An Introduction to the Irish Bishops’
Code of Ethical Standards for Healthcare
The first thing that needs to be said about The Code of Ethical Standards for Healthcare, a publication of the Consultative Group on Bioethics and the Council for Healthcare of the Irish Bishops’ Conference, is that it is a fantastic resource. It deserves wide readership. It rewards close study. As a presentation on a range of topics that are often, if regrettably, shrouded in technically forbidding language, it is both accessible and scholarly.
As the preface outlines, the Code is offered not only as a crucial resource for the Church’s mission in healthcare, but also as an act of service to all people of goodwill who work within the various spheres of the medical and pastoral care of the human person. This point underscores the document’s clear concern to articulate an authentically Catholic yet collaborative vision, whereby the good of the person, and not merely the ‘catholic patient,’ is front and centre in the delivery of healthcare services. As people rooted in faith, we can accept the coincidence of such ends as a given. The Code offers a rigorous, joyful and positive defence of this principle.
The purpose of this article is not to provide an analysis or an assessment of each topic covered in the component parts and sections, but rather to provide a general commentary and overview that reaffirms the nuanced richness of the Catholic ethical tradition and the breadth of vision that the Code contains.
In terms of format, the document is in two parts. Part 1 is given over to a brief but illuminating outline of the basic, foundational principles underpinning the practice of healthcare in the Catholic tradition. Part 2, which makes up the bulk of the document, then elucidates how these principles are applied to specific issues right across the spectrum, ranging from the role of the family in decision-making, to pre-natal interventions, the importance of chaplaincy, and on to end-of-life care and co-operation with the state.
With respect to the basic principles, a central place is reserved for emphasising the relational, anthropological and creation perspectives within which Catholic healthcare operates. The Code achieves this by drawing out the implications of a very simple question: who are we? Are we as individual people simply a collection of matter requiring medical intervention and care from time to time, or does the fact of our existence itself point to the giftedness of our beings as embodied creatures?
The Code is clear that within the Catholic ethical tradition, the status of the human being is directly related to the mystery of creation. Indeed, the truth that human beings are created in the image and likeness of God (imago Dei) is at the heart of Christian revelation. This theological anthropology, initially given to us in the Genesis account of creation (1:26f) and definitively in the Incarnation of Jesus Christ, is a normative assertion of the Christian faith, with powerful implications for ethical practice and the pursuit of justice in the healthcare arena.
The Code is clear that this yields the prophetic claim that unconditional respect is due to the human being (regardless of the position she or he holds regarding their origin from the Creator, the Lord and Giver of Life). A justice-orientated corollary of this point is that the human being, because he or she is made in the image of God, cannot be made ‘subservient to any this-worldly system or finality. Indeed it is for the sake of Trinitarian communion that human persons are created in the divine image.’
To paraphrase a line from Donum Vitae, these fundamental principles are placed at the heart of Part 1 in order to clarify and help resolve the moral problems raised by interventions on life, as it originates and as it develops through time. That journey through time will inevitably be confronted with the reality of suffering and it is here that the Code reaffirms the importance of solidarity as an accompanying of, and a presence for, the individual and families concerned. Chaplaincy, as a vital charism manifesting solidarity and as a Ministry that can sensitively accentuate the redemptive possibilities at work, is also addressed.
It was noted above how the faith-informed vision of the human person has considerable practical implications. Part 2 demonstrates this point with unyielding clarity in terms of the range and complexity of the human dilemmas and opportunities Catholic healthcare is confronted with on a daily basis. Here also, we are returned once again to the deceptively simple but inherently dynamic question: who are we?
With respect to the principle of embodiment, acknowledgement is given to the centrality and importance of human sexuality. The Code frames and robustly defends this in the language of ‘nuptial significance,’ and the ‘given-ness’ of male and female, as the normative sexual categories of the human person. This in turn reasserts the Catholic anthropological vision in the face of a determined and sustained cultural movement that rejects it out of hand.
The Code also situates the issues surrounding abortion, biomedical interventions on human reproduction, surrogacy and gender realignment within an environment of moral calculation that must always give due recognition to the ‘ends’ knitted into the fibre of our being by the Creator. It considers the preservation of human life, the prohibition of practices that diminish human dignity and the avoidance of surgical interventions that threaten the physical integrity of the body without legitimate cause.
In this context, space is also given to a consideration of human freedom and the challenges that present themselves when medical practitioners or families find themselves in a space where different values appear to be in tension. The Code is at pains to make it clear, however, that regardless of the ’negative’ ethical evaluation that may be made of any specific medical or surgical intervention, a parallel approach rooted in respect, truthfulness, Christian love and generosity must also take place. No other stance toward the person is permissible in Catholic healthcare, regardless of the choices that have been made.
That respect for the human being must be a permanent, enduring quality is seen in the Code’s reflections on end-of-life care and the treatment of the elderly. It locates this discussion within the fundamental Catholic insight that dignity for the person is neither dependent on, nor qualified by, function or capacity. As such, Catholic healthcare must avoid the reductionist temptation that equates economic value with existential value.
The later sections of Part 2 are given over to a highly informative outline on the ethical use of medical knowledge and the parameters within which the increase of such knowledge must confine itself. Medical knowledge is a vital human good, but its pursuit is not self-legitimising. As an action, it must give way to the priority of those ethical principles which shield the human person from being reduced to experimental material.
The Code ends with a section on healthcare institutions. There is no doubt that the principles and ethical vision outlined here will take centre stage in the coming months and years. The centrality of ethos as a de facto form of institutional conscience is considered paramount, as are the duties and requirements to protect the integrity of Catholic healthcare facilities when they may be mandated by positive law to participate in, or cooperate with, objectively unethical practices.
Here, at the very end, we face yet again the implications of that little question: who are we? For Catholic healthcare workers it is a question of identity. Whose image will we reflect back to the world? Will it be that of the Lord, the Giver of Life, and the Divine Physician? Or will it be the arbitrary, culturally-constructed mask of a system within which the human person is denied even the right to life under the guise of ‘healthcare’?
On this question and many more, the Code of Ethical Standards has much to teach us.
David Mullins is a Bioethics Commentator and a former postgraduate student of St Patrick’s Pontifical University. He has a special interest in the application of Christian ethics to emerging technologies.