Byrnes, Michael

Diamond, Eugene F.

English

epublications@Marquette

The Linacre QuarterlyVolume 62 | Number 4 Article 911-1-1995[Book Review of ] Ethics for Doctors, Nurses, andPatients, by H. P. Dunn and [Book Review of ]Medicine and Christian Morality, by Thomas J.O'Donnell, S.J.Eugene F. DiamondMichael ByrnesFollow this and additional works at: https://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationDiamond, Eugene F. and Byrnes, Michael (1995) "[Book Review of] Ethics for Doctors, Nurses, and Patients, by H. P. Dunn and [BookReview of] Medicine and Christian Morality, by Thomas J. O'Donnell, S.J.," The Linacre Quarterly: Vol. 62 : No. 4 , Article 9.Available at: https://epublications.marquette.edu/lnq/vol62/iss4/9BOOK REVIEWS Ethics for Doctors, Nurses, and Patients byH. P. Dunn Alba House, New York This is the fifth book by Pat Dunn, an internationally known Catholic obstetrician and gynecologist. It will not disappoint those who have come to know Dr. Dunn from his writings. It partakes of his style as a cogent and commonsense physician who has thoughtfully developed his own ethical approach to the practice of medicine from principles. The first three chapters of this book are an exposition of these principles. They are fundamentally the principles of natural law, the teachings of the Roman Catholic Magisterum and the time-honored principles of the Oath of Hippocrates. Of particular interest is the delineation of the occasions in which the Seven Deadly Sins may enter the life of a physician. There is also a proposal for a specific oath for the Catholic physician based again on the pagan-era Statement of Hippocrates. Dr. Dunn's treatment of common ethical issues is brief and anecdotal rather than detailed and encyclopedic. This is what makes the book a practical resource both for the busy practitioner and for the priest called upon to counsel on a specific medically-related problem. This is exemplified in the chapters dealing with the end of life decision-making and the care of the abnormal and the unwanted. These are issues of great concern for the medical profession at the end of the twentieth century. There is an unfortunate attempt to solve issues by pkbiscite or consensus or to believe that modern technology has made trademark approaches obsolete. Here in a few pages or a few paragraphs, the core issues are delineated and defined. Since Dr. Dunn is a seasoned clinician with a half century of experience as an obstetrician-gynecologist, the chapters on the reproductive system, contraception, sterilization, abortion, pregnancies and sterility are Quite authoritative and categorical in tone. The Church has been accused of being excessively preoccupied with so-called "pelvic morality" but the problems which affect men and women and families in this most fundamental and intimate area do not deserve to be subordinated or left to the unassisted personal conscience. John Cardinal O'Connor of New York has recommended this book as a resource for the medical profession and for pateints. Itis remarkable how much practical information and guidance have been compacted into a little over 150 pages. The book deservt:5 a wide readership and a place on the short shelf of important references for physicians, clergymen and educated laymen. - Eugene F. Diamond, M.D. Medicine and Christian Morality by Thomas J. O'Donnell, S.J. Staten Island, New York: Alba House, 1991. 331 pages, paperback. In Medicine and Christian Morality we find the fruit of over 35 years of reflection on moral issues facing those involved in the health care professions. In a revised and updated version of his 1976 work, Fr. O'Donnell extends his considerations to new problems in the medical field, such as the rise of a new "entrepeneurism," in addition to handling a wide range of the more common topics. 90 Linacre Quarterly As in the earlier edition, the aim is to present the moral teaching of the Roman Catholic Church to Catholics working in the health care professions, as well as to all those to whom it is of interest. We begin, as one might expect from the stated aim, with a brief examination of the teaching authority of the Church. O'Donnell identifies the three sources of the Catholic norm of morality: the natural law, the divine positive law, and the ecclesial magisterium. He concludes the chapter with a concise summary of the teaching of Vatican Council II on the extraordinary and ordinary exercise of the magisterium, and he joins with a number of theologians in raising the possibility of "infallible teaching recognized in retrospect" (p. 6). Fr. O'Donnell proceeds in chapter two to review basic principles concerning law and the obligations