have, prenatal diseases. Babies with Down syndrome, and those with spina bifida and hydrocephaly were commonly aborted. Diagnosis was made by ultrasound and by laboratory testing of the amniotic fluid. Despite the fact that there is no medical condition which is benefited by abortion, doctors will now do them for any purported medical reason or for no reason at all at the request of the mother.
Physicians, in general, have accepted both contraception and abortion as ethically justified. Many say that "An abortion is safer than a normal pregnancy." The facts are otherwise. In Canada one woman in 28, who has had a surgical abortion is admitted to hospital for severe complications.3 Complications of surgical abortion include ... more frequent miscarriage, increased maternal mortality due to hemorrhage and infection, suicide, substance abuse, and damage to relationships within the family.4 Janet Daling has demonstrated that women who have had an abortion have a 50% increase in breast cancer; those who have had an abortion before age 18, have 250% increase; those who have had an abortion before the embryo is nine weeks, and who are below age 18, and also have a family history of breast cancer, have a great increase in risk - they all succumb to cancer.5
Doctors are encountering increased pressure from patients and the media to participate in euthanasia or assisted suicide. There is also a growing tendency to redefine the meaning of palliative care of the dying. Instead of relieving suffering so that a person may die in a holy and peaceful way, doctors are beginning to hasten death as a means of treatment. Patients' relatives are expressing alarm about this, and can develop lasting feelings of guilt after their loved one dies.
Dame Cicely Saunders, opened St. Christopher's, the first academic hospice, in London. England, in 1967. She was very much against assisted suicide, saying "If a person asks to be killed, we have failed him." Yet Florence Wald, who established the first U.S. hospice in Connecticut in 1974, disagreed with Cicely's view "...on the basis that there are cases in which either the pain or the debilitation the patient is experiencing is more than can be borne ... for this reason, I feel," she said, "a range of options should be available to the patient, and this should include suicide."6
In 1989, the World Federation of Doctors Who Respect Human Life declared ... "In every care of terminal illness, it is a cruel and anti-medical practice to withdraw nutrition and hydration, thus causing the patient to die of hunger and thirst, which can only increase his suffering." In 1998 however, an article in a prestigious medical journal recommended that a patient, with terminal, or even if not terminal, incurable illness be allowed to commit suicide, provided the physician supplied "appropriate palliative care"!7 It is admitted that death from dehydration may take up to three or four weeks.8
In June, 1999, the British Medical Association produced draft guidelines, and in August of 2001, The General Medical Council of Great Britain, produced draft guidelines which allowed doctors to withdraw any "medical treatment", which includes hydration, if it is "in the patient's best interest." This would allow removal of tube hydration from non-dying patients so that they then die of dehydration - "a cruel death, the distress of which may not be adequately dealt with by pain killers", said Dr. James Bogle, a pro-life lawyer.9
Another ominous event is the recent development of "futile care theory" among bioethicists. This theory holds that when a physician believes that the quality of a patient's life is too poor to justify life-sustaining treatment, the physician is entitled to refuse care as 'inappropriate', even if treatment is wanted. Equally ominous is the fact that protocols are being put into place in many hospitals, which give the right to the physician to say "no" to treatment desired by the patient, over and above comfort care, and to withdraw such treatment over the family's objection. The Fall 2000, Cambridge Quarterly of Health Care Ethics advised hospitals to put these protocols in place as a way to prepare for litigation. The Mercy Health System, a group of Philadelphia-area Catholic Hospitals, instituted a futility program in the year 2000.
Treatments that are physiologically futile, that will not ease a symptom or cure a pathology, should of course, not be required of a physician. However, some proponents of this theory go so far as to cite tube feeding of a patient in a persistent vegetative state as "futile". But "futilitarians", as they are called, object, not because the treatment is futile, but because it achieves its aim . "Thus in futile care theory, the treatment itself is not denigrated as futile, the patient is."10 They assert that the quality of that person's life, and/or the cost of sustaining it, makes that life not worth living.
