Issue 21, April 2007
Deep within our conscience we discover a law which we have not laid upon ourselves but which we must obey. Its voice, ever calling us to love and to do what is good and to avoid evil, sounds in our heart at the right moment. . . . For we have in our heart a law inscribed by God . . . Conscience is our most secret core and our sanctuary. There we are alone with God whose voice echoes in our depths. (Gaudium et Spes n. 16)
Conscience and the Second Vatican Council
Issue 21, April 2007
Conscience features often in the documents of the Second Vatican Council. The Council declared that:
- All are bound to seek, embrace and live the truth faithfully;
- Conscience is experienced as an inner sanctuary or tribunal, rather than something external, yet it mediates a universal and objective moral law which is given rather than invented;
Editorial: Principles and Process: Lessons from Winter
Issue 22, August 2007
"The principles of partnership, participation and protection of resources contained in the Treaty of Waitangi cannot be ignored in any debate which brings us so close to the heart of human existence and our relationship to the whole of nature..."
--New Zealand Catholic Bishops' Conference Submission to the Royal Commission on Genetic Modification – 2000
In the opening address of his November 1986 tour of New Zealand Pope John Paul II described culture as "the first voice of the sacred." As shared systems of meaning and as rich templates for the celebration of life and death, birth and ritual, worship and service, cultures become the wellspring or soil into which the Gospel is received. Ideally such a process is mutually enriching and beneficial.
The increased use of Māori phrases is a reality in everyday conversation, in media reports, in cultural events and in sacred liturgy. This was clearly evidenced throughout Aotearoa in the use of "Te Reo - the Māori language" in the annual Māori Language Week recently, leading several commentators to remark that New Zealanders are becoming "more comfortable" with our bicultural heritage.
Such heritage and cultural sensitivity are increasingly in evidence in clinical practice in our nation's healthcare. For example, the ethical principles of partnership, protection and participation, which originate from New Zealand's Treaty of Waitangi, play a central role in the use of innovative treatment and in all healthcare research.
While "language weeks" help to raise awareness of possibility, and remind us of their necessity the effect of these events can remain cosmetic and superficial. Similarly ethical principles, which provide a necessary framework for healthcare delivery and for ethical practice in healthcare, require application if the culture of medicine is to be renewed and enhanced. Medicine is a science as well as an art. The ethical and cultural principles of participation, protection and partnership provide a rich backdrop for the healer's art when they are integrated into best practice.
Those coming to terms with a terminal or chronic illness may be overwhelmed by feelings of abandonment and hopelessness. In these circumstances particularly, communication and the giving of bad news requires great sensitivity. When truth-telling is done with sensitivity it becomes a model of partnership in practice. The truth can be harsh and shattering for patient and family alike. Nevertheless the telling of it need not be brutal!
Similarly the care of those living with chronic illness or diminished decision-making capacity, when done with sensitivity and compassion, becomes a form of protection in practice. The need for such protection is especially apparent when the elderly and terminally ill are admitted to an emergency department. Protection in practice not only includes thorough diagnosis, but also, and equally, adequate referral. Even given the pressures on the healthcare system in New Zealand, a two-three day stay in an overcrowded emergency department does not equate with the protection afforded by an in-patient hospice or designated palliative care bed.
In healthcare the ethical and cultural principles of partnership, protection and participation must be expressed in practice at the interface between the patient and healthcare system. This will only happen if adequate attention is given to them at all levels, from public consultation to allocation of resources and personnel.
Rev Michael McCabe, PhD
The Nathaniel Centre
Guest Editorial: The Stories We Live By
Dr Ron Hamel
Issue 24, April 2008
Every day, people within our health care organizations make a myriad of decisions. Some of these may be clinical or patient/family related. Others may have to do with strategic planning, business development, finance, human resources or the common interactions between and among employees. Each of these decisions – to greater or lesser degrees – express the moral character of the individuals making the decisions and, in some cases, express the moral character of the organization.
Giving and Receiving: An Alternative Framework for Discerning the Good. Revisiting the Question of Physician-Assisted Suicide
Issue 24, April 2008
... a person does anything and everything he or she does only because that thing at least 'appears' to be good. Even when I choose something that I know is bad for myself, I nevertheless choose it under some aspect of good, i.e. as some kind of good. (McGee, 1999, http://www.aquinasonline.com/Topics/natlaw.html)
The Wisdom of Enough
Issue 25, August 2008
In Old Testament Hebrew there is no word for charity. The word used instead was Tzedekah – or Tsedaqah – meaning Justice. Now there's a concept that is not always comfortable to live with. If we were to see our personal or corporate giving as justice, rather than charity, then perhaps we can let go of our notions of generosity and come to the same conclusion as St Augustine who said, "He who possesses a surplus possesses the goods of another."
Using the Internet to Research Bioethics: A Resource
Staff of The Nathaniel Centre
Issue 25, August 2008
In order to understand adequately the issues in bioethics from a Catholic perspective we must combine the insights of history and science with the insights of our Catholic moral tradition. This approach reflects the multidisciplinary nature of bioethics and also assists in discovering the rich complexity of the issues.
