Should Catholic hospitals ration care to the elderly and disabled?
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On Sunday, March 29, 2020, the Fifth Sunday of Lent, I offer this statement concerning the "Statement on Scarce Healthcare Resources" issued by the Texas Conference of Catholic Bishops" on March 27, 2020. I offer it out of prayer and with a sincere heart. I appreciate the effort of my brother Bishops in Texas to apply sound bioethical principles, as well as their concern that health care professionals are not held to an impossible standard in these challenging times.
Hospitals are having to improvise as more patients arrive than they can handle.
It is highly unusual for a bishop not to join his fellow bishops in such a statement. I want to explain my reasoning behind my difficult decision.
In the process of discerning whether I should sign the statement of the TCCB, I consulted with health care experts from the Catholic hospitals in my Diocese. They explained to me the use of a S.O.F.A (Sequential Organ Failure Assessment) if mass critical care exigencies arose. I was assured that age and the presence of a disability would not be considered.
On Saturday, March 28, 2020, the Office for Civil Rights of the Federal Office of Health and Human Services issued guidance to health care providers directing them not to ration health care based upon age or disability. Roger Severino, the Director of the Office for Civil Rights said "We're concerned that crisis standards of care may start relying on value judgments as to the relative worth of one human being versus another, based on the presence or absence of disability... We're concerned that stereotypes about what life is like living with a disability can be improperly used to exclude people from needed care."
The statement of the TCCB honors the above principles and insists that, although triage may be necessary, sound bioethical principles based on reverence for life and respect for the dignity of the lives of all, must govern decisions involving scarce medical resources. I do not fault the statement in that respect.
My major concern is with the support given for "waiving regulations and statutes which could result in fines, civil liability, and even criminal charges for decisions related to the allocation of resources during this declared disaster. Healthcare workers who sacrificially risk their own safety to save their patients' lives should not have to fear punitive action for making the best possible decisions in extremely difficult situations."
This statement of the TCCB, while flowing from a laudable concern for the difficult challenges faced by health care professionals in respect to limited resources, fails to show a due regard for the importance of law and amounts to asking Governor Abbot to abandon the excellent laws he has helped put in place to protect the vulnerable.
The fact is that waiving law can do more to benefit lawbreakers and the unscrupulous than good people. As generous and sacrificing as are most health care professionals, sadly, their ranks can include corrupt individuals, as does every profession. For instance, some health care workers may give preference to family, friends and the rich in the allocation of resources, rather than serve the real common good and take care to be fair to all in need. There may be others who allow prejudice and animus against certain ethnic groups, the disabled, the elderly or followers of various religions, for instance, to govern their decisions rather than to be guided by respect for the equality of all. These bad actors (who are vastly in the minority) give our excellent medical personnel a bad name and lead to fear and distrust of all those in the medical profession.
Sound laws lead institutions to put the proper safeguards in place and motivate them to act within the proper parameters. Good laws prompt health care institutions to formulate just policies and to ensure that their staff understand and abide by the policies.
Good laws protect honorable health care workers and serve to ensure the integrity of their profession as well as ensuring the rights of the ill, vulnerable, poor, and marginalized.
It is undeniably difficult to make the right decision in life and death situations when resources are limited. Fortunately, and rightly, the law itself has a degree of flexibility in it that enables judges to be prudent and take into account factors that may lead to questionable decisions not motivated by malice of any kind but rather by misguided compassion. Judges, juries, and the public must be understanding and give the benefit of the doubt to health care workers. But to suspend the law altogether is to remove a major incentive for ensuring that due diligence is exercised in difficult times and puts the ill, vulnerable, poor, and marginalized at risk.
Do I think that the principles I articulate are important only to the people of Tyler and not beyond? No, but my primary responsibility is to guide the people of the Diocese of Tyler. I do hope, however, that we Texans can come together and support laws and applications of laws that ensure fair treatment of everyone, patients and health care workers alike.
But laws are not our only or best guide to moral decision-making. There are essential principles of Catholic Moral Teaching which must always be applied. For example, the family should always be consulted and considered in making vital moral decisions such as these. The elderly, the disabled and the most vulnerable should always be protected and shown a love of preference or what is also called a "preferential option" because they are the poor in our midst, during this pandemic. The social ordering principle of subsidiarity must be applied. In short, a "one size fits all" approach does not fully recognize the need to attend to the needs of particular people. Most importantly, as the TCCB statement asserts, "Guidelines should reject rationing of healthcare resources based solely on age, disability, or future "quality of life" decisions."
For Healthcare workers, family members and proxies confused about what is the right decision in difficult cases involving rationing resources, this article, entitled "The Coronavirus Pandemic and the Ethics of Triage" explains the Church's principles well and I recommend it to you. The modern tendency to speak of the "quality of life", flies in the face of the Truth that God has revealed to us that all life is sacred. We must always be guided by the principles of justice and of love. And we must throw ourselves upon the mercy of God when we fail to live up to the demands of justice and love.
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