Customer Reviews

Good Care, Painful Choices: Medical Ethics for Ordinary People, Third Edition

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The previous review by Tevington says it better than I.

This book has nothing to offer someone who is looking for authentic Catholic teaching. Save your money.

It is deceptive and misleading.

The authors ought to be sued for false advertisement.

Despite back cover endorsements from "Sisters Today," "Liguorian" and the "National Catholic Reporter," I believe that there are a number of grave deficiences with this ostensibly Catholic medical ethics text - not the least of which is Father Richard Devine's advocacy for the acceptance of IVF within marriage. In addition to assurance of doctrinal soundness, I find the Vatican's 1995 "Charter for Health Care Workers," the USCCB's "Ethical and Religious Directives" (2004) and the Catholic Medical Association's ethical statement to be infinitely more readable, comprehensive and concise!

Part One

This section on fundamental moral decision-making features "The Person: At the Center of Morality," "Moral Decision Making: Morality in Action," and "Conscience: The Moral Guide." It contains a number of dated references to theologians who have dissented from the Catholic Church's magisterium (eg., the late Jesuit Richard McCormick, the former priest Daniel McGuire, and Father Charles Curran), without any corresponding reference to Pope John Paul II's 1993 encyclical on fundamental moral theology, "Veritatis Spendor" - which took dissenting notions to task - or the 1992 "Catechism of the Catholic Church."


Part Two: "Questions at the Beginning of Life"

All three chapters are characterized by minimal reference to John Paul II's 1995 encyclical on life issues, "Evangelium Vitae."

Chapter 4 "Abortion"
It seems odd that Father Devine should cite dissenting theologian Father McCormick for "The Classical Christian Teaching" (p. 78) on abortion. As per Father Devine, "for many anti-abortionists the sole value is the life of the fetus....It is difficult to imagine how the controversy can be resolved so long as this single-focus understanding of the question dominates the debate" (p. 55). Father Devine accurately notes that "In 1999, almost 862,000 legal induced abortions were reported to the CDC" (p. 60). As per its own Annual Report of 2001/2002, Planned Parenthood readily acknowledges having itself performed what would constitute about one quarter of those abortions. Father Devine may not appreciate that, in many cases, "anti-abortionists" are dealing with forces who share no interest with the "single focus" of the "anti-abortionists."

In regard to RU486, Father Devine writes: "Although not entirely free from risk, it avoids the inherent risks of surgery" (p. 59). "Not entirely free from risk" seems very inadequate phrasing. The Food and Drug Administration has been debating whether to make this abortifacient an "over the counter" medication - depite such stories as "Two More Women Die After Abortion Pills." (NY Times, 7/20/05).

Chapter 5 "Newborns with Disabilities"
Columnist George Will is the proud, loving father of an adult son with Down Syndrome. He tells us that "In America, more than 80 percent of the babies diagnosed prenatally with Down syndrome are aborted....the American Association of People with Disabilities....worries that increasingly sophisticated prenatal genetic testing technologies will mean that parents who are told their expected babies are less than perfect 'will experience pressures to terminate their pregnancies from medical professionals and insurers'" (Washington Post, 4/13/05). With fear of litigation about so-called "wrongful births," obstetricians could be tempted to engage in a "Search and Destroy" approach to prenatal diagnosis. If they suspect something to be amiss and subtly encourage abortion, they might imagine themselves to be free of the potential for future litigation. Amidst a de facto eugenic atmosphere, there has still been an increase in the number of newborns with disabilities. Why?

While mentioning such issues as maternal substance abuse and exposure to radioactivity or hazardous waste as predisposing factors to disability, Father Devine does not specifically explore the impact of histories of abortion, contraceptive use or sexually transmitted disease (STD). One reviewer gathered 59 studies, for example, documenting the relationship between histories of earlier abortion(s) and increased likelihood of premature birth, which in turn is directly relate to increased likelihood of disability (...). With each new televised advertisement for oral contraceptives, there seems to come a fastly worded, implied warning about risk to pre-born children. The CDC notes 15.3 million new cases of STDs annually, putting newborns of an infected mom at great risk (See Washington State's Department of Health STD Factsheets.).

