This article appears in the May 2002 edition of the Catholic Medical Quarterly
Is There a Catholic Medical Ethic?
Is there a distinct Catholic medical ethic? The short answer is no! Medical ethics are rules of conduct for physicians and, in an extended sense, for patients as well. They have been distilled from human experience since the beginning of recorded history, and can be identified in Western (including Jewish and Moslem) medicine, as well as in the Hindu and Buddhist medical traditions.
Medical ethics as rules of conduct are extrapolations of the understanding that human health results from the human body and mind s natural tendency toward "wholeness." Sickness is the disruption of this inclination. Society has always designated certain individuals as healers or physicians. Initially, healers shared some of the functions of priests; however, by the time of Greek medicine, their art was based on observation and experience, not on the supernatural.
Throughout the millennia medicine has traditionally involved the attempt of physicians and patients to conform to what is natural, or to wholeness, or health. The period of the Enlightenment, which strove to control and dominate nature, did not substantially alter the traditional orientation of medicine to nature. Physicians remained humble in the face of human disease and frailty. This was true until at least the last half of the twentieth century.
The medical profession, as well as society as a whole, has recognized the uniqueness of the art of medicine and has, therefore, traditionally set standards for learning and conduct. The professionalization of medicine has resulted in oaths which in general are covenants between the physician, patients and society. While there has been an element of self-interest in professionalization, its principal intent is to promote the healing that a physician can provide his or her patient.
The prototype of medical oaths governing the con duct of physicians is the Hippocratic Oath, attributed to Hippocrates (430-377 BC). It is remarkable how similar the Moslem, Hindu and Chinese medical oaths are to the Hippocratic Oath. There are four elements to the Oath. First, it is a covenant, or formal (usually witnessed to by a higher power) agreement between the physician, the patient and society. Second, and most importantly, it admonishes the physician not to harm. This has universally resulted in great reverence for life and nature and their corollaries, such as the self-evident prohibitions against direct killing (e.g., abortion, euthanasia). Third, physicians are to respect patients and their families. Finally, the medical profession is to maintain its standards, as it conveys its traditions to future physicians.
The Christian community of the West grew in a Roman environment where physicians inherited the medical ethics of the Hippocratic tradition. Al though medicine was without the current scientific understanding of pathophysiology and pharmacology, the physician was often able to benefit the patient with his experience in managing the relief of symptoms, in restoring homeostasis or health (where possible) and, finally, in always providing comfort. As order and stability declined in the Roman Empire, medical and spiritual care was maintained by the monasteries and was especially delivered to the poor and outcasts, such as lepers.
Prior to the Enlightenment medical schools had been founded in Salerno (11th century AD) and Bologna (13th century AD), and a more scientific approach to anatomy and disease was fostered. It should be noted that the Moslem world also developed centres of medical learning; yet the aforementioned Hippocratic ethic prevailed in all of these centres.
While the Enlightenment introduced a scientific understanding of chemistry and physiology, the actual practice of medicine continued to include such backward practices as purging and leeches from the 18th century through the early 20th century.
Medical ethics remained within the purview of physicians and was essentially Hippocratic; There was not a unique Catholic medical ethic. However, with the rapid establishment of Catholic hospitals in the latter portion of the 19th century, ethical guide lines (otherwise known as the Ethical and Religious Directives)1 were developed, primarily in the field of reproductive medicine and, particularly, in the areas of abortion and contraception. In general, these guidelines conformed to the Hippocratic tradition and were accepted by all staff physicians. Although codified in Catholic Hospitals, these guide lines were considered Hippocratic and followed by practically all practitioners. Books by identifiably Catholic authors such as Kelly,2 Kenny,3 and McFadden4 explicated these guidelines.
In answer to the original question set forth, there was a medical ethic that was Hippocratic, but not uniquely Catholic. It was subscribed to by practically all physicians in all cultures. It prohibited doing harm to the patient, promoted the sanctity of life and emphasized the value of conforming to nature when treating patients.
