Mirror of Justice

A blog dedicated to the development of Catholic legal theory.
Affiliated with the Program on Church, State & Society at Notre Dame Law School.

Tuesday, July 21, 2009

Political Reduction of the Church's Reality

By Michael Scaperlanda

Dino D'Agata concludes his essay, The Pope and the President:  From Notre Dame to Vatican City and Back, with these words:

[T]he Church’s claim—that it is the bearer of Christ Himself in the world despite many of the highly glaring flaws of its adherents, both clergy and laity alike, as well as despite its historical mistakes—is what was really at stake the day its leader, a human being whose task is to witness Christ and not to evaluate another human being according to ethical guidelines, met the first African American man to lead the free world. One would hope that many Catholics, starting from the bishops themselves, would understand that Christianity means a human encounter in which Christ makes Himself known through the very presence of the baptized believer—something the Holy Father exemplified for us in his encounter with Barack Obama—an encounter that cannot be reduced to either side’s “positions” on a variety of topics. One would hope that Catholics—conservative and liberal alike—take their cue from this and stop reducing their faith to a set of easily apprehended ethical tenets when the true ontology of faith is unpredictable, because it has to do with the mystery of how God takes on human flesh in the present—something that can potentially throw back any believer, liberal and conservative alike, because it removes faith from the realm of one’s own intellectual pretensions and transcends any facile reductions of what a human being actually is to what he or she thinks or believes.

The rest is here.  What do you think?  And, Michael P., how would "a post-metaphysical, apophatic Catholic/Christian" respond to D'Agata?

Monday, July 20, 2009

More on Health Care Rationing

By Michael Scaperlanda

Responding to my post on health care rationing, Denise Hunnell writes:

 

I responded to Peter Singer's article here.  The problem with rationing is that it judges the patient, not the treatment. Catholic teaching is that we must determine what is proportionate care and what is disproportionate care. This judgment is made from the perspective of the patient or the patient's surrogate. This teaching of distinguishing proportionate vs disproportionate care has been developed in two Magisterial documents. The first is the Pope Pius XII, Address To members of the "Gregorio Mendel" Italian Institute of Genetics on reanimation and artificial respiration (November 24, 1957)  In this document Pope Pius XII states that one is obligated to pursue ordinary or proportionate care.

In the Congregation for the Doctrine of the Faith, Declaration on Euthanasia, (May 5, 1980) n IV, the principles for the determination of what is proportionate care and what is disproportionate care are more clearly stated:

In the final analysis, it pertains to the conscience either of the sick person, or of those qualified to speak in the sick person's name, or of the doctors, to decide, in the light of moral obligations and of the various aspects of the case. Everyone has the duty to care for his or her own health or to seek such care from others. Those whose task it is to care for the sick must do so conscientiously and administer the remedies that seem necessary or useful. However, is it necessary in all circumstances to have recourse to all possible remedies? In the past, moralists replied that one is never obliged to use "extraordinary" means. This reply, which as a principle still holds good, is perhaps less clear today, by reason of the imprecision of the term and the rapid progress made in the treatment of sickness. Thus some people prefer to speak of "proportionate" and "disproportionate" means. In any case, it will be possible to make a correct judgment as to the means by studying the type of treatment to be used, its degree of complexity or risk, its cost and the possibilities of using it, and comparing these elements with the result that can be expected, taking into account the state of the sick person and his or her physical and moral resources

The USCCB ethical and religious directives (ERD) state:  “Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community”(ERD 56) and “Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden or impose excessive expense on the family or the community”(ERD 57)

In the case of your 85-year-old, there is the added complication of a limited supply of organs. It is fair to triage an 85-year-old to lower on the transplant list because his risk/benefit analysis may not be as favorable as someone else's. Then it must be determined if the risk of the treatment in this individual patient is worth the anticipated benefit. Cost can be a consideration. You are not obligated to bankrupt your family to pursue care. The point is, it must always be the treatment that is being judged for benefit and burden, not the patient.

Thanks for continuing this discussion.

More on Health Care Rationing

By Michael Scaperlanda

From a reader, responding to my post on health care rationing.

I think you're correct regarding the rationing question. In my opinion (and in the opinion of others more interesting than myself), the term rationing is being misused. Because resources are finite, rationing
*will* take place one way or another. The question is how those resources are rationed. A quick Google search revealed this linked article by Uwe Reinhardt, economics professor at Princeton. There, I think Professor Reinhardt does a pretty good job explaining the fundamental issue (though not in the most polite way, I'm afraid). In the end, I don't think it makes sense to be critical of rationing, but only of certain forms of rationing, and it's important to be clear what specific form we're being critical of.

Friday, July 17, 2009

Mountain man or new urbanist

By Michael Scaperlanda

Will the real Rick G., please stand up.  Are you a mountain man or a new urbanist at heart? 

