1 of 2 people found the following review helpful:
4.0 out of 5 stars
"Diagnosis Critical" - a MUST read for clergy & laity, October 24, 2009
This review is from: Diagnosis Critical: The Urgent Threats Confronting Catholic Healthcare (Hardcover)
An expert on health care law, Professor Leonard J. Nelson, III, provides an eye opening, disturbing account in "
Diagnosis Critical: The Urgent Threats Confronting Catholic Healthcare." This work is divided into six parts (i.e., "Moral Foundations," "Catholic Identity," "The Struggle to Maintain Catholic Identity as Reflected in Two Health Care Systems," "Catholic Health Care and the Right of Conscientious Objection," "End-of-Life Care," "Social Justice and Health Care Reform") & a Conclusion. Professor Nelson's 229 pages of eye-opening text are readable and enthralling (He also provides 113 pages of end notes.). In his introduction, he warns that "Catholics may have to focus their future efforts on the creation of alternatives to acute care hospitals such as free clinics, specialized centers for reproductive medicine, and hospices for end-of-life care that could reinvigorate health care ministry" (p. 19).
MORAL FOUNDATIONS: Within chapters on "The Catholic Natural Law Tradition," "Challenges to the Catholic Natural Law Tradition," "The Reassertion of Absolute Norms" and "Secular Bioethics versus Catholic Bioethics," Professor Nelson undertakes an ambitious history and survey of contemporary Natural Law adherents, dissenters, and acknowledged opponents. At times, he may inadvertently lend a veneer of legitimacy to dissenters, by using the term "revisionist." A more direct challenge to those who engage in sophistry to mislead Catholics into thinking that some teachings of the Magisterium are not binding (cf., # 2034 & #832 of the
Catechism of the Catholic Church) would have also been appreciated. He does certainly acknowledge that "In terms of its practical effect, the widespread prevalence of dissent among both religious and lay Catholics may make it more difficult for Catholic health care institutions to persuade policymakers that they should be exempt from laws of general application requiring the provision of sterilizations and abortions. And, of course, the situation of Catholic health care institutions has become even more problematic since it has become commonplace for high-profile Catholic politicians to be openly and avowedly `pro-choice'" (p. 32).
The chapter on "Ethical and Religious Directives" provides a fascinating history of the U.S. Bishops'
ERDs and an often disturbing look at how they have been received: "compliance with the ERDs has been uneven when it comes to contraception and sterilization. Typically, obstetrician-gynecologists practicing in Catholic hospitals and physician office buildings owned by Catholic hospitals provide prescriptions for contraceptives to their patients" (p. 53). Kudos go to Professor Nelson, when he straightforwardly challenges the disregarding of Catholic medical ethics:
* Professor Nelson reminds us that "the bishop is responsible for monitoring compliance with the ERDs in his diocese" (p.55).
* "By 2003, at least two Catholic hospital systems were performing early induction of labor...where the baby had a condition that would significantly shorten its life....it seems clear that these policies are not morally licit under Directives 48 and 49 of the 2001 ERDs" (p. 77).
I believe that Professor Nelson's treatment of several other topics should have been similarly straightforward:
* So called "Emergency Contraception" is discussed in Chapter 5 & 12. It has elsewhere been reported that "Catholic hospitals in several dioceses in North America are currently administering the pill (Plan B) to patients who claim to be victims of rape....The only Vatican opinion on the subject, absolutely prohibiting the use of the pill, was released by the Pontifical Academy for Life in 2000. Since then, however, the Catholic Health Association, advisor to many bishops conferences, has suggested that there is no moral impediment to using the pill in cases of rape....[...] asked Bishop Sgreccia if there was an exception in cases of rape. The [then] President of the Pontifical Academy for Life replied, `No. It is not able to prevent the rape. But it is able to eliminate the embryo. It is thus the second negative intervention on the woman (the first being the rape itself)'" ([...], 2/29/08). Section 23 of the Vatican's 12/08
Dignitas Personae offers no guidelines for the supposed "moral" use of Plan B (aka, the "morning-after pill", so-called emergency "contraception"). It reminds us that so-called contraceptives are "interceptive if they interfere with the embryo before implantation and contragestative if they cause the elimination of the embryo once implanted...the use of means of interception and contragestation fall within the sin of abortion and are gravely immoral." This appears to require change at Catholic hospitals, regarding the treatment of individuals who identify themselves as victims of sexual assault.
