Furlong, Francis P.

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The Linacre QuarterlyVolume 18 | Number 2 Article 45-1-1951Medico-Moral NotesFrancis P. FurlongFollow this and additional works at: https://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationFurlong, Francis P. (1951) "Medico-Moral Notes," The Linacre Quarterly: Vol. 18 : No. 2 , Article 4.Available at: https://epublications.marquette.edu/lnq/vol18/iss2/4• .5() THE LINACRE QUAHTERI.Y Medico-Moral Notes Francis P. Furlong, S.J. 1\Iorality in the Journal of the Arnerican llledical Association. In these "Notes" I should like to go through a few of the ven· l'ecent numbers of the Joiirnal of the American Jlledical Associt;­t·ion, and consider some of the moral implications of an occasional article, 01· note, or report, or answer to a query. I am more con-. cemcd about correct.ion and clarification of points that might lciul to error. Still, this will also affoJ'd a welcome oppol'tunity to speak a word of prnise when praise is due. References to the cunenl volume 145 of the Journal will be made simply by page. * * *Unnecessary Surgery Dr. Philip Thorek, for instance, in reporting the result of vagotomy for idiopathic ulcerative colitis and reo-ional enteritis 0 prefaces his article with: "One naturally assumes that before any form of surgical intervention is contemplated for this condition proper medical and psychiatric therapy have been aiven a thorourrh . 1 o o tna ." (P. 140) In concluding the discussion in which less radical therapeutic measures had been emphasized the doctor repeated tlu.' above and made but one prudent request. "However, these patients must not be 'studied to death,' nor must they be conservativelJtreated to the point of surgical irreversibility. Vagotomy warrn11ts further careful investigation." (P. 146) vVe can agree, too, I believe, with the remarks of Dr. P. Robb McDonald in concluding the discussion of his article "The Dislu­ca ted Lens." "Dr. ,�7halman stated that we should have the patientunder control. I also think that the surgeon should be undercontrol and not try to do too much." (P. 226) . Again is not a right concem about what the patient has tugam or lose shown in the following? I quote from an abstract ofR.N. Janes' article on "Lobect.omy and Pneumonectomy for Pul­monary Tuberculosis": THE LJNACHE QUAllTERLY 51 "The results of the procedure can be regarded as reasonably ,alisfactory when it is realized that the group comprised patientsin whom other types of treatment had failed nncl those in whom noother kind of treatment was likely to be effective. Excision shouldnot be regarded as a substitute for the other types of therapy,particularly for thoracoplasty. The fact that the average mortal­it 1· from 589 t.horacoplasties done in the six-year period from 1942t� 1948 was one per cent illustrates the relative risk of the two proc.:edures." (P. 523) Lobotomy This is just another example, really, of the general subject trrated above as unnecessary surgery. Since it is mentioned fn·quently, however, it will be more convenient to treat it sepa­r11tely. L. Drubin in a "Preliminary Report of 62 Prefrontal Lobotomies on Psychotic Male Veterans" says: "Loss of agitated, self-destructive and  disturbed behavior in chronic psychotic 1111tients is the out.st.anding accomplishment of lobotomy in a substantial percentage of the cases." (P. 263) In the Journal for 1950, (vol. 144, P. 1520) there is Dr. :;tengel's report on his follow-up of 330 of 345 patients who were submitted to prefrontal lobotomy. He concludes: "The limitations of leukotomy in the treatment of schizophrenic r<'action types of disorder and paranoid states have again been demonstrated in these patients. Full remissions have been observed mainly in patients whose personalities and mental conditions had features that are generally regarded as assets from the point of l"iew of prognosis. There is no general consensus as to whether such patients should be operated on .... Leukotomy, therefore, set in motion a process that might have taken place without it." In mai-iagement of intractable pain E. A. Smolik sa_ys: "Lobo­tomy was offered only as a last. resort in all instances." (P. 589) Similarily of intractable pain Drs. Laine and Soots stress: "the pain did not disappear completely but lost its agonizing character in six of the seven patients reported on." The_y claim further that: "Leukotomy according t.o Popen's technic does not induce person-'f ,l ,I 4 . , \. I y 52 THE LINACRE QUARTERLY ality changes and may be ·clone more rapidly than topectomy." (P. 526) After these considerations may we not cite as prudent the answer to a query on "Amputation Stump Pain and Lobotomy?" "Lobotomy has been used successfully for the relief of pain follow­ing amputation, but the results, as far as return to an effecti\'e social life and