"Til Joint Assisted Suicide Do Us Part"

By Michael Scaperlanda

More on health care and the culture of death:

British conductor Sir Edward Downes died last week, alongside his wife, at an assisted-suicide facility in Switzerland. Lady Downes was in the final stages of terminal cancer; Sir Edward was ailing ("almost blind and increasingly deaf," according to his son), but his condition wasn't fatal. He just wanted to die with his wife.

Of course, "just" probably isn't a fair word to use in this context; it minimizes the enormity of the decision—not to mention the profound commitment that these two people, married for over five decades, had to one another. But then again, in some ways it feels like precisely the right word: What could be more natural, more simple, than this decision?

And there's something of that bracing quality to the Times' newspaperly account of the Downes' final moments:

On Friday, the [Downes'] children said, they watched, weeping, as their parents drank “a small quantity of clear liquid” before lying down on adjacent beds, holding hands. “Within a couple of minutes they were asleep, and died within 10 minutes,” Caractacus Downes, the couple’s 41-year-old son, said in the interview after his return to Britain. “They wanted to be next to each other when they died.”

The son goes on to say, “It is a very civilized way to end your life, and I don’t understand why the legal position in this country [Britain] doesn’t allow it.”

Allen's gut check

By Michael Scaperlanda

Thank you Michael P. for posting John Allen's latest.  I wanted to highlight two bits of Allen's essay:

[T]he real "losers" from Caritas in Veritate are Catholics who operate as chaplains to political parties, cheerleaders for political candidates, and spin doctors for either the Bush or Obama administrations, cherry-picking among church teachings to support those positions. Needless to say, the American Catholic landscape is dotted with prominent examples of all the above.

and

Can American Catholics evangelize the country's politics, or are we content to be evangelized by it?

That, in any event, seems to be the gut-check posed by Caritas in Veritate.

More on Health Care

By Michael Scaperlanda

At the end of his discussion of Peter Singers call for rationed health care, Fr. Araujo says:   "If the treatment is available and will do good for that person, it should be made available."  Is this always true?  Two further questions:  at what cost and who bears the cost?  Two more:  who decides what is good and by what criteria? 

Even if we get medical and pharmaceutical costs under control, is it the case that a parent ought to be able to take a child to the doctor every time she gets the sniffles (easy to do back in the HMO days with a $5 co-pay)?  Should an otherwise healthy 85 year old be eligible for a heart transplant? 

My intuition is that we have (and will continue to have) health care rationing at multiple levels - government, insurance company, and individual. Am I wrong about this?  I'm more concerned about the criteria for rationing.  Singers criteria, based upon his anthropology, would lead to a furher entrenchment of the culture of death.  A Catholic anthropology, taking into account all that Fr. Araujo discusses, would lead to the building of a culture of life.  Thoughts?

Thursday, July 16, 2009

Survey of religion at America's colleges and universities

By Michael Scaperlanda

First Things is taking a survey (online) about the state of religion on America's campuses both private and public.  If you are intersted please click here and fill out the survey.

Health Care Debate

By Michael Scaperlanda

Thank you Fr. Araujo for linking us to Peter Singer's article on health care.  I hope to have more to say on that later.  Denise Hunnell, who has a certification in health care ethics with the National Catholic Bioethics Center in Philadelphia, has posted some interesting thoughts on the health care question at her blog where you can read her full post.  Here is the beginning:

President Obama is ready to drop over one trillion dollars on a health care reform initiative. Let me be clear. Every human being is entitled to basic health care. Our current health care system is not doing an adequate job of providing basic health care to every American. However, I am not an impulse shopper. I want to know what I am getting for my money. We do not know what we are getting with this health care initiative, because the health care is yet to be determined by a Benefits Advisory Council. Let me clarify what we do know and more importantly what we do not know. ...

Wednesday, July 15, 2009

"The Government Want YOU .... to stay in Love .... What?"

By Michael Scaperlanda

MOJ friend and alum, Helen Alvare, has a thoughtful post on the Culture of Life Foundation website.  It begins:

Several columns ago, I addressed the worry that our country’s nearly 40% out of wedlock birthrate might represent some sort of tipping point for marriage, for  children’s well-being and for our society’s shared future.  I reviewed in-depth interviews with single moms which revealed nearly bottomless wells of mistrust regarding the men who fathered their children. The men’s behavior did not seem to merit better. This past Father’s Day, President Obama spoke to an aspect of this mistrust: he asked the fathers to step up to their fathering responsibilities. (See http://www.politico.com/news/stories/0608/11094.html)  He explicitly discussed his own fatherless upbringing and the hole it left in his life. Good for him, and for the young men there in the Rose Garden. And good for the country too. A robust father-child bond is a crucial piece of the puzzle of that is a healthier future for U.S. children.

"But President Obama’s message, like a host of other attempts over the past several decades to ameliorate the situation of the children of lone-parents, is incomplete.

What’s missing? Or rather, Who is missing? The mother, as well as the father’s relationship to her. Advocating fathering of the children is great, but forgetting that everything related to fathering begins with the mother is foolish.

Read the rest here.

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