Balancing medicine and ethics

On the campus of a Catholic university like Boston College, issues such as stem cell research, birth control, and assisted suicide often generate contentious debate. Conflict between Catholic values and the more liberal viewpoints often held by members of university communities comes to a climax over the sensitive subject of bioethics.

On Thursday evening, Dr. Edmund Pellegrino, chairman of the Presidential Bioethics Commission, spoke on these subjects and other issues in the annual LaBrecque Medical Ethics Lecture titled "Bioethics and Catholic Conscience."

Established in 2002 by the children of Alice D. and Frederick C. Labrecque, BC '31, the annual lecture focuses on medical ethics from the perspective of the Roman Catholic Church and places special emphasis on maternal and fetal issues.

Pellegrino began his lecture with a question to the audience: "How does a Catholic organization put into practice the teaching of the church while remaining faithful to its conscious in the evolving world of bioethics today?"

Pellegrino, who has been involved in bioethics for 60 years, launched his attempt to reconcile the worlds of the church and the institutions of health care, emphasizing that, no matter the situation, "we must obey our conscience."

According to Pellegrino, however, there are rising trends in the health care industry that make this task difficult. The doctor offered six explanations for the prevalence of this conflict in today's society.

The first signs of contention came in the '60s, when social revolution called society to challenge all authority and brought autonomy and self-assertion to the primacy they enjoy today.

This movement suggested that patients have the right to demand the treatment they see fit, a phenomenon Pellegrino described as "micromanagement at the bedside."

"[Patients] demand abortion, assisted suicide, all kinds of expected reproductive health, and we are expected to comply. Doctors have no right of contentious objection," said Pellegrino.

The second basis for controversy, said Pellegrino, is the enormous success of biological science through media and celebrity outlets.

"Religion has no place anymore; if something can't be scientifically backed, it isn't worth knowing," said Pellegrino.

The third point in Pellegrino's speech addressed the force of militant atheism in today's society.

"Today, there's a conviction that any religious perspective is evil and should be eradicated, that religion should be exiled because all it has done is create enmity between people," said Pellegrino.

Pellegrino's fourth point spoke to the erosion of education of Catholics in the foundation of the faith.

He suggested that people today watch television and hear about "these hyped-up stem cells."

"I want my patients to get better," said Pellegrino, "but not at the price of other young lives. I'm distressed at how we water down philosophy and theology."

"Thou shall not do evil so good may come of it," said Pellegrino as he pounded his fist on the lectern in front of him.

In his fifth point, Pellegrino addressed the erosion of the Hippocratic Oath, a pledge typically taken by physicians regarding ethical practice in medicine. Without this oath, said Pellegrino, "there is no way to guide conscious. The oath had moral absolutes within a set of moral precepts, which is congruent with the Catholic medical tradition." The Hippocratic Oath demands that physicians do such things as treat the sick to the best of their ability and to preserve their patient's privacy.

In addition to these two "erosions" is the gradual wearing away of the legal notion of contentious objection.

"There is a strong movement," said Pelligrino, "toward saying that the physician should be morally neutral, and separate her personal life from her professional life. When asked for an abortion or to hasten the death of a dying patient, she should satisfy the request because the patient is autonomous."

Pellegrino said that the prevalence of the attitude that Catholic physicians should not be allowed to practice if they don't provide all that is legal takes away the practitioners' power of conscience.

In the face of these six sources of tension between conscious and the evolving industry of health care, Pellegrino asks the question, "What can we do?"

The doctor's first suggestion was to be wary of governmental control over medical ethics. He also proposed that Catholic hospitals defend their purpose outside the realm of the social needs they must meet. Catholic institutions once upheld Catholic values in practice; more and more though, it seems as if the word is becoming a mere label.

"Physicians feel that they don't have to ascribe to any ethical laws. They can chose all, one, or none," said Pellegrino.

Pellegrino's central solution, however, was that physicians, nurses, and laity alike must be educated about science within ethical restraints. They must let their patients know in advance what they will do, and more importantly, what they will not do.

"There are not enough physicians trained in bioethics … universities are not doing their job. Ethical practice doesn't come from an athletic team," said Pellegrino.

Other actions that could have a positive impact on bioethics include training and attracting more young people to the field and engaging in civil discussion on disputed questions that facts alone cannot answer.

"It is time," said Pellegrino, "for the laity and the clergy and the health care professionals to live in a pluralist society and not impose our views on others, but on ourselves. We can't compromise the truth." n