Many doctors approve of and/or cooperate in the prescription and promotion of the use of condoms and chemical contraceptives. What are the relevant facts about contraceptives? First of all, the availability of contraceptives increases sexual promiscuity. This leads to an increase in unwanted pregnancy and hence, to an increase in abortion. It has also aggravated a world wide epidemic of sexually transmitted disease (STD). Nonetheless, the medical profession has vigorously promoted the idea that the use of the condom is the secret of "safer sex". According to a National Institute of Health report, consistent use of a condom prevents transmission of the HIV - AIDS virus in only 85% of cases. In other words, the condom fails to prevent this horrendous and fatal disease in approximately one of every six acts of intercourse.11 The same report found that condoms were not found to provide universal protection from eight sexually transmitted diseases - HIV, gonorrhea, chlamydia, syphilis, chancroid, trichomatosis, genital herpes, and human papilloma virus (HPV)12
An estimated 20 million Americans are infected with the genital HPV virus, which causes nearly all cases of cancer of the cervix of the uterus. This is the third most common cancer in women world wide and about 15,000 cases of cervical cancer are diagnosed in the U.S each year. The strain of human papilloma virus (HPV 16) that is believed responsible for at least half of all cervical cancer infects one in five U.S. women between the ages of twelve and fifty-nine.13 The Department of Health and Human Services reported in 2001 that, in the U.S. more than 65 million individuals are living with an STD., (the majority of which are viral) and that each year, approximately 15 million new sexually transmitted infections occur in the U.S. Almost 33% of condoms tested in a U.S. Food and Drug Administration (FDA) laboratory study leaked HIV sized particles.14 Researchers have also found that increased condom use would increase the number of transmissions of HIV that result from condom failure because availability of condoms encourages greater sexual activity.15 The World Health Organization reported in October, 2002, that of the top ten hazards to health world wide, after malnutrition, unsafe sex was second.
Most people believe that the oral contraceptive pill (OCP), including the "morning after pill" (MAP), acts only as a contraceptive. The truth is that it frequently acts as an abortifacient, by preventing implantation of the early embryo in the womb. Eighteen out of twenty studies, since 1980, show that women who take OCPs before their first term pregnancy have an increased risk of cancer of the breast.16 In Canada, the Royal College of Obstetricians and Gynecologists and several provincial colleges of pharmacy, have recommended that the MAP be administered "over the counter" by pharmacists, without a prescription. This shunts the responsibility from the physician to the pharmacist in regard to the prescription of the pill and its effects of contraception or abortion and of any complications that may occur. This is causing a very difficult problem of conscience for pharmacists. Some researchers have calculated that the OCP, of all kinds, causes between 1.53 and 4.15 million chemical abortions a year in the U.S.17
A study by Merethe Kumle of 103,000 women in Europe, showed that women who take the OCP at any time, had an increased risk of breast cancer of 26%, and one of 58%, if they took it over longer periods.18 It has been estimated that an additional 40,000 80,000 cases of cancer will occur in the U.S. annually when the cumulative effect of OCPs on all cancers in considered. Again, in defiance, or in ignorance, of these heinous outcomes, the medical profession, and also many in the research community, repeatedly deny the facts. Typically, a physician will not even try to encourage an adolescent to be chaste, complaining that "they won't listen", yet, that same physician will emphatically tell that same adolescent not to smoke. It should also be noted that many spurious research projects are still being carried out in order to assure women that they have nothing to fear from the contraceptive pill.
Many infertile couples now resort to artificial methods of conceiving a child. The woman is given heavy doses of drugs to cause her to produce multiple ova. These ova are then aspirated from her ovaries and mixed with sperm on a Petri dish. Up to five or ten embryos may be conceived. Only two or three are implanted in her uterus. The others may be preserved, discarded or given to research workers. Sometimes the embryos are tested to rule out inherited disease. Only those which are not diseased may be implanted. Some embryos are killed in the process of developing stem cells which are cultivated with the aim of curing disease, though this form of research has never yet cured anyone, and may cause tumors or tissue rejection. Obviously, IVF disrespects both marriage and the embryo and results in an untold number of deaths of human embryos. Nevertheless, the medical profession has resolutely practiced and promoted this activity. Again, sad to say, many Catholics do not know that IVF has been condemned by the Catholic Church; in fact, they think it is just fine.