working ability are concerned, have not been goocl. Standard prefrontal lobotomy is too extensive. Too few patients have Leen treated by other psychosurgical means to permit a definite expression of opinion. Since there have been reports of relief of phantom limb pain following electro-shock therapy, this might be tried first, followed by transorbital lobotomy and further shock treatment if necessary." (P. 774) I understand that some might have greater concern about possible bad effects from a transorbital lobotomy. vVhat I should like to praise is the cautious conservative approach. Can we 1101 see here a responsible member of the medical profession carefully working towards the solution of a difficult problem, much as a moral theologian painstakingly arrives at a tentative solution? For instanc·e, Father Gerald Kelly, S.J. in Hasp-ital Progres.s (Febru­ary, 1950, P. 56) suggests: "we may apply to lobotomy for pain the same rule 1hat is given in the code for lobotomy in the treat­ment of mental illness. In other words, the operation is permissible: a) as a last resort; and b) when there is solid hope that its bene­ficial results for the patient will outweigh its harmful effects."Post-Mortem Cesarean Section Dr. Kronick describes a "Successful Post-mortem Cesarean Section following Death from Pulmonary Tuberculosis." It is most unfortunate that: "No previous cases of post-mortem cesarean section done on patients who had died from pulmonary tuberculosis have been recorded." The unfortunate thing is not that they hal'C not been recorded, but that likely they have not been performe,I. Catholic medical men above all should indeed keep in mind: "vVith an estimated 90,000 patients with active tuberculosis confined to sanatoriums and rest homes the incidence of pregnancy among the women patients might be significant, and the possibility of a THE LINACRE QUARTERLY 53 n·sarean section at the time of death should be realized. There is 110 reason to suspect that the rescued infant ma_v not prove healthy 1111 cl normal in all respects whether the death of the mother was caused by pulmonary tuberculosis or other disease." (P. 933) A question of life and death here! In that reported case even 11ucstion of normal healthy life for thi� pilgrimage and exile on this planet earth. Yet even suppose the child was not to be nor�al _andhl'althy, what about life eternal? In ho\\' many cases when it might lie in;possible to deliver a child that would live for any le�gt� of time, would it be vossible for the zealous, competent, consc1enb�us ,urcreon to provide for the eternal life of the fetus by extractmg ii f�r _immediate Baptism? "When a mother d-ies ·in pregnancy and the fetus is judged to be at least probably alive, it should be i111mediately extracted and baptized. Before doing this, one should ha1·e the consent, at least reasonably presumed, of the proper relatives." ("An Instruction on Baptism," Gerald Kelly, S.J., .1/cdico-M ornl Problerns I, 50.) Vasectomy . On legal and medical grounds Dr. Vincent J. -O'Conor argues well the case against vasectomy "as the easy and safe way to effect sterilization." He does so in a letter to the editor of the Journal(rol. 144, P. 1502). He remarks: "The surgeon that considers doing a vasectomy for any purpose other than the direct treatment of local disease must know that in practically every state in the L;nion this operative procedure is considered an illegal one." As a member of the medical profession Dr. O'Conor appeals to his own experience. Since he is also a Professor of Urology his testimony is of greater value. "Making a man 'safe sexually' has often resulted in marital infidelity, domestic discord, separation ancl divoi·ce. These experiences are frequent in our records in contrast with those quoted by the authors in their 50 cases." Finally Dr. O'Conor argues from the experience of others. He is convinced that: "Most experienced urologists will agree that prnfound sexual neuroses and imaginative ills often follow vasec­tomy when it has been performed purely to prevent pregnancy." I'I 'I I, I l, I ',; ! I I I. I t I I • y THE LINACRE QUARTERLY . Such a vasectomy, one done purely to prevent })rerrnancv i d . t t ·1· . d • o ., ' S II uec s en 1zat10n, an as such somethmrr bad and wronrr in ·t l( Wh . . d" I:) b I SC • en we porn t to I ts 1sas trous consequences we are not ai·rr · th . . b . . ' I:> Ulllg at it 1s ad because it 1s not expedient. It is just another instance of "Bad morals, bad medicine." Dr. O'Conor's arrruments are va1· 1 I l.k } f' 5 < I( 1 anc 1 ·e y o more force for many than any ethical or relier· · j · . . • i:,10l1S c?ns1c erabons of direct sterilization as the usurpation of thrrights of God. Abortion 1:ven here we can find something to praise, since we shall firstco� 1dcr �hrcatened abortion. It is good to see how Dr. M. Dumontweighs w1tb