Catholics find themselves involved in some surprisingly arcane discussions of ethics and medical care these days. Some of the topics are both obvious and ominous. Others are less obvious but equally important. All are worth keeping an eye on. From my perch as a physician-lawyer turned bioethicist, here are my “top five” issues in bioethics to pay attention to in the coming year.
- End-of-life care, euthanasia and so-called “medical aid in dying.” End-of-life care is always a difficult medical balance and there is no dearth of strong, divergent opinions among Catholics on what care is necessary, what is obligatory and what must be discretionary. As governments expand the “right” to euthanasia to include the mentally ill and the underage, Catholics are concerned about increasing pressure being put on patients with expensive illnesses (or who are simply old or disabled) to end their lives prematurely by voluntary restriction of otherwise appropriate care, or by assisted suicide. Along with this worry comes a “flip side” concern: In the face of controversial, high-profile end-of-life cases and the heated rhetoric that comes with them, some Catholics may second-guess their already difficult, perfectly appropriate end-of-life decisions — to their detriment.
- The care of transgender youth. Catholic teaching has a lot to say about sex and sexuality, of course, but how our teachings apply to gender dysphoria depends on understanding the basic biology and, importantly, the psychology that is still evolving. There is clearly an explosion of young people questioning their sexuality. What remains unsettled is how much is driven by social contagion, how much results from as yet undefined physical or psychological influences (One question: Has 60-plus years of massively increased use of hormonal treatments, both natural and artificial, impacted the environment, and is it related to all the rest?), and what interventions are therefore appropriate in any given case. The tendency to reduce solutions to policies or ideologies, and the ever-present desire of government policymakers to intervene in medical situations, adds to the confusion. Until we understand these intersecting concerns better, the first rule — written all those years ago by Hippocrates — is still “first, do no harm,” especially with complicated treatments or policy positions that are potentially damaging or irreversible in young lives.
- The increasing control of individual health care decisions by insurance companies or governments whose goals are cost savings over optimal patient care. Insurance companies often aim to reduce their provisions of costly but life-changing drugs in order to control expenses. Sometimes this action leaves patients with no option but to accept less effective treatment or pay astronomic out-of-pocket expenses. Crippling costs are compounded by inescapable ads selling the general public on game-changing, highly expensive drugs for treatment of diseases ranging from eczema to multiple sclerosis. It raises the question: Of what value to the patient is a drug that costs in excess of $50,000 a year, and what is the Catholic responsibility to find ways to make such drugs more affordable?
- The crisis of mental health care and the damage that decades of policies preventing involuntary treatment have created. Recent events and news stories suggest that society may be rediscovering the Catholic principle that caring for the most vulnerable among us is a profound social need. How do we prioritize and deliver care to the most vulnerable of our brothers and sisters within a system that is politically fragmented, morally confused and so driven by the profit-motive that people who are a danger to themselves or others due to mental illness are simply left to live on the streets, affecting whole cities?
- The intersection of conscience and medical care. Expect attempts to compel Catholic medical providers to engage in procedures to which they object on moral grounds to increase. What remains to be seen is whether governmental concern for patients — that they receive the kind of care they desire — will extend to Catholic patients who want care consistent with their deeply held beliefs, delivered by physicians who either share or respect them.
Barbara Golder is a physician-lawyer-bioethicist. She can be reached at firstname.lastname@example.org.