arising from it, certain "reflex principles" to be applied in doubtful matters, voluntariety, and the determinants of the moral act. In this section he dismisses briefly the "revisionist" (proportionalist) position that there can be no intrinsically evil moral act. Calling it a movement of the 1970's, O'Donnell does not seem to regard it as the contemporary issue it remains. Because of how pervasive this approach has become, especially on a popular level, a more thorough-going discussion of its tenets and attending weaknesses is warranted. He does provide a solid review of the principle of double effect, as well as principles for distinguishing formal and material cooperation and their application in a few specific cases. An important distinction is made in the third chapter on human life, namely, that human beings do not possess an "absolute prerogative" over human life, but only a "useful" one. We have the responsibility and right to wisely administer our lives, but always with the awareness that we do not "own" them. In an age where many seek to usurp the rights of God over human life - whether through abortion, euthanasia, physician-assisted suicide, cloning, etc. - this approach to stewardship of the gift oflife stands in prophetic contrast. O'Donnell requires that a crucial question be considered before any procedure, "Is the contemplated act one of ownership, or of wise stewardship?" (p. 47). In many cases this question alone will suffice. Yet he also deals thoroughly with the hard cases involving prolongation procedures in dealing with terminal illness by an excellent summary of classical and more contemporary views of what are ordinary and extraordinary means of sustaining life, and what are important considerations in deciding if and when to withdraw extraordinary measures. With respect to the question of the withdrawal of artificial nutrition and hydration from patients in terminal coma, O'Donnell recognizes that there is some divergence of opinion among Catholic theologians as to whether or not these means constitute ineffective and burdensome measures (criteria for withdrawal of treatment established by the Declaration on Euthanasia, Sacred Congregation for the Doctrine ofthe Faith, May 1980). Pending further clarification by the Vatican, O'Donnell argues, "in the case of clinically verified terminal coma, artificial nutrition and hydration can be discontinued because they have become clinically useless" (p. 72). While he does summarize the opposing position, O'Donnell would serve us better by also referencing contemporary writers (e.g. William May, et at., "Feeding and Hydrating the Permanently Unconscious and Other Vulnerable Persons," Issues in Law and Medicine 3 (1987) 203-210). The principle of stewardship is applied in chapter four to aspects of surgery and suppressive sugery. All procedures must respect the "immanent teleolgy of the body and its parts" (p. 75), and removal or suppression of various parts of the body may be performed only when it is necessary for the good of the whole. One note on this section is that might be more helpful to those trained in medicine rather than philosophy to better explain and substantiate what is meant by "immanent teleology." The principle oftotality is sufficient to handle most ethical problems, except in matters dealing with the generative system which is oriented not only to the good of the individual but also to potential others. In such situations the principle of double effect may need to be invoked to sort out whether the intended effect of a given procedure is therapeutic or contraceptive. Fr. O'Donnell applies these principles to a wide range of procedures including cosmetic surgery, vivisection, transsexual surgery, human experimentation, hypnotism, and psychosurgery. He devotes several pages to the question of treating uterine damage after multiple cesarean sections. In fairly careful terms he offers the opinion that there is solid probability that a tubal ligation intended to isolate the damaged uterus is a morally acceptable alternative to a therapeutically necessary hysterectomy. O'Donnell takes great pains to explain that such "uterine isolation" should not become a "morally acceptable semantic for various forms of clearly contraceptive sterilization" (p. 143). Yet it is the November, 1995 91 opinion of this reviewer that the distinction is too fine to stand up against the prevailing "contraceptive mentality" that pervades Western society. In consideration of the moral aspects of pregnancy and delivery in the fourth chapter, O'Donnell proposes the principle of the inviolability of human life as fundamental to sorting out many of the moral problems of