MO820CE Catholic Medical Morality and Ministry

Rationale

As a deacon, you will be asked to help parishioners grapple with emotionally charged medical issues.  This course will present fundamental Church principles relating to ethics and medical ethics that will assist you in these discussions.

Course Focus

This course studies the theology of the human body, personhood, and human dignity in protecting life from beginning to end and in treating illness.

This course will be of particular interest to deacons involved in hospital, nursing home, ministry to the aging, or other similar settings.

Included Topics

The following topics have been chosen for this course since they are the most difficult topics in the ministry of medical and health care. They include:

This course draws from the disciplines of

to emphasize the critical importance of ministering to the faithful as they seek to live moral and ethical lives.

·       Church documents

·       Current research

·       Practical pastoral experiences

in order to help Deacons adequately respond to the issues faced by today’s Christians.

·       Be familiar with the ethical principles of the Church that inform medical and health care morality.

o   Be cognizant of the ethical principles being employed by parishioners.

o   Logically guide parishioners through the thought process to arrive at a conclusion based on Church principles.

Diaconal Standards Presented During the Course

All of our course objectives are directly linked to the approved standards presented in the National Directory for the Formation, Ministry, and Life of the Permanent Deacons in the United States.

Paperback: 336 pages

Publisher: Our Sunday Visitor; 3rd edition (July 21, 2013)

Language: English

ISBN-10: 1612787029

ISBN-13: 978-1612787022

Link to subscribe to "Ethics and Medics" at the NCBC website.

You will be using this site for readings on a weekly basis.  Each reading is approximately two pages, and the ethical issues are timely. Your subscription will allow you access to the readings and will allow you to stay current on biomedical ethics for a year. You will discover what a wonderful site this is and how it will keep you informed and involved in an important area of ministry.

Upon completion of this module, you will be able to:

·      Clearly state basic moral principles.

·      Differentiate between basic moral principles and biomedical ethics.

Read about bioethics and theology and how they are related at http://www.christendom-awake.org/pages/may/bioethics&theology.htm

Why?

Try to keep your answer not more than 500 words.

Upon completion of this module, you will be able to:

·      Elaborate on the idea that family is the essence of medical morality.

·      Share with parishioners texts that illustrate families at the center of medical morality.

Participate in the Forum discussion on an ethical issue presented by one of your colleagues.

Assume for the moment that you live in a state where same gender marriage (or civil unions) are legal.  Adam and John (or Adelle and Jane) live together.  They are both Catholic, but not attending mass. You work with Adam (or Adelle).  You have never been invited to comment on their relationship or their homosexuality. But you have always treated them respectfully and graciously.

This afternoon, Adam (or Adelle) stopped by you office and asked if you would perform a marriage ceremony for them.

Respond based upon what you have read in the course.

Forum 2:

Initial impressions on bioethics? The course? Relevance to diaconal ministry?

Upon completion of this module, you will be able to:

·      Assist parishioners with the ethical issues surrounding procreation.

·      Suggest medical practitioners who can assist parishioners with procreation concerns.

Field work – Identify medical practitioners who can assist parishioners with procreation issues, and post your findings to the Forum. Did you have an easy or hard time finding these practitioners? Where their numbers few or large?

Forum - What is your response to the 12th General Assembly's position on human embryos? Is there a difference between theory and practice?

Forum – Participate in the case presented by one of your colleagues.

Your response.

Upon completion of this module, you will be able to:

·      Assist parishioners who are experiencing fetal abnormalities.

·      Identify the flawed logic regarding stages of fetal development and soul creation.

Stem Cells – Answers (in March 2003).

Read pages 159-197 in Catholic Bioethics and the Gift of Human Life 3rd Edition by William E. May.

Continue participation in the Forum discussion begun last week about the directives that came out of the 12th General Assembly. Did the readings, included in the module, alter your impressions?

Participate in the Forum case discussion presented by one of your colleagues.

One Wednesday night you came into the hospital to bring a communion to several patients and bump into Ben.  He looks a bit tearful.  He explains that Becky passed out at work; when they got her to the hospital, they discovered that she had a ruptured tubal pregnancy. They operated, and she is doing well. But the pregnancy was lost, and she lost a Fallopian tube. He is a little macho and says, "It's not like it was a real baby!"

Respond to his comment, being careful to be gentle and compassionate, but instructive..

Upon completion of this module, you will be able to:

·      Respond to parishioners’ questions regarding artificial contraception.

·      Diffuse illogical notions regarding the spiritual impacts of artificial contraception.

Read pages 127-156 in Catholic Bioethics and the Gift of Human Life 2nd Edition by William E. May.

Participate in the Forum discussion about the principles of totality and double effect. Where could confusion arise? Why are both principles needed for biomedical ethics?

Participate in the Forum case presented by one of your colleagues.

