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Pius XII makes two key statements. He distinguished between the death of the whole person and the death of organs. But considerations of a general nature allow us to believe that human life continues for as long as its vital functions—distinguished from the simple life of organs—manifest themselves spontaneously or even with help of artificial processes [ 31 ].
It remains for the doctor, especially the anesthesiologist, to. These statements were later used to affirm the Catholic position that neurological criteria, determined by the medical community, were appropriate definitions of death. The authors of the Harvard criteria drew on this statement in their report. In his writings and talks, he developed a clear and consistent understanding of determining death that followed from the statements of his predecessors. In , the Pontifical Academy of Sciences revisited the issues.
Brain death has been a highly important and useful concept for clinical Medicine, but it continues to meet with resistance in certain circles. The reasons for this resistance pose questions for medical neurologists, who are perhaps in the best position to clarify the pitfalls of this controversial issue. In this report the Academy noted that cardio-pulmonary criteria had long been the standard for determining that death had occurred, but with the advent of the ventilator and need for organs, medicine developed new criteria.
In discussing the Academy findings, John Paul II delineates the Harvard Criteria and subsequent emendations to it in an argument that affirms his acceptance of these criteria when strictly applied. He clearly states that it is appropriate to turn to medical authorities in order to assess the criteria and notes that Harvard Brain Death Criteria and that the Uniform Determination of Death Act are accepted by all 50 American States, the American Medical Academy and the American Bar Association. Because Papal authority carries significant weight, the roughly Catholic hospitals in the American medical system all adhere to neurological determination of death.
They uniformly oppose the use of neurological criteria and argue instead that cessation of the cardio-pulmonary system is the only licit determination of death. It results from the separation of the life-principle or soul from the corporal reality of the person. Because the official position of the Roman Catholic Church firmly asserts that brain death is death, there is no difficulty in ending the mechanical means that was used to support the patient prior to the determination of death.
The Church uses guidelines to assist in deciding when withdrawing support prior to determining death is a morally fitting decision. To assess the appropriateness of an action in a complex moral situation such as withholding or stopping treatment, Roman Catholicism draws on an ethical system developed by thirteenth century theologian, Thomas Aquinas, and a 16th century lecture on stopping treatment by Francisco diVittoria. Both men provide a method for ethical analysis. Four criteria must be met for an action to be considered moral.
First, the action must arise from a good will, second, there must be a proportion of good over evil arising from the action, third, the evil may not be directly intended, and finally the evil must not be the means of producing the good. Administering a drug that will provide pain relief to a terminally ill patient the good but will also depress the respiratory system and hasten death the evil exemplifies double effect. Giving the drug can be considered acceptable if the action is intended to benefit the patient, the lessening of suffering is sufficient to outweigh the shortening of life, the death is not directly intended and the patient is not killed in order to end suffering.
In addition to Natural Law, Roman Catholic medical ethics make use of several principles Francisco DiVittoria set out in his discussion of end of life issues. He developed the categories of ordinary and extraordinary means [ 39 ]. In his address Pius XII referred to both Natural Law and extraordinary means in his discussion of when treatment can be withdrawn. Following Aquinas, he advises decisions based on the proportion of good over evil in direct relation to the particular circumstances of the individual. Extra-ordinary means, in the face of an incurable illness, are not required.
Instead, he uses only the terms proportionate and disproportionate means which can be determined by analyzing particular cases and the types of treatments, costs, physical and moral resources of the patient. Because of the hierarchical system of Roman Catholicism, statements of the papal authority have significant weight in the Catholic Health Care system.
There is one set of directives, for example, for all Catholic health care facilities in the United States. This includes withdrawing enteral or parenteral nutrition in a patient who is dying, but not from someone in a persistent vegetative state. The schism that divided Christianity into two main factions began in over issues that are not germane to this discussion.
Contemporary Eastern Orthodoxy differentiates itself from Roman Catholicism in several ways, two are important for the moral issues discussed here.
Eastern Orthodoxy does not recognize the Roman Catholic Pope as the supreme authority over all of Christendom. Eastern Orthodoxy is organized into autonomous regional churches. Each regional Church has its own governing body which results in differences across the tradition in a variety of areas including some medical ethical issues. Though it is hierarchical, Orthodox Christianity sometimes cedes the decision making in ethical dilemmas to the individuals in consultation with their spiritual fathers.