obstetrics: while some treatments of certain complications may endanger the life of either mother or child, no direct attack may be made on the life of either to preserve the life of the other. In cases where the death of one may be the result of a measure to save the life of the other, there is no general answer to the question of which is to be preferred (mother or child). After a solid examination of the medical, moral and canonical aspe<:ts of abortion, there are briefer considerations of ectopic pregnancy, eclampsia, chorioamnionitis, ancephalism, hydatidiform mole, and treatment of the victims of rape. Fr. O'Donnell treats of the medical-canonical and medical-moral aspects of marriage in chapter six. He provides a very thorough analysis of the canonical impediment of impotence. O'Donnell bases his evaluation of family planning and fertility control primarily upon the papal documents Casti connubii and Humanae vitae, lending the physician a careful review of the moral aspects of various methods of fertility control, including the practice of periodic continence (a phrase he seems to prefer to "natural family planning"). He deals with the various methods to treat infertility by summarizing the 1987 Instruction on Respect for Life in its Origin and on the Dignity of Procreation issued by the Sacred Congregation for the Doctrine of the Faith (included in entirety in the appendix). He also deals with two methods not covered i.n that document, Low Tubal Ovum Transfer (LTOT) and Gamete Intra Fallopian Transfer (GIFT). While he notes certain indications that such procedures may actually serve as a substitute for the marital act rather than an aid to it, the reflex principle of probabilism and the fact that responsible and reliable Catholic theologians view them as probably acceptable leads O'Donnell to conclude that "they may be adopted in practice barring any statements by the Holy See" (p. 240). The main body of the book concludes with a chapter on professionalism in medicine. In addition to the observance of patient confidentiality and the general obligation to inform a patient of a negative diagnosis, O'Donnell raises what he sees as the growing problem of medical entrepeneurism. His response is that even the appearance of placing financial interest over that of the care of the patient, whether by unwarranted surgeries or kickbacks from medical supply companies, should have no place in the practice of Catholic health care providers. In addition to the above-mentioned Instruction on Respect for Life . . . the appendix includes several other Vatican declarations on sterilization in Catholic hospitals, tubal ligations, euthanasia, as well as Ethical and Religious Directives for Catholic Health Facilities (USSC, 1977). Medicine and Christian Morality is an excellent compendium of Catholic teaching on a wide range of medical moral issues. Fr. O'Donnell elucidates crucial principles for evaluating such problems and applies them with great consistency in his analyses. Some will no doubt have difficulty with the fact that a number of the references appear somewhat dated (some of the "modem" works quoted date to the I 940s), but O'Donnell has clearly attempted to bring much current material into the work. Of some concern to this reviewer is that the author perhaps assumes of his intended audience a stronger background in and greater docility toward Church teaching than may be the case. Given the overwhelmingly secular character of many of the medical schools in North America, one suspects that many even of Catholic health professionals do bring a thoroughly converted mind to sorting out moral problems. Many may require more than a brief presentation of Catholic teaching in order to understand the proper moral evaluation of many of the issues. In addition, a small suggestion for improvement of the work would be to include a glossary of certain terms,as well as a bibliography. Finally, O'Donnell's work should not only prove to be of use to medical personnel seeking the stance of the Church, but many who work in pastoral care of the sick should find it a ready reference for their ministry. 92 - Michael Byrnes Detroit, MI Linacre Quarterly 

[Book Review of] \u3cem\u3eEthics for Doctors, Nurses, and Patients\u3c/em\u3e, by H. P. Dunn and [Book Review of] Medicine and Christian Morality, by Thomas J. O\u27Donnell, S.J.

https://epublications.marquette.edu/cgi/viewcontent.cgi?article=2049&amp;context=lnq

[Book Review of] \u3cem\u3eEthics for Doctors, Nurses, and Patients\u3c/em\u3e, by H. P. Dunn and [Book Review of] Medicine and Christian Morality, by Thomas J. O\u27Donnell, S.J.

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