care the value and the risk of the use of neostiO'minc fo r pregnancy test. "Neostigmine is of definite therapeutic value in a111�11on-hc�. It sl_wuld be used cautiously in obstetric practice usa d1agnosbc test for early pregnancy, because it has been followed Ly auortion in a significant proportion of cases." (P. 766) VVit�1 that, though, our praise must stop. What about that ugly tlpng called therapeutic abortion? Now the Journal docs state: "The_ �nsw�rs here published have been prepared by compe­tent a\1.tl _1onbe_s_. They do not, however, represent the opinions of any of11cial bodies unless specifically stated in the reply." (P. 126) The "authority" discussing "Retinal Detachment during Pre(l'­nancy" may be most competent medically. Yet he is most certaint not competent to condemn to death the innocent child in its mother's womb. He may feel that medically: "the risk is so O'rcat that there i · little difference of opinion as to proper action: Preg­nancy must be te�·minated." (P. 128) Still the doctor, as everyman, must recog111zc the limitations placed upon him by a highc·r authority. "Thou shalt not kill!" ' . In an abstract on the management of pregnancy during heartdisease we are told �o(dly: "ln?ications for prevention of preg­na�cy and therapeutic mterruptwn are presented and methods forthcu· accomplishment discussed." (P. 593) I wonder how many of the doctors who would routinely recommend interruption of p�·eg­nancy because of heart disease will read Dr. C. Curtiss' report: "that of 99 patients referred to the antepartum cardiac ·clinic in THE LINACRE QUARTERLY 55 011c year because of suspected heart disease, the diagnosis was.·,rntirmcd in only 12, who had chronic rheumatic heart disease."l)r. Curtiss points out that: "it is easy to be misled by a loud,rstolic murmur, which is commonly heard in pregnant patients11:ith normal hearts, or by a loud mitral first sound ordinarily311 ,mestin O' mitral stenosis but also heard in normal hearts duringr-,e, b pregnancy." (P. 760) Is there not food for thought in this that: "In the managementur most of the cases of rheumatic heart disease in this series intcr­niption of pregnancy was not considered because of religiousobjections. Thus, in some cases, in which the pregnancy wouldordinarily have been interrupted, it was found the patient faredbetter than had been expected." (P. 760) Is this another instanceor "Good morality, good medicine?" Be that as it may, no matterwhat the circumstances, "Thou shalt not kill!".Last year, too, among the Journal's solutions was a calm acceptance of therapeutic abortion as the way out of a distressing case of "RH Isosensitization by Pregnancy." (vol. 144, P. 1417) ·'Where the expectant mother is strongly sensitized to the RHfactor and the husband is homozygous for the RH factor, a thera­peutic abortion may be indicated, provided the pregnancy is nottoo far advanced. The abortion would be indicated not only becausesuch a pregnancy would be futile but because it involves increasedhazards for the mother, since toxemia and severe post-partum hem­orrhage are not infrequently associated with hydropic stillbirths."Obviously we cannot make an issue of therapeutic abortion in every number of the LINACRE QUARTERLY. The cases cited should suffice to direct the attention of Catholic doc�ors to the danger there is of their own moral resistance being worn away just by the constant repetition of a pagan policy. Drops of water, we know, falling ever so gently but steadily, wear away the hardest stone. Contraception Encl ess repetition of propaganda to make something morally foul, be accepted as convenient, as expedient, and therefore as r I I I t J i I1,· I I' I. ·,I I I . I I I t .l . ,. • , 56 THE LINACRE QUARTERLY good, is characteristic of the advocates of race-suicide, the birth­controllers and those who li,·e on the sin and the moral corruptio11 of others. They can glory now in being acceptable to the Journalof the A. AI. A., and in being allowed to con tribute not a little in the form of ads for contraceptive instruments and aids, ads often repeated and more often than not full-page spreads. Yet withul they are but promoting and encouraging sin. That outward show of soundness and serious concern for the well-being of the nation docs but "film und screen the ulcerous spot whilst rank corruption mining all within infects unseen." Doctors should know enough to probe. Would that the Journal had the courage to apply to its ow11 advertising of contraceptfre devices the very principles it expounds so well in an editorial on "Advertising for Home Remedies." "Responsibility for clean advertising copy rests with the manufac­turer or distributor and h is advertising representative, sometimes with his sales outlet and always with those who control the medium through which the advertising appeal is made. No one who