Whether we are receiving our drivers licenses, watching TV news, or reading the newspapers, we cannot miss the campaign to induce us to sign an organ donation card. The public is told that organs can be taken only after all efforts to save your life have been exhausted and brain death has been declared.
Pope John Paul 11, in his address to the thirteenth International Congress of the Transplantation Society on August 29th, 2000, stated that there were " clearly determined parameters, commonly held by the scientific community" which allow a clinician to declare a person "brain dead" and, by implication, actually dead. The Pope explained that "the use of these parameters, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology."
There is evidence, however, that the Pope may have been misinformed. A prestigious medical journal stated in 2001, that the consensus in regard to the equation of "brain death" with death is not free of metaphysical, cultural, legal, and medical controversy, and that, since this has led to the idea that death is a malleable concept that can be adjusted for utilitarian purposes, many people are ambivalent about organ donation.19
In an essay published in the Catholic World Report, March, 2001, Bishop Bruskewitz of Lincoln, Nebraska, and others, point out that the debate about when a person should be considered dead with complete certainty, has not been resolved.20 Doctor Neil M. Lazar has stated that: 1) Brain death is defined as "the absence of all brain functioning demonstrated by a profound coma, apnea, and absence of all brain-stem reflexes", 2) Brain death as a criterion for determining the death of a person "is perhaps justification in the context of organ donation and transplantation", 3) "when death occurs is not simply an agreement about medical and biological criteria, but is also a social formulation." Note that the article uses medical and biological criteria to define "brain death", but refuses to use only those criteria to determine the "death of a person", or unequivocally to justify the removal of organs and their transplantation.21 Since when has social approval ever established the truth of matters which can only be determined by medical, biological and moral reasoning? Abortion is an example of an evil which has received the kind of social approval that the medical profession is now seeking for the determination of the death of a person.22
"When death has occurred" has already become the subject of a social formulation. In 1997, the Institute of Medicine (IOM) research arm of the National Academy of Sciences, delivered a report on what it termed Non-Heart Beating Organ Donation (NHBD). The procedure usually followed is: ventilation is withdrawn; wait for the heart to stop; cardiac death not brain death, is declared, either immediately or after waiting 2 - 5 minutes; then the organs are taken. NHBD is quietly being implemented and is increasingly being seen as a 'fall back' position, where the criteria of brain death cannot be met.23 An ominous development in the United States is the mandating of representatives of transplant procurement organizations, rather than the intensive care unit or hospital-based teams, to interact with families at the time of death in the intensive care unit.24 Dr. Michael DeVita, who supports NHBD, has predicted that " if assisted suicide becomes acceptable, then a discussion about organ donation is probably reasonable.25 In 1997, the I O M report, described the potential non-heart-beating donor as follows: "Those patients are either competent with intolerable quality of life, or incompetent, but not brain dead, because of severe, generally neurological, illness or injury with an extremely poor prognosis." Note that this description includes people who are fully conscience and find their lives "intolerable."26
Some members of the medical profession have interpreted the Holy Father's address as a tacit, unconditional approval of organ transplantation. The truth, the Catholic World Report essay states, is that the Pope's speech sets forth stricter guidelines which are currently being violated, misinterpreted, or ignored, and that these facts call for an "urgent" clarification of this important matter of doubt. In the light of these facts, Catholics have the right to know what criteria are being used in the diagnosis of "brain death" in our Catholic hospitals.
It is clear that in many respects, the medical profession has abandoned its duty in regard to the practice of the virtue of justice. It can also be stated that it has abandoned its duty in another regard. St. Thomas has taught that the natural law demands that we exercise the virtue of fortitude as well as the virtue of justice. Jacques Maritain exhorts us to have "Fortitudo Martyrium" and, speaking of impending trials for the Church, warns that "The proper preparation of the mass of human material for political warfare means that the whole people shall be nurtured on fable and steeped in imposture; that they shall be taught to call good evil, and evil good, and shall be clothed in the plaster of stupidity ..."27 . St. Paul, (Ephesians: 4.25) tells us to "Put away lying and speak truth, each one with his neighbour, because we are members of one another."
