Coaching Catholics through ethical dilemmas

The National Catholic Bioethics Center has an active consultation line. The vast majority of calls taken by the ethicists concern end-of-life decision-making. The principal analytical tool used in these cases is the distinction between ordinary and extraordinary means of treatment.

The Catholic Church holds that we have an obligation to use ordinary means of treatment, but that we may forgo those that are extraordinary. Typically what is meant by ordinary is any procedure that is easy to carry out, not painful, and whose benefits clearly outweigh the burdens. The extraordinary include procedures that are very difficult, very painful, too expensive, or cause some measure of deep psychological distress. Some of these criteria are more objective than others. 

We often receive questions about medical treatments for those who are elderly. On analysis, many qualify as extraordinary and may be forgone. The line between ordinary and extraordinary is not a stable one but rather varies according to the age and condition of the patient. A procedure that might easily be performed on a young person, and that would be clearly beneficial, may turn out to be much more difficult for someone who is in a fragile state of health. Burdensome treatments are not necessary, though we are always free to try extraordinary measures if we wish.

We also receive many calls from concerned loved ones who are upset by decisions made by others that do not conform to Catholic teaching. If one is not the designated proxy, and does not have the authority to make decisions, it can be very difficult to watch others make errors, but there is little that can be done about it. The only power one has in these cases is that of moral persuasion.

Thus it may be that an elderly person has requested in writing that he or she be provided with no food and water if unconscious for any prolonged period of time. Generally, we should die from some underlying condition, not from dehydration or starvation, though there are some unavoidable exceptions. Ideally, one would override this bad decision. At the other extreme, no one should be placed on a feeding tube when still able to swallow, even if he or she is unable to meet his or her full daily nutritional requirements. 

We have begun to receive calls on gender dysphoria. A father recently recounted how his autistic son had been convinced by a psychologist to undergo sex-reassignment surgery. The young man was living at home, had no job, and was over 21. The father had no legal authority to prevent him from following through on this decision. Obviously, this was not the right course of action. All he and his wife could do was to try to dissuade their son and express their strong objections to the psychologist.

In another call, a wife described the decision of her husband to transition to a female. She and their adult children were devastated. In words that I will never forget, she said that he had lied to her at the altar when he had promised that he would love her until death. He said had made this promise as a man, she rightly insisted. The NCBC opposes all gender transitioning and holds that psychological counseling is the best course of action for those suffering gender dysphoria.

Then there are the calls from physicians or family members concerning problem pregnancies. These are the most difficult of all, coming at any time of the day or night and often requiring a moral judgment under a time constraint. These are the decisions that keep an ethicist awake at night.

EDWARD J. FURTON, PH.D., is director of publications for the National Catholic Bioethics Center in Philadelphia and among its team of seven ethicists. He’s editor-in-chief of NCBC’s award-winning National Catholic Bioethics Quarterly and Ethics & Medics.