engages in any part of the transaction can turn away with the thought that tl;e promotion is not his problem. If he has any sense of moral obligation to those who turn to him in trnst, he will not disclaim responsibility Lut instead will be eager to assume it." (P. 987) Donor Insemination On September 29, 1949 Pope Pius XII treated this point of donor insemination in his more general discourse to the delegates in Rome for the fourth International Convention of Catholic Doctors (LINACRE QUARTERLY, October, 1950). We read there on this precise point : "Artificial insemination in marriage with the '·use of an actirc clement from a third person is equally immoral and as such is to be rejected summarily. Only the marriage partners have mutual rights over their bodies for the procreation of new life and these are exclusive, non-transferable and inalienable rights. So it must be out of consideration for the child. "Ily virtue of this same bond, nature imposes on whoeve·r gi,·es life to u small creature the task of its preservation and cducatio11. THE LINAC!lE QUAllTERLY 57 JMwccn the marriage partners, however, and a child which is the fruit of the active clement of a third person - even th�ug!1 _the husband consents-there is no bond of origin, 110 moral or .) und1cal bond of conjugal procreation. " Modern paganism rampant is t? be seen in the �nthusiasm )hown for donor insemination. ,i\Te Judge not the mot'.ves o_f t _he authors of "Sociologic and Psychological Aspe�ts of Artificial I · t· ·th Do11or Semen " (Pp. I 062-64) Nevertheless theynsemrna 1011 w1 · . d t. something morally wrono- for any human bemg 110 arc a voca mg i:, 111atter what his race or religion may be. ,vith re o-ard to the conclusions of the above art�cle "': m�st · I d btl1at· "The medical indications for donor msemmation ,1111p y eny O • 1 " t arc broader than is generally appreciated." Even thoug �: a present this procedure offers practically the sole l_10pe of relief not 1 · · of" absolute male sterilitv but also 111 a much larger on y m cases · . . · f . f · vhich the male partner is only relatively m er-group o cases m ' h I tile", still evil is not to be done that good may result. Even t oug 1: "The experience of hundreds of couples has proved that d�nor insemination can bring great happiness"; though : "there is a "rowing interest in the procedure among physicians, as well as a ;tcadily increasing demand for it on the p'.1rt of the laity"; thoug�: "Donor insemination is undoubtedly destmcd to be employed mo1e and more"; still evil is not to be done that good may result. We should like to stress the conclusion: "B�t sociologic and psychological contraindications are_ n.umerous and important. lnca�­culable harm will be done if practi t10ners neglcc� these a'.1d �tai t using donor insemination as a sort of assemb�y line t��hmc aimed at mass production, as a routine manipulat10n of l_tfe or as a:� impersonal rccrimen tat.ion of the human reproductive powers. (P. 1064) Do�or insemination is repudiated �·�ti�·ely, however, not 1. f ·t b· d cff·ccts but because in itself it 1s al\\'ays brutally uccause o i s ti , immoral. Conclusion ,ve have go�e through these recent issues of the Journal to note the moral implications of some of the matter there presented. . . I , I• II• rl -� ,1 I' • I I• 58 THE LINACRE QUARTERLY This we h,we done not to evaluate the publication as a professio11al journal, but to praise correct moral judgment, and on occasion to speak that sufficient word to Catholic doctors to put them on guard. Doctors have consciences, it is true, and must form correct moral judgments for themselves. Indeed, many of the contributors to the J oitrnal showed a fine sense of responsibility and good moral judgment. There are some, however, who take unto themselves thl' office of professional theologian, of teaching Church, of Almighty God Himself. International Catholic Medical Congress to be held in Paris, France between July 6 and 9, 1951 Interested doctors are urged to contact The Federation of Catholic Physicians' Guilds, 1438 South Grand Boule­vard, St. Louis 4, Missouri. * "Medical Chats," a regular feature of The Pilot, Catholic paper published in Boston, are prepared by members of the Guild of St. Luke of Boston. Considerable space is allotted these weekly articles by doctors who are members of the Guild. * Word comes from Tokyo that plans are being made for an all-Japan federation of Catholic physicians. Committees have been set up in key cities and a general meeting of representatives held. The Chaplain of the Tokyo Federation of Catholic Physicians said a national organization would permit all members to be advised of the latest developments in medicine and surgery. 

Medico-Moral Notes

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Medico-Moral Notes

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