There is no Forum assignment for this module, please look at the assignment for Module 6 in which you will be asked to write an essay on either of two topics.

Use this time to start thinking about the topics and organizing your thoughts.

Upon completion of this module, you will be able to:

·       Discuss the moral positions presented in the principles of totality and double effect.

·       Apply the principle of double effect to issues of life and sexual issues.

Participate in the Chat Room to discuss these moral issues – locate a current news article that exemplifies some of these “thorny” issues, email a copy of the article or send the internet address to the other members of the class so they read several (3) before the chat. Be prepared to lead the discussion on your article and participate in the discussion of two others.

Participate in the Forum case presented by one of your colleagues.

1. Discuss and defend the Church's teaching on contraception. Consider how, in a pastoral situation, you might speak with a couple that is struggling with this issue. Give them some helpful suggestions.

-OR-

2. Examine the question of abortion.  Consider a "hardship" case. Apply the Church's teaching to the particular case.  Make sure to address the pastoral dimensions of the case,

Upon completion of this module, you will be able to:

·      Respond to parishioners’ questions regarding pregnancy and delivery biomedical ethics’ concerns.

·      Comfortably guide parishioners through the distinctions between direct and indirect causation.

Read and consider from Ethics and Medics, Anencephaly and Survivability from November 1993, Human Nature and the Anencephalic Infant from January 1997 and Reply to Ford from January 2004.

Read and consider from Ethics and Medics, Induced Delivery and Fetal Anomalies from December 2000 and Case Against premature Induction from May 2004.

Discuss in the Forum the importance of choosing an OB-GYN who will support your values rather than finding out when there is an emergency and a difference of values.

Respond to the Forum scenario presented and suggest some alternatives to two of your colleagues’ suggestions.

Brad's wife, Julie, is nearly 24 weeks pregnant but critically ill with H1N1 influenza. She came down with symptoms of the flu three days ago and has been getting worse. She is unconscious and her condition has been worsening.  The doctors have told Brad that they VERY strongly recommend that they perform a C-section delivery.  There is risk to both Julie and to the baby.

Julie will probably survive the surgery, but they do not know for sure what her progress will be in fighting the H1N1 flu.  Not operating will she will continue to fight but the baby will continue to put physiological burden on her.  They want to operate on her tonight because of the progression of her disease.

The doctors say that in theory and in practice, there is moderate  hope of the baby surviving in a neonatal ICU.  At this point, they usually they consider 24 weeks  to be the point at which the baby stands a reasonable chance of survival. They can have the helicopter from the Regional Medical Center here when they are operating, along with a flight nurse trained in neonatal intensive care.  The baby will be stabilized before departure.  The doctors believe that the baby stands a good chance of making it to the NICU at the medical center - particularly with the helicopter ride being only 17 minutes. They will have the baby connected to monitors that are connected to the NICU at the medical center.  The baby will be monitored by them from before the baby leaves the operating room.

The doctors believe that Julie is not a good risk to transport. The doctors have told Brad that the odds of Julie surviving without the C-section are rather low, and getting lower by the minute.

You know that NICU care is extremely expensive; but you also know that Brad is independently wealthy.  So financial burden is not an issue.

Brad says to you, "I really want them both to make it. But I don't want to do anything that will kill the baby. I have to be certain that this is not doing anything immoral."

Help Brad work through the moral dilemma.. He is inquisitive, so give him sound moral reasoning. But do so quickly since the medical staff needs a decision.

Upon completion of this module, you will be able to:

·      Support parishioners as they confront surgical decisions for their family.

Read and consider from Catholic Bioethics and the Gift of Human Life - 2nd Edition by William E. May, pages 315 - 356.

Read about the ethical issues that surround organ and tissue donation from  http://www.wf-f.org/05-1-OrganDonation.html

Discuss on the Forum the religious concerns as technologies continue to broaden medical possibilities - just because we can, should we?

Respond to the Forum scenario presented and suggest some alternatives to two of your colleagues’ suggestions.

Ron was recently divorced.  He explains that he has suffered terribly on a psychological level for years.  His marriage ended when he acknowledged to his wife that he had always known that he was "a woman in a man's body and wanted to undergo gender reassignment surgery."

He said that this has been bothering him for years. He has "dealt with it in therapy and now is the time to act."

He says, "You have always been sensitive and helpful to me; you have always been honest with me; so I want to have your blessing on this before going ahead."

How do you respond bearing in mind both the moral and pastoral dimensions of the problem.

Upon completion of this module, you will be able to:

·      Discuss the moral and ethical ramifications of medical experimentation with parishioners.

Read what the Bishops have written about the patient - professional relationship from http://www.usccb.org/bishops/directives.shtml#partthree

Read what the Bishops have written about genetic testing from  http://www.usccb.org/shv/testing.htm

Discuss on the Forum the concerns and implications of animal organ transplantations.