As per Father Devine, "There is no major teaching or document of the church [sic] that refers specifically to the dilemna of the medical care of newborns with disabilities" (p. 92). While this statement may be technically true, it strikes me as being as informative as saying, "There is no Catechism of the Catholic Church written solely for an audience of people under 5' 2"." There is certainly clear teaching of the Church, applicable to "the medical care of newborns with disabilities"! It is the same teaching applicable to people under 5'2" and every one of us! Father's statement could so easily be misconstrued. There is no theological free pass to forego the ordinary, proportionate care of an ailing newborn!

Chapter 6 "In Vitro Fertilization & Other Artificial Technologies"
This chapter appears uninformed by Pope John Paul II's addresses of 1979 - 1984, which constitute his "Theology of the Body." The Holy Father proclaimed - for a new age - the absolute beauty of open-to-life sexual intercourse within marriage. Also appearing uniformed by the faithful-to-the-Magisterium fertility work of the Pope Paul VI Institute at Creighton University, Father Devine tries to make the case for acceptance of IVF within marriage. Near the close of "Donum Vitae" (Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation), then Cardinal Ratzinger wrote: "the Congregation for the Doctrine of the Faith addresses an invitation...to theologians, and above all to moralists, that they study more deeply and make ever more accessible to the faithful the contents of the teaching of the Church's Magisterium in the light of a valid anthropology in the matter of sexuality and marriage and in the context of the necessary interdisciplinary approach....The precise indications which are offered in the present Instruction therefore are not meant to halt the effort of reflection but rather to give it a renewed impulse in unrenounceable fidelity to the teaching of the Church." Again quoting Father McCormack, Father Devine treats Donum Vitae's "invitation" as though it were an invitation to dissent. For Father Devine to infer that the Church may alter its view on the immorality of homologous IVF with Embryo Transfer is outrageous!

Father Devine dismisses concerns about IVF's enhanced risk to the pre-born child (i.e., "McCormick replies that this objection is now moot since we know form experience that there is no greater risk to the fetus from the artificial reproductive technology than there is from normal conception" (p. 115).). Astonishingly, the head of the United Kingdom's Human Fertilisation [sic] and Embryology Authority would disagree. Because IVF is quite expensive, women often have multiple embryos implanted: "'We know that the biggest risk from fertility treatment is caused by multiple births....Multiple births are more likely to be premature and the babies below normal birth weight....Women are designed to have healthy babies, one at a time, and with natural conception this is what usually happens'" (Daily Mail, 7/28/05).


Part Three: "Questions Concerning Illness & Disease"

Chapter Seven "Genetics"
Father Devine oddly mentions that "no formal or authoritative declaration regarding cloning has yet been issued by Vatican authoritites since the appearance of Dolly on the international scene" (p.148). This is another example of a "There is no Catechism written solely for people under 5' 2"" statement. Yet, he would readily acknowledge that the Vatican was never caught off guard by Dolly's arrival and had already clearly condemned human cloning.

Chapter Eight "Organ Transplantation"
At least in this section, Father Devine does not address the pertinent issue of brain death criteria - an issue with which John Paul II and the Vatican showed tremendous concern. As per Pope John Paul II's "Address to the International Congress on Transplants" of 8/29/00: "With regard to the parameters used today for ascertaining death -- whether the 'encephalic' signs or the more traditional cardio-respiratory signs -- the Church does not make technical decisions. She limits herself to the Gospel duty of comparing the data offered by medical science with the Christian understanding of the unity of the person, bringing out the similarities and the possible conflicts capable of endangering respect for human dignity....the criterion adopted in more recent times for ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict....Only where such certainty exists, and where informed consent has already been given by the donor or the donor's legitimate representatives, is it morally right to initiate the technical procedures...for the removal of organs for transplant."