Physicians, as individuals, and in their professional associations, must have the courage to speak out about the flood of scientific misinformation that inundates society. Our duty as Catholics above all, is to witness to the Faith. For physicians, a major task is to shine the light of moral truth relative to their profession, so that others may come to know it and, with God's help, accept it in their hearts. Throughout the world today, physicians are increasingly being called by the voice of conscience to be the rock that opposes current practice and opinion and not the feather that floats with the flow.
1 Joseph M. Magee, Ph.D. http://www.aquinasline.com [Back]
2 ST 11-11, q. 58, a. 1. [Back]
3 Hospital Mortality, 1992 - 93, Statistics Canada. [Back]
4 Soderberg H. et al., "Emotional distress following induced abortion: a study of its incidence and determinants among abortees in Malmo, Sweden." European Journal of Obstetrics and Gynecology and Reproductive Biology 79: 173 - 178 (1998). [Back]
5 Janet Daling, Journal of the National Cancer Institute, Vol. 86, No.21 pp. 1586 - 1592, Nov. 12, 1994. [Back]
6 Florence Wald, MSN. JAMA. 281; 1683 - 1685, May 12, 1999. Hospital Care in the United States: A Conversation with Florence S. Wald, M.J. Friederich. [Back]
7 Franklin G. Miller, Ph.D., Diane E. Meier M.D. Annals of Internal Medicine, April 1998, Nos. 128: 559 - 562. [Back]
9 CNS News.com. London Bureau Chief, Aug. 08, 2001. [Back]
10 Wesley J. Smith, "Futile Care" and Its Friends, http://www.nrlc.org/news/2001/NRL08/wes.html [Back]
11 National Institutes of Health and Human Sciences. July 20, 2001. Report on Condom Effectiveness. [Back]
13 Katherine Stone et al., Seroprevalence of Human Papilloma Virus, Type 16 Infection in the Unites States. The Journal of Infective Diseases, Nov. 15, 2002; 186: 1390 - 1402. [Back]
14 Ronald F. Carey et al., "Effectiveness of Latex Condoms as a Barrier to Human Immunodeficiency Virus-Sized Particles Under Conditions of Simulated Use." Sexually Transmitted Diseases, July - August, 1992, pp. 230 - 33. [Back]
15 John Richens et al., The Lancet, Jan. 31, 2000. S.H. Vermund, Editorial "Casual Sex and HIV Transmission." American Journal of Public Health, 1995, 85 (11): 1488 - 1489. [Back]
16 Chris Kahlenborn M.D., Breast Cancer. p. 150. One More Soul. 2000. [Back]
17 Chris Kahlenborn M.D. Booklet Breast Cancer, Abortion and the Pill. One More Soul. 2000. [Back]
18 Dr. Merethe Kumle, Institute of Community Medicine in Tromso, Norway. Data assessed from the Women's Life Style and Health Study carried out in Norway and Sweden reported at the third European Breast Cancer Conference in Barcelona. March 2002. [Back]
19 The New England Journal of Medicine. Vol. 344, No. 16, April 19, 2001. [Back]
20 Catholic World Report. March, 2002. [Back]
21 Neil M. Lazar et al., Canadian Medical Association Journal March 20, 2001 "Bioethics for Clinicians: 24. Brain death." [Back]
22 Nancy Valko R.N. Voices - Miscellaneous, 2002, vol. X111. No. 3. [Back]
23 Non-Heart-Beating Organ Transplantation: Medical and Ethical Issues in Procurement (1999). Institute of Medicine. National Academy Press. [Back]
24 Graeme M. Rocker: oxygen and tissue donation in the intensive care unit, for the Canadian Critical Care Society Working Group on Organ and Tissue Donation. CMAJ. Nov. 2002; 167 (11). [Back]
25 Dr. Michael DeVita, PBS News Hour Online Forum; Organ Transplant Controversy. Jan. 2, 1998. [Back]
27 Jacques Maritain, "Freedom in the Modern World" 1936. P.161. Charles Scribner's Sons. New York. [Back]