Life or Death Decisions: A view from two practitioners

In response to several articles in America by Kevin O’Rourke, O.P., concerning Bishop Thomas Olmsted’s reaction to an alleged direct abortion performed in a Catholic hospital in Phoenix, Ariz., Charles F. MacCarthy, M.D and John P. MacCarthy, M.D., O.Praem., offer their insights on medical decision making and the bishop’s disciplinary decisions. (The three articles are: “Complications,” 8/2/10; “From Intuition to Moral Principle,” 11/15/10; and “Rights of Conscience,” 8/1/11.) Both authors are graduates of the Stritch School of Medicine, Loyola University Chicago, in Marywood, Ill. Charles is an ophthalmologist, now retired, and John is a missionary priest/physician in a remote jungle hospital in Peru.

Physicians make ethical decisions every day, though few are as dramatic as the Phoenix case, and few come to the attention of any bishop. Nearly all diagnostic and therapeutic decisions have some ethical implications. When the risks are small and potential benefits are large, decision making is easy. But during a pregnancy, when two or more lives are involved, decisions are hard.

For a physician, every decision about surgery involves weighing risks and benefits and explaining them so the patient and/or the family can share in the decision-making process. Still, after listening to even the most detailed explanation, the question from the patient is usually, “What do you think I should do, Doctor?” The patient implicitly trusts the physician to recommend a course of action that is best medically and ethically.

Decision making near the end of life is often challenging. Would another CT scan, surgical procedure or chemotherapy regimen really help? What are the costs, in dollars and discomfort? Do the patient and family members agree? In an emergency, what attempts should be made to resuscitate? Should life-support measures be started, continued or discontinued?

At Charles’s hospital in Wausau, Wisc., these questions are discussed by the physician and other caregivers, including physician specialists, nurses, social workers and chaplains. In especially challenging situations, the hospital ethics committee may be asked to consult.

In a remote jungle hospital, Father John often has found himself working as the only physician—de facto chief of medicine, surgery, obstetrics and pediatrics, hospital C.E.O., chaplain and sole member of the ethics committee—with no one but the Holy Spirit to guide his decisions.

In all these situations, the physician feels responsible for making the decision—to operate or not, etc.—whatever the situation demands. The physician may consult colleagues and medical literature, talk further with the patient and family, pray about it, sleep on it but will still feel responsible at the end. The majority of physicians we know take this responsibility very seriously. They ask themselves what they would do if the patient were their father, mother, sibling or child. They know that their decision may turn out to be wrong, even when they are “certain” they are doing the right thing.

The one step the physician probably does not take is to ask the opinion of the bishop, unless the bishop is a personal friend or has participated in ethics committee discussions, bedside conferences with the patient and family hospice care discussions or has otherwise indicated a willingness to share the burden of complex medical decision making. Even then, the physician would not abdicate his decision making role to the bishop. We can not imagine saying to a patient, “I have talked to the bishop about this....” The response would be: “The bishop! What does he know about this? You are my doctor. What do you think I should do?”

If the bishop offers an opinion or judgment after the decision has been made, Father O’Rourke suggests two possible responses. First, to accept the bishop’s statement and follow it, while disagreeing. Second, to “accept the authority of the statement but disagree with its reasoning and so not follow it because doing so would violate one’s own conscience.”

In those rare instances when a bishop’s opinion is known before a medical decision is made, we believe the first option is not valid. We see no justification for abdicating our responsibility as physicians to the bishop or anyone else. And we consider the second option as not only a right but a responsibility of the physician. We will do our best to educate ourselves and seek advice from others who may be more knowledgeable. But each patient has a right to our best advice for them, and we accept that responsibility.

We place our confidence in Sister Margaret McBride and the physicians and others on the hospital ethics committee who decided to do what they thought was best under very difficult circumstances. Our hope is that Bishop Olmsted will become a part of the discernment process for difficult medical ethics decisions in his diocese and that other bishops will also do this. It may give them some sleepless nights, but it will give them empathy for those making difficult medical decisions, allow them to share their ethical insights as decisions are made, and it could offer a lesson in humility about the limits of ethical “certainty” in medical decisions.