In "'Brain Death' - Enemy of Life and Truth," a number of physicians and others comment on the Pope's 2000 address, maintaining that "None of the shifting sets of 'so-called neurological criterion' for determining death fulfills the Pope's requirement that they be 'rigorously applied' to ascertain 'the complete and irreversible cessation of all brain activity'....For vital organs to be suitable for transplantation... they must be living organs removed from living human beings....persons condemned to death as 'brain dead' are not 'certainly dead' but, to the contrary, are certainly alive....adherence to the restrictions stipulated by the Pope and the prohibitions imposed by God Himself in the Natural Moral Law precludes the transplantation of unpaired vital organs, an act which causes the death of the 'donor' and violates the fifth commandment of the divine Decalogue, 'Thou shalt not kill' (Deut. 5:17)."

Shortly before his own death, Pope John Paul II announced that "The Pontifical Academy has chosen to dedicate this session... - as on two earlier occasions during the 1980's - to a theme of particular complexity and importance: that of the 'signs of death', in the context of the practice of transplanting organs from deceased persons....From the clinical point of view..., the only correct way - and also the only possible way - to address the problem of ascertaining the death of a human being is by devoting attention and research to the individuation of adequate 'signs of death', known through their physical manifestation in the individual subject."

Chapter Nine "Acquired Immunodeficiency Syndrome"
While primarily pastoral, this would have been an opportune place to review John Paul II's "Theology of the Body" and the Vatican's "Truth and Meaning of Human Sexuality."


Part Four: "Questions at the End of Life"

Chapter 10 "Death and Dying"
As per Father Devine, "One issue that remains unresolved is the question of the administration of artificial nutrition and hydration" (p. 216). As of Pope John Paul II's March 2004 "Address to the Participants in the International Congress on 'Life-Sustaining Treatments and Vegetative State,'" the issue has been thoroughly and clearly resolved: "the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act."

Chapter 11 "Euthanasia"
Father Devine awkwardly writes: "one must distinguish between deliberately and intentionally causing death by killing the suffering patient (euthanasia) and simply allowing death to occur by withholding or withdrawing life-sustaining treatment" (p. 225). By this poorly written statement, one might misconstrue that withholding insulin was only tantamount to "allowing death to occur." How much more clear and less susceptible to misunderstanding is the Catechism's own definition: "Whatever its motives or means, direct euthanasia consists in putting an end to the lives of handicapped, sick, or dying persons. It is morally unacceptable. Thus an act of omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. The error of judgment into which one can fall in good faith does not change the nature of this murderous act, which must always be forbidden and excluded" (# 2277).


Part Five "Questions Concerning Health Care in General"

Chapters 12 addresses "Informed Consent," while 13 addresses "Health Care Reform." In the latter, Father Devine reflects that "If this had been written shortly after the election of 1992, it would surely have conveyed a sense of optimism, a conviction that the nation was at last prepared to wrestle with this most complicated and vexing question" (p. 258). Such a swooning take on Hillary Clinton's botched attempt to "reform" health care is embarassing. Many rejected Hillary's plan, because of its treatment of abortion as a health care "right."


Conclusion

Anyone seeking an accurate account of Catholic medical ethics should start with the Vatican's 1995 "Charter for Health Care Workers" and the Catholic Medical Association's concise ethical statement. In addition to being doctrinely sound, these documents are infinitely more readable, comprehensive and concise, than Father Devine's book. As they are online, they are also free of charge.

In today's world, complex beginning and end of life issues, advances in medical technology, and heightened media coverage abound. It may be difficult to know where to turn to determine the Church's teachings on medical ethics issues. Along with reading Papal Encyclicals and staying abreast of statements by our Bishops and the Vatican, another helpful resource for Catholics is Good Care, Painful Choices: Medical Ethics for Ordinary People by Richard J. Devine, CM (Paulist Press, September 2004, paperback, 272 pages.)

Written in non-technical wording, Good Care, Painful Choices provides an accessible overview of many of the most common issues facing us today. Father Devine, who recently celebrated the 50th anniversary of his ordination, has spent the bulk of his career in higher education and currently teaches Medical Ethics full time at St. John's University.

I greatly enjoyed the clear, comprehensive and not overly technical presentation of the medical ethics topics presented in this book. The discussion questions which follow each chapter of the book provide a wonderful opportunity to consolidate and digest the information provided on each of the topics.