* Father Tad Pacholczyk, Ph.D.'s of the National Catholic Bioethics Center has discussed the treatment of ectopic pregnancies ("When Pregnancy Goes Awry, 10/09). Citing the principle of "double effect," Catholic health care has allowed the removal of a fallopian tube to save a mother's life, in the case of an ectopic pregnancy. This unintentionally and indirectly results in the death of the preborn child. Yet, Father Tad further explains that "A significant number of Catholic moralists hold that the use of methotrexate is not morally permissible because it constitutes a direct attack on the growing child in the tube and involves a form of direct abortion. Another morally problematic technique [i.e., salpingostomy] involves cutting along the length of the fallopian tube where the child is embedded and 'scooping out' the living body of the child, who dies shortly thereafter." It is troubling to find that a 1998 article by Father Kevin O'Rourke remains on the web site of the Catholic Health Association of the USA, in which Father O'Rourke appears to suggest that salpingostomies and methothrexate ARE acceptable treatments.
CATHOLIC IDENTITY: The title of Chapter 6 speaks for itself: "Transformation of the Catholic Hospital from Religious Ministry to Business Enterprise." I believe that a good number of Catholics would be absolutely shocked to know that "Occasionally, in order to reduce opposition to a merger or affiliation, Catholic hospitals have entered into arrangements to allow continuation of services such as surgical sterilizations in separate facilities to be provided by unrelated organizations" (p. 88). Chapter 7 takes a look at "Catholic Hospitals and Canon Law."
THE STRUGGLE TO MAINTAIN CATHOLIC IDENTITY AS REFLECTED IN TWO HEALTH CARE SYSTEMS: While some Catholic health "systems have entered into arrangements to provide services such as direct sterilizations and abortion referrals....The existence of such arrangements increases the risk of scandal and could embolden those who favor a mandate requiring all hospitals...to provide a full range of [so-called] reproductive services" (p. 102).
CATHOLIC HEALTH CARE AND THE RIGHT OF CONSCIENTIOUS OBJECTION: As per Professor Nelson, "If legal protection for individual conscience erodes, then this also endangers legal protection for institutions that refuse to perform sterilizations and abortions....any argument in favor of exemption from laws requiring a hospital to provide these services may be substantially undermined by the fact that the Catholic hospital is already, in some fashion, involved in either providing those services - as in the case of sterilizations - or involved in partnerships with entities providing such services" (pp. 132, 137).
END-OF-LIFE CARE: I found myself wishing that Professor Nelson's treatment of this topics was also more straightforward; however he finishes strongly:
* In its introduction to End-of-Life directives, the 2001 ERDs state that "The USCCB Committee on Pro-Life Activities' report...points out the necessary distinctions between questions already resolved by the magisterium and those requiring further reflection, as, for example, the morality of withdrawing medically assisted hydration and nutrition from a person who is in the condition that is recognized by physicians as the `persistent vegetative state' (PVS)." Since 2001, the Vatican has directly addressed that very matter on at least two occasions....
* As per a 3/2/04 address by Pope John Paul II, "I should like particularly to underline how the administration of water & food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary & proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering."
* As per the Vatican's 2007 Responses to Certain Questions Concerning Artificial Nutrition and Hydration, "The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented.... A patient in a `permanent vegetative state' is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means."
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2 of 4 people found the following review helpful:
5.0 out of 5 stars
Required reading on the subject, July 21, 2009
This review is from: Diagnosis Critical: The Urgent Threats Confronting Catholic Healthcare (Hardcover)
When I first saw mention of "Diagnosis Critical: The Urgent Threats Confronting Catholic Health care by Leonard J. Nelson III on Amy Welborn's blog I knew this was a book I wanted to read. The issue of Catholic Health Care has certainly emerged on this blog as I have covered stories regarding this important subject. There are plenty of comparison between Catholic health care and the Catholic education system with the decline of so-called Catholic identity. But as this author points out in his conclusion the Catholic health care system has faired better in this regard for the most part. Not that there are not major ethical problems which are certainly pointed out.
The title of the book certainly gives it an urgency about the seriousness of some of the real problems. Though this is not a book containing chapter after chapter of horror stories of bad things going on in Catholic health care. The author who is a professor in a school of law and an expert surrounding healthcare law goes way beyond just detailing problems.