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The decision to use non-abortive contraception, which the Church generally opposes, is left to individuals in consultation with their spiritual father. Although Eastern Orthodoxy still shares a concern for basing morality on the Bible and authoritative interpretations from the Church Fathers with its Roman counterparts, it does not accept the traditions that developed in Rome after the split. This includes the development of moral theory that began with Thomas Aquinas in the thirteenth century.
Eastern Orthodoxy does not believe that moral issues can be understood through either the processes of reason or the use of philosophical analysis. Greek Orthodox bioethicist, John Breck describes what is necessary to do ethics.
Philosophical ethics are not sufficient to handle of complex ethical issues because the human mind does not have the requisite knowledge to determine what the consequences of an action will be. That knowledge can only be gained through prayer and the study of scripture and the Church Fathers [ 44 ]. Breck uses the example of a physician treating a terminally ill patient who has assented to a plan to alleviate suffering in a way that will hasten death, Breck notes that by using the principle of double intent, this action would be permissible, because the evil here the death of the patient is not technically intended.
He believes, however, that it is unreasonable to expect that the doctor will be able to suppress the underlying desire that the patient die so that suffering is permanently relieved; hence the intent actually is to end the life of the patient. Breck along with other Orthodox ethicists believe it morally acceptable to lessen suffering even if the method brings an earlier death when it is done for the benefit of the patient; their disagreement is with the method of arriving at this conclusion [ 45 ]. Some writing on behalf of their Church fully accept the idea of brain death.
This branch of Orthodoxy does not take any position on what criteria the physician should use.
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Two views present themselves from the Greek Orthodox Church. Despite his disagreement with basing determinations of death exclusively on medical criteria, Hatzinikolaou goes on to state:. It seems that brain death will remain open to discussion. However, from a spiritual point of view, this does not create any ethical problems to transplantations. It may be even better for it makes us transcend the scholastic certainty of a clear-cut definition of death and introduces us to the uncertainty of a risky decision.
Love cannot be expressed without taking risks! While the church has clear teachings about such matters e. These views are unified in their overarching position that each moral issues must be looked at individually. Indeed, Orthodox moral reasoning can turn to the principle of Economia , which allows flexibility where there is a clear cut pronouncement that does not seem to be the right decision in the case at hand. Economia in canon law and in ethics authorizes exceptions to the rule without considering the exception either to set a precedent or to abrogate the rule.
The justification for applying Economia is avoidance of the greater harm that would come from the strict application of the rule.
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Orthodox Catholicism, like its Roman counterpart, accepts the withdrawal of life support systems for those who are dying and quotes the Roman Catholic position on withdrawing treatment. He goes so far as to say that in some situations withdrawing treatment is obligatory [ 45 ]: Protestantism entered the world religious scene in when Martin Luther — posted his 95 theses on the door of the Wittenberg Cathedral.
Two core principles of this Protestant Reformation were the priesthood of all believers and Sola Scriptura , ideas which form the core of many contemporary forms of Protestantism. The term, priesthood of all believers, refers to the belief that there is no separate ethic, responsibility, or ability among the believers, clergy or laity, to make moral determinations and it includes the notion that individuals are responsible for turning only to scripture and not to authority to ascertain the morality of an action.
The result of Sola Scriptura is that most Protestants will not automatically turn to authoritative figures from the past to make determinations though they certainly consult them. It is just as likely that they will turn to present day religious leaders, science, medicine, or philosophical ethics to inform their moral views when Scripture provides no clear guideline. The contemporary Anglican Communion bases its decisions on reason, scripture and tradition.
The divisions continued; the result is minimally hundreds of variations of Protestant Christianity with new forms regularly emerging. Many forms of Protestantism do not have official statements on the appropriate criteria to use in making a determination of death.
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Lutheran, Anglican, Presbyterians and churches belonging to the National Association of Evangelicals in America l have more substantial writings on these issues than do the groups listed above. The Lutheran tradition comes directly from the reformation in Germany. Today, it is organized into autonomous regional churches. It holds firmly to the original principles of the priesthood of all believers and Sola Scriptura.