Respond to the Forum scenario presented and suggest some alternatives to two of your colleagues’ suggestions.

The Emergency Room physician determined that he had broken two vertebrae.  The neurosurgeon determined that the break had done a great deal of damage to the spinal cord and that damage could not be repaired.  Jack would be a paraplegic.

Since Jill is the medical librarian at the medical center, and since Jack is medical student, they began doing an extensive literature search to find out what treatments are out there worldwide.  Jill finds a reference to group in a foreign country that is doing adult neural stem cell treatments on an experimental basis.

The protocol is pretty straightforward:  The surgeon obtains cells from the olfactory bulb which can be accessed through the nasal passages.  The stem cells are from the patient's own body, so there is no risk of rejection. The stem cells are grown out in culture dishes and then inserted into the spinal cord.

This is still experimental, but preliminary results seem to be positive.  It has not been approved by the US Food and Drug Administration.  Nor has it been sanctioned by any of the medical societies.

There are risks with both the process of collecting the stem cells and with the insertion of the cells into the spinal cord. Potential risks include menigitis, septicemia and any number of other problems in the spine, as well as death.

Jack and Jill want your blessing before leaving for the foreign country. And they want to make sure that there are not moral objections to proceeding.

How do you respond on the moral issues?  Are there pastoral issues that also surface that you address as well?

Upon completion of this module, you will be able to:

Advise parishioners as end of life issues are discussed and considered.

Read and consider from Ethics and Medics, Killing vs. Allowing to Die from March 2005

Read the appropriate readings as noted.

Participate in the Forum discussion on vitalism - what is it, why is it an important ethical principle?

Respond to the Forum scenario presented and suggest some alternatives to two of your colleagues’ suggestions.

After mass about 8 weeks ago, they mentioned that Ed was having a lot of aches and pains, and that he wasn't feeling well in general. You ask whether he has seen the doctor; Ed replies, "Oh! They don't know what they're doing half the time!"

Then about a week later, Ed stumbled when he was out walking his dog; as he started to get up, he realized that he had probably broken his leg.  When he got to the ER they did the X-rays to visualize the suspected break. They then began doing a lot of additional tests because something did not look right on the X-rays.

Long story short: Ed has metastatic cancer in several bones and is not expected to live very long.

He wants to talk with you. He already realizes that bone cancer is pretty painful. The doctors are able to control his pain reasonably well. But he fears it getting a lot worse.  He says that if it does get to the point that he can't stand it, he wants to know "whether it is OK to just get enough pain medicine to end it all?  Sometimes I think we treat our dogs better than we treat our folks suffering from cancer."

How do you respond, taking into account both the ethical issues and the pastoral issues?

Upon completion of this module, you will be able to

·      Guide parishioners as they grapple with life and death issues

Read and consider from Ethics and Medics, Papal Address on Food and Water from June 2004 and Thoughts on the Papal Address, from February 2005

Go back and review Catholic Bioethics and the Gift of Human Life - 3rd Edition by William E. May pages 251 - 288.

Read and consider from Ethics and Medics, On Vegetative Human Beings in January 2005, Caring for the Unconscious in July 2005, and End of Life Care of John Paul II in November 2005.

Respond to the forum scenario presented and suggest some alternatives to two of your colleagues’ suggestions.

The assignment will require you to choose either of two questions and writing an essay in response.

Upon completion of this module, you will be able to:

·      Assist parishioners who face issues surrounding material and formal cooperation in both their daily and business lives

Read and consider from Ethics and Medics, Formal and Material Cooperation in June 1995 and Reexamining the ERDs on Cooperation in May 2001.

Read and consider from Ethics and Medics, The Nebraska Fetal Tissue Case in January 2001.

Read and consider from Ethics and Medics, Politics, Abortion and Communion in January 2006.

Read and consider from Ethics and Medics, Statement on problematic Vaccines in December 2005.

Read what the Bishops have written about new partnerships that have emerged from http://www.usccb.org/bishops/directives.shtml#partsix

Read the appropriate readings as noted.

Participate in the Forum discussion on how close a person can get to "evil" before they are also responsible for that evil. Can you really be an innocent bystander?

Respond to the Forum scenario presented and suggest some alternatives to two of your colleagues’ suggestions.

Complete the course survey.

1.     Based upon your study in this course, examine Catholic Bioethics as an integrated whole. What elements stand out as being issues that you can actively engage in your preaching, teaching or counseling of those to whom you minister?  What challenges do anticipate in working with people on these issues?

OR

2.     Select one topic or bioethics dilemma.. Examine it in depth. Discuss its importance as the topic might emerge in diaconate ministry. (Your need not limit your discussion to your own present ministry; deacons have varied ministries which can shift over time.)