In fact the book take as systematic approach and starts with moral theology and especially the Catholic natural law tradition. He gives a good overview of this in regards to health care along with a history of the applicable theology. As you would expect there is coverage of the theologians who have departed from traditional moral theology into relativism, proportionalism, and consequentialism which has caused damage to the culture of life in this area.
In the area of bio-ethics they have tried to create a system apart from natural law that develops a consensus in the secular world. There is of course no such consensus and this area of ethics has turned more and more into defending the indefensible. The Pope in his latest encyclical addressed the problem in this area where ethics has come to mean something entirely unethical
Eventually, those who dissented from Humanae Vitae realized that the traditional natural-law approach did not approved a satisfactory basis for their dissent and began to develop alternative approaches. Building on the principle of double effect, they developed a new approach that deemphasized the application of absolute moral norms.
This paragraph is a very good synopsis of what has happened in theology by dissident theologians throughout the world and not just in health care. Once you separate theology from absolute moral norms than it is no surprise they find reasons that evils such as abortion, contraception, euthanasia, doctor-assisted suicide, and sterilization
He spends five chapters on moral norms that ends with a discussion and history of Ethical and Religious Directives (ERDs) used in Catholic health care settings. The discussion of ERDs is actually very interesting to see how they responded to changing medical technology. They have remained consistent with the teaching of the Church. What has not been consistent is personnel in health care following them.
Again and again throughout the book we are treated to the history behind Catholic health care and I thought this was one of the most important parts to understanding how we got to where we are today. He devotes some time to talking about the transition from hospitals mainly run and staffed by a religious order to the situation we see today where there is some connection to the founding order, but is mostly run by lay people who often are not even Catholics. Plus you have all the mergers and takeovers by Catholic health care systems of secular assets and the problems that has occurred. A couple of chapters detail specific Catholic health care systems and problems that resulted when local bishops and/or the Vatican complained about evils such as surgical sterilization and even abortion occurring at these acquired assets.
There is much in the state of Catholic health care that frankly angers me. Often it seems that some are seeking loopholes instead of following the moral law. While surgical abortion is for the most part not occurring in Catholic hospitals, it has in the past along with other morally dubious practices. But in the area of surgical sterilization they seem to be gaming the system by referring people to other centers or in one case having a hospital within a hospital on the fifth floor of one institution that did it for them. Sterilization is mutilation and destroys a functioning part of the body. There is no medical need for direct sterilization. But it seems like this is a wink-wink situation where "Hey we don't do this because we are not suppose to, but we will help you out in getting it done." So much for teaching the Gospel and an actual teaching opportunity of explaining why sterilization is gravely evil. The same goes for contraception and euthanasia where some Catholic health care have formally cooperated with evil.
As this book and in fact the daily news demonstrates is that we are being attacked both from without and within. No we aren't ready to run to the catacombs, but the government and other outside groups are doing what they can to make Catholic health care not a whit different from secular health care. From within we are being attacked by dissident theologian and those who follow them. Some specific cases of government interference is also covered in this book and goes through some famous cases where legislatures tried to force their will on Catholic institutions by mandating contraceptive coverage or in myriad other ways. Increased pressures by the Culture of Death are certainly trying to force Catholic hospitals into gravely evil areas and the same goes for individuals with the attacks on conscience clauses.
I think we will only see more of these problems especially with the push for national health care. The author makes note of how these mandates for services not allowed under the ERDs is moving ahead and says "Despite these possibilities, Catholic organizations have continue to be strong advocates of a governmental system of universal health care." When it comes to providing for our neighbor in terms of the Gospel - the government is not our friend. The USCCB calling for national health care even with the caveats they mention is very shortsighted in my opinion. This is not subsidiarily in any way and only funnels our health care dollars through the government so that there will be even less to pay for actual health care. It also opens up our non-profit hospitals for even more attacks at they try to standardize everything. It would be rather ironic if Catholics were forced out of the hospitals considering we were the ones that created them in the first place.
Well I don't want my review to be longer than the book. But the subjects covered and the thorough way they are covered really makes me want to write about them. This is such and excellent book in so many ways and is not just gloom and doom. There is a lot covered even interesting information about Catholic health care in regards to canon law. For anybody wanting to learn more about Catholic health care from the morality and history on I can't think of a finer book to recommend. This book is quite well researched and footnoted and the notes take up over a hundred pages at the end.
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