Being Pro-Life: Who Lives? Prioritizing Care in a Time of Limited Resources
In 2012, Hurricane Sandy was hitting New York City, and Bellevue Hospital was facing the failure of their main generators. Left with only six working power outlets for 50 patients in intensive care, the medical director had to make decisions she never wanted to make. Which of the 50 would be able to continue to have their very lives supported by powered equipment, and which would not.
We have all heard the news by now. Many estimates suggest that as COVID-19 continues to spread, the demand for ventilators—a key component in treating severe cases—may exceed the supply. We could also simply run out of critical care beds in our hospitals. Deciding when one patient can be released from the ICU so another can enter is something healthcare workers decide on a daily basis, but that kind of scenario on a grand scale with a great number of patients in need of critical care is something new. Hospitals are having to dust off their policies about how to decide who gets care and who doesn’t, and hope they never have to use them.
The Director of the Office for Civil Rights for the U.S. Department of Health and Human Services recently opened an investigation, after receiving complaints from disability rights advocates that protocols recently discovered in Alabama and Washington were discriminatory. Washington referred to “loss of…cognition” while Alabama specifically mentioned “mental retardation” as a factor in deciding who should be given less priority in a time of rationing. At the time of writing this article, both states’ health departments had made statements that suggest an openness to doing what is necessary to address any concerns of discrimination. Nonetheless, many people are uneasy that policies being formulated in our current crisis are not influenced by ideas related to the basic life worth of a person with disabilities. So what does the Catholic Church teach about how to make such critical decisions?
I spoke with Dr. Ken Craycraft, Chair of Moral Theology at Mount St. Mary’s Seminary & School of Theology, on this topic. The first rule of thumb he mentioned was the existence of other terminal conditions which are not going to be aided by treating the conditions related to COVID-19. In other words, if someone already has a terminal illness, and curing him or her of COVID-19 is not going to change the status of the other terminal illness, that could certainly be a factor in deciding who would not receive critical care over someone who does not have another underlying terminal illness, in a time of scarcity. What he stressed was this: “What we don’t consider is age, we don’t consider mental capability, we don’t consider factors that don’t have to do with survivability.” That means we don’t consider what some might consider to be quality of life issues related to disability. That is an affront against the dignity of every human person, no matter the physical ability.
Ethical and Religious Directives for Catholic Health Care Services, published by the USCCB, produces guidelines to help us make end-of-life decisions consistent with Catholic teaching and human dignity. At a minimum, Catholic hospitals are required to abide by those directives. They are not always sufficient in and of themselves, because they are often broad principals, and a Catholic hospital may at times need more specific policies on how to apply them. Anyone, however, can read this for free online. Another great place to go online for more information is the National Catholic Bioethics Center at www.ncbcenter.org.
There is always a silver lining to any crisis, and one of them could be that more people look to advance directives and health care proxies that are in keeping with Catholic teaching on end-of-life issues, before they find themselves in a crisis. You can find an example on our website here
If you want to listen to the full interview with Dr. Craycraft, the podcast will be released on April 21. Find the series on your favorite podcast player, or look for the link at www.catholiccincinnati.org/being-pro-life. As our country moves forward with responding to this current crisis, may we fearlessly move forward in a way that respects the inherent human dignity of all of us.
 The Hardest Questions Doctors May Face: Who Will Be Saved? Who Won’t? U.S.News, March 21, 2020