Condon, Robert V.

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The Linacre QuarterlyVolume 20 | Number 2 Article 25-1-1953Ethical Principles Applied to Extensive PalliativeAbdominal OperationsRobert V. CondonFollow this and additional works at: https://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationCondon, Robert V. (1953) "Ethical Principles Applied to Extensive Palliative Abdominal Operations," The Linacre Quarterly: Vol. 20 :No. 2 , Article 2.Available at: https://epublications.marquette.edu/lnq/vol20/iss2/2FEDERATION OF CATHOLIC PHYSICIANS' GUILDS President WILLIAM P. CHESTER, M.D. 742-68 Maccabees Bldg.Detroit 2, Mich.First Vice-President JosEPH J. ToLAND, Ja., M.D. 1241 W. Lehigh A venue Philadelphia 83, Pa. Second Vice-Pre,ident MELVIN F. YEIP, M.D. 7431 Detroit Avenue Cleveland 2, Ohio Third Vice-Pre,ident WILLIAJ!I J. EGAN, M.D. 1547 Centre Street Newton Highlands, Mass. Err:ecutive Secretary M. R. KNEIFL1488 So. Grand Boulevard St. Louis 4, Mo. Moderator RT. REV. MsoR. DoNALD A. McGowAN 1812 Massachusetts Avenue, N. W. Washington 5, D. C. Secretary A RTHUR J. OFFERMAN, M.D. 48051h South 24th Street Omah.a, Nebr. Trea.8urer DANIELL. SEXTON, M.D .. University Club Building St. Louis 8, Mo. Editor, THE LINACRE QUARTERLY REV. JOHN J. FLANAGAN, S.J. 1438 South Grand Boulevard St. Louis 4, Mo. Affiliated Guilds BOSTON GUILD BRONX GUILD BROOKLYN GUILD BUFFALO GUILD C�VELAND GUILD CALGARY, ALBERTA, CANADA 'DETROIT GUILD DENVER GUILD MINNEAPOLIS GuILD ·WILMINGTON GUILDNEw ORLEANS Gun.D OMAHA Gun.D PoR'rr.AND, OREGON, Gur1.11 PHILADELPHIA  Gun.D SACRAMENTO GUILD ST. Louis GuILD NEW BEDFORD GUILD Sioux CITY GUILD Sioux FALLS GuILD I ,os ANGELES GuTLn II LIN4CRB QUARTERLY ................................................ � .............................................. MAY, I 9 5 3 Ethical Principles Applied to Extensive Palliative Abdo�nal Operations ROBERT V. CONDON, M.D., F.A.C.S. Guild of St. Luke Boston, Massachusetts ·pRESENT day advances in surgical technique, parenteral fluid and . blood replacement, anesthesia, antibiotics and general medical knowl-edge have extended the field of abdominal operations. This applies clinically to surgical procedures from the curative or palliative viewpoint. Extensive surgery has been particularly developed as pertains to abdominal cancer located in the bladder, uterus, genital organs, rectum, stomach, pancreas, kidney, and retroperitoneal structures. The ethical position of these operative procedures, when applied in a clinical curative sense, has been well developed and accepted. The performance of such extensive procedures in more recent years, where the decision to ·operate is based on easing distress rather than cure, has been used, to varying extent, in different institutions. In illustrating extensive abdominal procedures, which may be performed for palliative reasons, one may list the following examples: rectal cancer surgery with removal of the rectum and colostomy formation; bladder cancer surgery where cystectomy may be performed with implantation of the ureters in the sigmoid colon; uterine or ovarian malignancy where the uterus, adnexae, lymphnodes, fascial structures and possibly rectum or bladder may be removed; nephrectomy in the presence of varying amounts of pulmonary cancer spread. The surgical judgment whereby such procedures palliate is most difficult, and it is the purpose of this article to consider the ethical principles which· serve to formulate this. Surgeons of Catholic faith have been guided in medico-moral principle by several Diocesan medical, surgical, and hospital codes: "The Surgical Code of the Catholic Hospital Association of the United States and Canada" and the more recent review called "Ethical and Religious Directives for Catholic Hospital ," dated 1949. These moral principles and practical applications have religious authority and a scientific basis insofar as they represent expressions of the natural law. Abdominal surgery, ethically, is considered under the subject of mutilation .. Such single operative procedures as removal of the appendix and gaUbladder are licit in that such organs have a natural subordination to the good of the whole body. In such cases, the 30 THE LINACRE QUARTERLY defined the moral ethical principles that underlie surgical judgment in , .di cases. Previous. to surgery in such cases, it is