If we are to bring a Catholic perspective to the public debate on key bioethical issues in a way that enables meaningful dialogue with others, it is also important to be familiar with the questions and perspectives of other people who think differently from ourselves.
Editorial - Hope and Bioethics: The Power of Narrative
Issue 26, November 2008
Hope is the virtue that enables us to look to the future with real confidence. It is not to be reduced to wishful thinking. We can all pass the time daydreaming, imagining a future that has nothing to do with reality. Wishful thinking has no bounds: it admits of no limitation; it is not criticized by what is actually possible...Hope is grounded in life...Hope is not limitless; it is limited by real possibility. Hope needs help if it is going to go beyond the expression of desire...Without help; hope remains an orphan – abandoned in the nursery of the mind..."
--Dennis McBride, CSSR.
In 1984, while a member of the Chaplaincy team at Wellington Hospital, I recall meeting a remarkable priest, Father Gerard Bourke, CSSR. When I met him he was a patient in the Orthopaedic Ward and was in traction. Early each morning I would take him communion and he would ask me to give him an intention for his prayers each day. Over the weeks I gradually got to learn something of his remarkable story.
Among other things, he had been a Chaplain in the Second World War and was imprisoned for some time in the infamous Changi Prison, Singapore. He built a little Church in the prison camp and dedicated it to Our Lady of Perpetual Succour after the previous Church had been destroyed by bombing. Father Gerard accompanied work parties into Singapore city and ministered for a time in several of the other prison camps before that was disallowed by his Japanese captors.
He spoke vividly about the pain and destruction caused by war and hatred and how the lives of many Allied Soldiers and civilians ended so brutally. In all of this suffering he continued to minister to the many. On one occasion he told me, "this time in Changi Prison was the lowest ebb of my life – spiritually, emotionally and psychologically..."
As a newly ordained priest and newly appointed hospital chaplain who was struggling to make sense of the pain and suffering that I was encountering on a daily basis, his words felt like the voice of an angel. Perhaps that was why my reply was a little inelegant, resonating as it did with my own experience of helplessness. "Well then", I asked, "how did you survive? How did you remain a priest in the face of such suffering?"
He did not seem to mind the question, and with a gentleness born of great pain, he said, "every time I could not stand the suffering and bloodshed anymore, and every time I wanted to go AWOL, the Lord would send someone into my tent who needed help. This soldier would inevitably pour out all his troubles and suffering to me. I was always so moved by these stories that I knew I had to stay because I could make a difference to these soldier's lives. In truth, these soldiers made a difference in my life, because they gave me hope...so much so I am still a priest!"
Embedded within the suffering of each of us are deeper layers of meaning. This meaning, when we embrace it, can be a rich and powerful source of hope to both the sufferer and caregiver alike. This is the irony of hope - it can only be discovered with the help of others and by taking the risk of love and compassion.
Thomas Aquinas links hope with love and describes hope as the virtue that causes and increases love and uplifts the human spirit. "Hope causes, or increases, love; sometimes by virtue of the emotion of pleasure, which it arouses; and sometimes by virtue of the emotion of desire, which it intensifies; for without some hope there is no strong desire." [Summa Theologiae I-I, 27, 4.] "Hope adds to desire a certain drive, a buoyancy of spirit about winning the arduous good." [Summa Theologiae I-I, 25, 1.]
In his 2007 Encyclical Letter, "On Christian Hope", ["Spe Salvi"], Pope Benedict XVI speaks similarly when he says that, hope enables a person to face "the present, even if it is arduous." [n.1] He describes hope as a distinguishing mark of Christians because it is based on the "fact that they have a future." Even though they do not know the details of what awaits them, "they know in general terms that their life will not end in emptiness." [n.2] Even so, discovering hope remains somewhat elusive and challenging, not only for those without a faith or belief in the transcendent, but also for those with the gift of faith.
Cultures and professions can communicate hope in the way they engage the gifts of individuals and communities. Environments can reflect hope in the way in which they assist in uniting the world of the sufferer with the world of beauty and transcendence. However, while good structures enhance the future, they are not of themselves enough for the presence of hope. Hope requires others. The other – be that an individual, a community, and ultimately God – provides the "scaffolding" for hope to occur and for it to be maintained at a communal and personal level.
The late Cardinal Joseph Bernardin once described the Church as a "community of hope" and also referred to the healthcare profession as a "witness to hope." Human life cannot be lived in isolation and hope is diminished when people are reduced to commodities in healthcare or deprived of the witness of the community. That is why the need for hope can perhaps be seen most clearly at the beginning and end of life, and why the interdisciplinary field of bioethics has the responsibility to be a carrier of the community's hope. As Pope John Paul II reminded us, bioethics represents a "meeting place" where many different voices can be creatively and respectfully present.
Perhaps more than anything our very presence at this meeting place will remind those of us who minister in the field of bioethics of our own need for hope; hope in the professions, hope in society, and hope in the future? To paraphrase Father Gerard Bourke, even amidst dwindling and limited possibilities, and even against the backdrop of deep existential suffering, it is possible to discover a meeting place whereby hope is reborn. Often that meeting place will be a simple conversation with our neighbour in which personal stories are shared.
Rev Michael McCabe, PhD
The Nathaniel Centre