As health care professionals in the United States and around the world work to treat patients suffering from the COVID-19 virus with increasingly limited resources, Catholic bishops, bioethicists, and doctors stressed that concern for the dignity of each and every patient — regardless of age, disability or other factors — must always guide decisions about administering medical care.
Patrick Lee, the director of the Center for Bioethics at the Franciscan University of Steubenville, told the Register that an April 3 statement by the U.S. Conference of Catholic Bishops was a necessary reminder that Catholic teaching doesn’t change in times of crisis.
“There are some basic ethical principles that we have to fall back on,” Lee said, adding, “I think what happens is sometimes is when people get into a new discussion, they don’t call to mind some of the things they know in other contexts.”
In their April 3 statement, Bishop Kevin Rhoades of Fort Wayne-South Bend, Indiana, chairman of the USCCB’s Committee on Doctrine, Archbishop Joseph Naumann of Kansas City, Kansas, chairman of the Committee on Pro-Life Activities, and Archbishop Paul Coakley of Oklahoma City, chairman of the Committee on Domestic Justice and Human Development, praised doctors, nurses, and other health care professionals who they said “have all demonstrated courage, compassion, and truly remarkable professional care in a time of growing crisis.”
The bishops said the current pandemic “has highlighted the fact that we have limited resources and therefore may be facing some difficult decisions ahead. At all times resources are limited — there are only so many beds and so many supplies — but this crisis has and will continue to challenge us greatly.”
“Every crisis produces fear, and the COVID-19 pandemic is no exception,” they continued. “However, this is not a time to sideline our ethical and moral principles. It is a time to uphold them ever more strongly, for they will critically assist us in steering through these trying times.”
The bishops added, “in a time of crisis we must not discriminate against persons solely on the basis of disability or age by denying them medical care.”
“Good and just stewardship of resources cannot include ignoring those on the periphery of society, but must serve the common good of all, without categorically excluding people based on ability, financial resources, age, immigration status, or race,” they continued. “Foremost in our approach to limited resources is to always keep in mind the dignity of each person and our obligation to care for the sick and dying. Such care, however, will require patients, their families, and medical professionals to work together in weighing the benefits and burdens of care, the needs and safety of everyone, and how to distribute resources in a prudent, just, and unbiased way.”
The Ethics of Triage
The bishops’ statement followed a report from The New York Times that said “overwhelmed” doctors in Italy “are withholding ventilators from older, sicker adults so they can go to younger, healthier patients.” The newspaper also reported that in the United Kingdom, officials have indicated the its taxpayer-funded National Health Service must “prepare to withhold scarce resources from the weakest patients in order to save more of the strong, especially with the use of life-sustaining ventilators,” but authorities have not indicated how they will make these determinations between patients.
Triage — or the way medical professionals determine how to allocate limited resources in order to save the most patients in times of shortage or emergency— can be done in a just and ethical way, Catholic doctors and bioethicists told the Register. They said that any triage policies adopted in the face of the pandemic must be based on objective clinical criteria, not subjective criteria such as arbitrary age restrictions or disability.
Joseph Meaney, president of the National Catholic Bioethics Center, a group that provides free consultation on ethical dilemmas by trained experts, told the Register in an interview that this pandemic “is not a time to sideline our ethical and moral principles, it’s a time to uphold them ever more strongly.”
“So yes, there’s extraordinary circumstances, yes, there’s a crisis, yes, hard choices have to be made, but no, we do not have to abandon our principles, our ethics, our solidarity with the poorest and the most vulnerable,” Meaney said.
If decisions about administering care are made with anything other than “objective clinical criteria,” such as considerations about quality of life, disability, or age, Meaney said that is when “you can see the discrimination seeping in.”
“The medical perspective is — can this person survive without treatment? Do they desperately need it right now? Or can this be provided to another person?” he said.
Meaney called reports of rationing based solely on age coming out of Italy “heartbreaking,” and said he is concerned that “overwhelmed” heath care professionals there “might be falling back on ideas that are not sound.”
Broadly, Meaney said determining prudent triage policies, “really kind of comes down to this culture of life versus culture of death.”
“You have a situation where does every human life have absolute dignity you know, and absolute equality and value or do you have this perspective that some lives are more worthy of living than others?” Meany said, adding the latter ideology “translates to an unjust triage system.”
Charles Camosy, an associate professor of bioethics at Fordham University, also expressed concern about members of vulnerable groups without an appropriate approach to triage. He told the Register “we don't treat people differently based on their being elderly or having underlying conditions.”
“Someone who is elderly, for instance, might have a better chance of surviving on a ventilator than someone who is younger,” he said. “The key is to ration based only on clinical factors like ability to survive.”
Camosy said Catholics should react to reports of rationing based solely on age “with horror,” calling the practice “ageism.”
“One can defend giving the last few ventilators to those who are most likely to survive regardless of age,” he said adding, “Focusing on age alone, however, is not only a violation of human dignity as understood theologically, it is a violation of U.S. civil rights law which requires that everyone have equal access to health care regardless of age.”
Catholic doctors also explained that when triage is necessary, if can be done without forsaking patients that are members of vulnerable groups, such as the elderly or disabled.
Dr. Grazie Pozo Christie, a policy adviser for The Catholic Association, told the Register in an interview that Hippocratic medicine has commonalities with a Catholic approach because the former holds “the equal and immeasurable dignity of each and every human person regardless of their age, their race, their sex, or their stage of development.”
“Standing on that foundation then, when we come to a place where our resources aren’t able to take care of everybody that’s sick, then what we need to do is clinically distinguish between people, not on their value, their relative value as we as human beings might assess them, but simply make a clinical determination which of the patients need it most, or are more likely to benefit from the treatment,” Christie said. “So this is very different from an approach where you measure one person against another depending on their relative worth, that’s unethical, from a Catholic perspective but also from a classical medical perspective.”
Christie stressed that in situations where there is a lack of medical equipment or supplies, decisions about priority of care must be made based only on objective clinical factors, like the patient’s immediate needs and chances of survival.
“It’s not proper to distinguish between two patients and say, this patient is more worthy of my care because this patient is younger,” she said.
Dr. Barbara Golder, J.D., a member of the Catholic Medical Association and editor of the group’s publication The Linacre Quarterly, told the Register that a Catholic medical professional approaches triage “within a set and unyielding framework of Catholic ethics that is centered on the intrinsic value of each human life — that is what keeps us from setting aside whole and unrelated categories of people as excluded from consideration for resources.”
“It is legitimate — even necessary — to apply resources in the most medically reasonable way possible, not ‘wasting’ resources on futile cases,” she said. “But that is very different than deciding that an entire category of people, regardless of their individual medical condition, are not to be considered for care.”
Golder applauded the bishops’ statement because she said it is a needed reminder that “Catholic social teaching says you don’t dismiss people because they fall into a particular category, a general category, you deal with the situation at hand.”
She pointed to the recovery of Dan Burke, the founder and president of the Avila Institute for Spiritual Formation and a former EWTN executive, from coronavirus, as a good example of why patients who are in high-risk groups shouldn’t be written off. Burke suffers from a chronic lung condition.
“You have a very good example coming out of the EWTN family,” she said. “Dan Burke had COVID-19 and he was in a very high-risk group and did very well. Despite being in a group that was very high risk, he got care.”
Kate Scanlon is a producer with EWTN News. She writes from Washington, D.C.