Abstract
This article critically examines, from the perspective of a Roman Catholic Healthcare ethicist, the second edition of the Core Competencies for Healthcare Ethics Consultation report recently published by the American Society for Humanities and Bioethics. The question is posed: can the competencies identified in the report serve as the core competencies for Roman Catholic ethical consultants and consultation services? I answer in the negative. This incongruence stems from divergent concepts of what it means to do ethics consultation, a divergence that is rooted in each perspective's very different visions of autonomy. Furthermore, because of the constitutive elements of Catholic ethics consultation, such as the Ethical and Religious Directives for Health Care Services, the tradition needed to apply those directives, and the Catholic facility’s membership in the institutional Church, the competencies needed for its practice differ in kind from those identified by the report. While there are many practical points of convergence, the competencies identified by the report should not be adopted uncritically by Catholic healthcare institutions as core competencies for ethical consultation services.
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Notes
It does, however, reference a survey tool produced by Ascension Health, the largest Catholic healthcare system in the United States, as well as an article regarded data collection by Repenshek (ASBH 2011, p. 43, n. 114 and p. 11, n. 18).
Incidentally, two of the three authors that the Task Force cites in reference to this “growing demand” for credentialing are members of the Task Force itself.
John Evans highlights the prevalence of the Principlism, stating, “the principles have been replicated so many times—printed in so many textbooks, spoken in so many meetings—that it becomes hard to imagine any other way of making decisions” (see Evans 2000, pp. 32–38).
Following their presentation of the principle of Respect for Autonomy, it would be proper to interpret “unconstrained choice” along the lines that Beauchamp and Childress draw out, “For an action to qualify as autonomous in our account, it needs only a substantial degree of understanding and freedom from constraint, not a full understanding or a complete absence of influence” (see Beauchamp and Childress 2009, pp. 99–101).
Kipnis theorizes, “So let us suppose we have reached consensus on the salient task of CEC, on the values and practice standards that should inform our work, and on the knowledge and skill that would have to be mastered before taking on responsibilities as a CEC. How do we move from that foundation to the certification of CECs and the accreditation of graduate programs that might prepare novices for the work?” And later, “Assuming we could achieve consensus on the salient tasks of the CEC and on the requisite competencies and normative commitments, we would still need to reach agreement on how to assess these masteries in candidate CECs, and how to accredit graduate programs that would want to prepare CECs for work” (Kipnis 2009, pp. 258–259).
Earlier editions of the ERDs included a small section discussing the Principles of Cooperation. However, due to widespread difficulty in appropriately interpreting and applying these principles, the USCCB removed the section in the 2001 revisions. For further reading see Hamel (2002).
For the CHA’s recommendations for hiring potential Roman Catholic clinical and organizational ethicists see the document “The Ethics Role in Catholic Health Care,” available online at http://www.chausa.org/New_Ethics_Overview.aspx .
It is important to draw a distinction between presenting the patient with information about his or her legally and medically available options and assisting the patient in receiving the morally problematic procedure. Catholic ethicists tend to agree that presenting a patient with information that a morally problematic procedure (according to Church teaching) is one of the patient’s legally available options—though the Catholic hospital is unwilling to compromise its moral commitments by participating or assisting in the procedure taking place—is acceptable. This type of knowledge is necessary for the patient to make a decision with a truly informed conscience. It therefore also represents a valuable teaching moment. Here, the physician or ethicist can inform the patient why the Catholic hospital is unwilling to participate in providing the particular procedure.
Roman Catholic moral theologians traditionally recognize the Principle of Double Effect (PDE) as containing four conditions. Joseph Mangan, SJ, offers a classic formulation of the principle and its conditions, explaining:
A person may licitly perform an action that he foresees will produce a good and a bad effect provided that four conditions are verified at one and the same time: 1) that the action in itself from its very object be good or at least indifferent; 2) that the good effect and not the evil effect be intended; 3) that the good effect be not produced by means of the evil effect; 4) that there be a proportionately grave reason for permitting the evil effect (Mangan 1949, p. 43).
Within Catholic moral theology, the PDE is used quite often. For instance, the spring (2011) issue of the National Catholic Bioethics Quarterly (Vol., 11, No. 1), a leading Catholic bioethics journal, was entirely devoted to the PDE.
In the words of theologians Benedict Ashley, OP, Jean deBlois, CSJ, and Kevin O’Rourke, OP, the,
proportionalist method reduces all ethical decisions to the fundamental principle of proportionate reason (or principle of preference): “Do only those acts that have a proportionate reason in their favor”…Proportionalists reject the traditional view that some kinds of concrete acts can never serve as means to true happiness and hence are intrinsically evil and are forbidden by absolute (exceptionless) moral norms (Ashley et al. 2006, pp. 15–16).
One such situation was widely publicized in 2008 when the bishop of Tyler, TX became aware that health institutions under his diocesan jurisdiction were, according to his authoritative interpretation, performing direct surgical tubal ligations, something that is explicitly prohibited under ERD 53 (Agency 2008).
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Acknowledgement
I would like to thank my professors, especially Jeffery P. Bishop, MD, PhD, Michael Panicola, PhD, and Dan Bustillos, PhD, for their helpful discussion on earlier drafts of this paper as well as the peer reviewers and editor of HEC Forum for their insightful criticism and directions.
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Bedford, E.L. The Core Competencies: A Roman Catholic Critique. HEC Forum 23, 147–169 (2011). https://doi.org/10.1007/s10730-011-9169-2
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DOI: https://doi.org/10.1007/s10730-011-9169-2