By Paula Day

Sister Joanne Lappetito, RSM, an ethicist on the staff of St. Joseph’s Hospital in Atlanta, recently presented a series of workshops explaining Georgia’s Durable Power of Attorney for Health Care.

A moral theologian, Sister Lappetito has completed her studies and is a candidate for an STL, a licentiate in sacred theology, from the Jesuit Theologate in Cambridge, Mass. There she had access to the Boston theological consortium, made up of Boston University, Boston College, Harvard, and Weston School of Theology.

The following interview is an effort to inform readers about the Church’s guidance regarding health care decisions.

A. What is your role as an ethicist in the Catholic Church?

A. My role is to be clear in presenting the teaching and promoting the Roman Catholic position on moral issues. These include not only medical and sexual ethics, but social ethics as well.

We must remember moral theology is a derivative body of knowledge, that is, it has its groundings for applying ethical principles in Sacred Scripture, Tradition and ecclesiology.

Q. What would be the underlying principle for the Church’s teachings in the area of social ethics?

A. At the heart of our faith are the very words and deeds of Jesus. When we look at Jesus’ life we notice His love of God that compelled Him to do the work of charity and justice. While we make positive statements about the life of Jesus, moral theology breaks this down to principles that can be applied as guidelines in concrete human situations. The most central value that is upheld is the dignity of the human persons. Persons have value in and of themselves, but, more importantly, persons have value because of their relationship with God by virtue of the gift of creation and baptism. Social ethics addresses questions of rights and responsibilities in relationship to other members of society.

Q. Recently the U.S. Congress passed the federal Patient Self-Determination Act. What does this law require?

A. Federal law has mandated each state set its own standards for providing “clear and convincing evidence” of a person’s wishes for medical treatment if and when that person should become incapacitated and cannot make known his or her wishes for medical treatment. Flowing from that, a majority of states have laws for advance directives (laws that allow patients to document their health care directives before they become incapacitated).

Q. Is there any contradiction between the Church’s position and the Patient Self-Determination Act?

A. A person’s moral right pre-exist constitutional and state’s rights. With that said, there is no contradiction. The Church has a 400-year-old tradition of medical ethics that has been developed and refined to keep up with developments in medical technology. Other theological traditions have accepted and use Catholic tradition in medical ethics. Catholic tradition is an integral part of the accepted standard.

Because the human person is free, the Church has always upheld the value of patient autonomy, which means a person has the right to choose medical treatment. But the Church also provides guidelines and teachings instructing the patient on how to make those decisions. Besides the tradition of the moral principles of patient autonomy and patient beneficence, (doing what is most beneficial to the patient) the Church also offers contemporary documents such as the 1980 “Declaration on Euthanasia,” and the 1987 “Respect for Human Life in Its Origins and on The Dignity of Procreation,” published by the Sacred Congregation for the Doctrine of the Faith.

B. Are there any moral limitations to a person’s right to choose medical treatment?

A. The basic limitation is the realization that life is a gift and therefore we are to be good stewards of it. This prevents us, according to our faith, from taking our life. I’d like to make a distinction here. Life is a gift and a very important value, but it is not an absolute value. Only God is an absolute value and there are other transcendent values that the Church holds as very important, for example, charity and justice. This theological context provides the justification for martyrdom and the redemptive death of Jesus.

Q. What does the Church say about the obligation to preserve life?

A. While life is very important and we are to be good stewards, the point of life is to return to God. The Church provides guidelines on when it’s “reasonable and appropriate” to withhold or withdraw life-sustaining treatment. It is my opinion that under certain circumstances, medical technology no longer sustains life but forestalls death. Under those conditions the Church’s traditional guidelines are very helpful in determining when treatment is burdensome to the patient rather than beneficial.

Q. Is there a distinction between taking one’s own life and directing another person not to provide life-sustaining medical care in case of one’s incapacitation?

A. Taking one’s life deliberately is a contradiction to the stewardship of nurturing the gift of life. It is a very deliberate, proactive step. Letting a person die under some circumstances where medical intervention is deemed ineffective is simply letting nature take its own course. The Church has always taught in the past that one does not have to use extraordinary means to save one’s life.

Q. How can a person make a directive today and be certain that it is ethical tomorrow?

A. First, it must be understood that an advance directive is a legal document which has ethical and medical components. It gives instruction based on one’s medical condition, hopefully with input from one’s physician, directing health care providers as to what treatment one desires based on the principle of beneficence. A 21-year-old window washer and a 65-year-old coronary artery disease patient would give different instructions.

Q. What is the distinction between euthanasia, which the Church opposes, and withholding various forms of treatment the result of which will hasten a person’s death?

A. The intention of euthanasia is to bring about death. When life-sustaining treatment is removed because it is futile, the intention is not the death of the patient. The death of the patient is an indirect result of withholding or withdrawing treatment. The patient’s pathology is the immediate cause of death. It is Catholic teaching that when medical technology can no longer provide health then we allow the person to go back to our Creator. Our goal is compassionate and graceful death.

Q. How can a person educate oneself about the Church’s teachings in these matters?

A. Attend adult education courses. Ask the pastor to make programs available. These issues affect people in their 40s and 50s who have aging parents. This is not a subject for the senior community only. I somewhat humorously suggest that a Durable Power of Attorney for Health Care should be attached to every motorcycle registration form. Anyone in a high-risk occupation – construction workers, window washers, high-risk sports – should be informed about advance directives documents.

Q. Has the Church offered any directives or guidelines regarding the use of funds for high-tech medical care vis-à-vis the use of funds for improving the health care of the poor in this country or abroad?

A. The Church, because it is universal, will not get into specific details on individual issues. But, from the perspective of social ethics, the Church will uphold the value of the person, the person’s rights and responsibilities in relation to the common good.

Here in the United States we have so many medical resources by comparison on Third World countries. When I was in Belize, Central America, I visited a small hospital where they have to put two patients in a bed, something that would never happen here in the states. Here, the Church will address the issue of access to health care by saying there are 37 million persons without health insurance and who have no access to health care. The U.S. bishops’ conference is currently drafting new guidelines on health care. The Catholic Hospital Association is providing a plan for health care reform that addresses these issues.

The Georgia Hospital Association puts the number of uninsured Georgians at one million. Of the 50 states, we have the highest rate of infant death, a rate comparable to some Third World countries. So the Church here will try to create awareness about this problem and advocate that these people are entitled to health care if they are to achieve any decent standard of living.

C. Is there a place in all of this for reliance on God and his healing power?

A. I think the starting point for those of us who are Roman Catholic is our faith and trust in God, and that we pray to be open to discover what God’s will is for us. That, while we may pray for healing and would certainly hope for that, we also discern through prayer how to use the medical gifts God has given us. I don’t want to put the onus of healing on God as a demand. Nor do I want to shrink my responsibility to steward the gift of life. The process is one of prayerful discernment between God and the person.

(Sister Lappetito has been invited to give presentations in several parishes regarding health care ethics. St. Joseph’s Hospital offers adult education sessions in this area. The Catholic Health Association of the United States has prepared two pamphlets, “Advice on Advance Directives,’ and “Durable Power of Attorney for Health Care.” These may be obtained for $50 a piece for the first 10 by sending a self-addressed, stamped #10 envelope to: The Catholic Health Association of the U.S., 4455 Woodson Road, St. Louis, Mo. 63134.)