However, medicine has changed. The past tense was used deliberately in the previous paragraph. A fundamental transition occurred during the last fifty years. There are currently two medical ethics: 1)the Hippocratic ethic (to which the Catholic health tradition, as well as most others, subscribe) and 2) for want of a better word, a "bioethic." The former continues the traditional medical ethical tradition of Greek medicine, its descendants (Jewish, Christian and Moslem), as well as the medical philosophies of the great Hindu and Chinese cultures.
Bioethics, while its utilitarian origins date back to the Enlightenment, could reasonably be said to have begun with the Belmont Report.5 This report articulated the tenets of principalism,6 the regnant ethic of contemporary culture. Bioethical decisions were made after applying the norms of beneficence, non maleficence and social justice. Later, autonomy was incorporated: it has since become the defining norm of current bioethics.
Medical ethics and bioethics are fundamentally different. The Hippocratic tradition is a personal relationship between physician and patient whose purpose is to restore health or nature�s tendency to wholeness. Bioethics, however, is the impersonal relationship between an autonomous individual and the healthcare system. The Belmont Report criteria responded to the government�s need to have guidelines (e.g., autonomy) that were non controversial and that conformed to the relativism of the Zeitgeist. Hippocratic ethics is based on a realist philosophy. Nature provides norms that are exceptionless; a physician must attempt to heal, not deliberately kill. Life is sacred! Contemporary culture is guided by an utilitarian ethic.7 If the quality of a person�s life is deemed substandard, euthanasia may be indicated. Partial birth abortion killing is constitutionally protected!
Inasmuch as these two ethics are incompatible, the medical community is divided. More recent ethical codes such as the Geneva Convention,8 the Declaration of Helsinki9 and the AMA ethical code,10 all drift further from the Hippocratic Code. The fact that most medical school graduations employ oaths (or for those troubled by oaths, pledges), other than the Hippocratic suggests that there are significant differences in contemporary medical ethics.
Given this discussion, the answer to the original question remains "no." There is not a distinct Catholic medical ethic. There is a single medical ethic, Hippocratic. There is also a parallel ethical system, known as "bioethics" which is utilitarian. Unlike the latter, the guiding principal of the former is "primum non nocere."
As a final thought, it is interesting to note that despite efforts to promote abortion and euthanasia, there appears to be public resistance to open-ended cloning and stem cell research.11
Let us hope and pray that the utilitarian incursion into medical ethics may have peaked and that there will be a return to an ethics of nature, that of the Hippocratic tradition.
Ethical and Religious Directives: United States Catholic Conference, Washington, DC 1995.
Kelly, Gerald: Medical, Moral Problems. Catholic Hospital Association, St. Louis, 1958.
Kenny, John: Principles of Medical Ethics. Newman, Westminster MD, 1952.
McFadden, Charles J: Medical Ethics, 6th Ed. Davis, Phil., 1961.
Belmont Report: US National Commission for the Protection of Human Subjects. US GPO, 1978.
Beauchamp, Tom and Childress, James: Principles of Biomedical Ethics, Oxford University Press, New York, 1979.
Singer, Peter: Practical Ethics. Cambridge University Press, London, 1985.
The Geneva Conventions of 1949. In Human Rights Documents: Compilation of Documents Pertaining to Human Rights. pp 325-461, Washington DC U.S. Government Printing Office, 1983.
World Medical Association, Declaration of He!sinki. Bulletin of the Pan American Health Organization, 24, No.4, 606-609,1970.
Code of Medical Ethics, American Medical Association, 2000.
Gorner, Peter, Kolulak, Ronald: Passions of the heart collide with reasons of the mind in debates over human cloning. Chicago Tribune, Perspectives Section, page 11, December 9, 2001.
Dr. Patrick Guinan, MD is President of the Catholic Physicians Guild of Chicago.