proper Catholic hos1 1.al directive that such cases have consultation with section chiefs or Se(' on members who have an extensi,·e knowledge and impersonal judgment , ,n­cerning such cases. ·,vhere medico-moral issues may be involved in ori- ns such as the uterus or ovaries, appropriate chaplain consultations shouk be had beforehand. Both ethically and on sound scientific surgical judgm nt, extensive surgical procedures should be performed only for the proportioi ,te good of the patient inrnlved and not from the viewpoint of proce, ,re application. Medical management, appropriate old and newer medical ns combined with personality management and spiritual guidance remain or many such cases preferable palliative procedure. It is felt, in summary, , ,at iri this field of difficult surgical judgment Catholic ethical principles afl rd a basis for good surgical judgment and emphasize the wisdom of the exp ·s­sion, "'Vhat is good medical ethics is good medicine." BIBLIOGRAPHY l\IcFadden, Charles J ., l\Iedical Ethics for Nurses. Philadelphia: F Davis Company, 1946. Kenny, John P., Principles of Medical Ethics. ViTestminster, faryla l: The Newman Press, 1952. Creevy, C. D., "Facts about Creterosigmoidostomy," The Journal of 1c American Medical Association 151, (January 10, 1953), 120-123. Ethical and Religious Directives for Catholic Hospitals. St. Louis: '� .1e Catholic Hospital Association of the United States and Canada, 1 c Kelly, Gerald, Medico-Moral Problems, Part I. St. Louis: The Cath< 1ic Hospital Association of the United States and Canada, 1949. Kelly, Gerald, Medico-1\Ioral Problems, Part III. St. Louis: The Cath, :ic Hospital Association of the United States and Canada, 1951. Kelly, Gerald, :Medico-Moral Problems, Part IV. St. Louis: The Cath<-lic Hospital Association of the United States and Canada, 1951-1952. THE LINACllE QUARTERLY 31 Medico-Moral Notes GERALD KELLY,· S.J. EUCHARISTIC FAST T HOSE who have _a copy,�f Me�ico-Moral Problems_ IT,�' will note th�tit contains an article on fhe fast Before Commumon (p. 42). Tlus article explains the law of the Eucharistic fast, as well as the princi­pal exemptions, as it existed prior to Janua1·y 16, 1953. On this date the provisions of the Apostolic Constitution Christus Dominus and of the accompanying instruction by the Sacred Congregation of the Holy Office took effect. These provisions a fleet both the law and the exceptions. They concern evening 'Niass, privileges for priests who are to celebrate Mass, and privileges for the faithful who receive Communion.' The bishops will explain the norms concerning evening �lass when they grant this permission; priests no doubt know the norms that apply to them. Doctors should know the privileges that might apply to themselves, nurses, and patients as regards the reception of Hol�- Communion. For this purpose, the following summary may be useful: I. For Everyone: Plain water (i.e., water not mixed with any other sub­stance) no longer violates the fast. It should be clearly understood that thisapplies to everyone and that no necessity whatsoever is required for taking advantage of it. Ordinary tap water in cities, even though purified by chemicals, is still plain w.ater; and so too is the natural water in certain districts which has a mineral content. 2. For the Sick:A. If they are in danger of dwth: Canon 858, §1, completely exemptsthose in danger of death from the duty of observing the Eucharistic fast.There is absolutely no restriction on this privilege as regards the quality ofthe food taken or the nature of the liquid taken. No permission is neededfor its use. This provision of canon law has not been changed by therecent legislation.B. If they are not in danger of death, but their illness is such as to 1nakethe observance of the complete fast' difficult: With the approval of aconfessor, these may receive Holy Communion after having taken refresh­ment or nourishment in liquid form and medicine in solid and liquid form.The illness need not be confining. There is no time limit on this privilege;the permitted liquids and mcdieinc may be taken right up to the time of

Ethical Principles Applied to Extensive Palliative Abdominal Operations

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Ethical Principles Applied to Extensive Palliative Abdominal Operations

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