Christian Medical Ethics
A basic exploration
of fundamental concepts
and a problem solving process
Common approaches to medical ethics
1. Virtue ethics (Existential)
1. Good = What a good person would do
2. Look at motives and behaviour
2. Consequence ethics (Teleological/ Utilitarian)
1. Good = Aiming at good goal / consequences
2. Look at facts and consequences
3. Duty ethics (Deontological)
1. Good = What the law says
2. Look at laws, protocols, standards, creeds, norms
What is Christian medical ethics?
Theological basis: Matthew 22: 37-39
Application: How love our neighbour in healthcare?
Reverent,
systematic,
analytical and
critical thinking about
how medical professionals ought to behave.
We consider virtues, consequences and
duties in loving God and our neighbour
As a science:
Ethics problem-solving flow-chart
Define moral problem
Develop possible courses of action
Determine preferred course of action
Deploy planned course of action
Deployment evaluated and appropriately handled
Case study: Patient requests euthanasia
 Christian nursing home, Christian doctor doing rounds with successor
 Male patient:
 Early sixties, divorced (no contact with ex-wife), three children (no contact with
one of them, poor contact with the other two),
 Grew up in Christian environment, drifted away as teenager and stayed that way
 Poor vascular system, upper leg amputations both sides because of this; still
smoking - under supervision because of fire hazard; several large decubitus
ulcers
 Has requested euthanasia once before. Doctor then explained that it is against
the institutional code and against the doctors’ conscience to do so. Patient
accepted it at that stage. His family was not informed about his request.
 Now complains of severe ongoing pain, feels depressed, sees no future for
himself, requests euthanasia again
 Doctor reminds patient of earlier conversation; discusses the various
complaints with patient; prescribes more potent pain relief protocol; adds
that patient will have to move to other nursing home if he persists with
euthanasia request; recommends a talk with a pastoral worker
 Patient declines pastoral care; promises to think more about the issue
In the groups
1. Appoint persons in following roles:
1.
2.
3.
4.
One person = doctor doing ward round
One person = patient
One person = son who has no contact
Rest = ethics committee members of institution
2. Define the problem
3. Develop possible courses of action
4. Determine preferred course of action
1. Define moral problem
1. What are the facts of the situation: medical, nursing,
legal, economic, social, organisational?
2. Who is involved?
1. What does each party think about the situation?
2. What are their responsibilities in the situation?
3. What interests do they have in the situation?
3. What are the underlying world view perspectives?
4. Is there a moral dilemma? If so, which? More than
one dilemma?
5. What is the scope of the problem? (Micro, meso, macro?)
6. State the problem as a specific question
2. Develop possible courses of action
1. Which courses of action could be taken? (including
those you would not agree with)
2. What virtues / consequences / duties are relevant in
each of the possible courses of action?
3. Which virtues / consequences / duties are in danger
of being neglected in each of the possible courses of
action?
4. What would each possible course of action mean for
each of the key persons involved?
5. If different underlying opinions / preferences / world
view issues are evident, specify.
2.1a General Virtues and Vices
 Seven Virtues
1. Faith
2. Hope
3. Love
4. Fortitude
5. Temperance
6. Justice
7. Prudence
 Seven Vices
1. Pride
2. Envy
3. Gluttony
4. Lust
5. Wrath / Anger
6. Greed
7. Sloth
Q: What does my conscience say? How become
more Christ-like through grappling with problem?
2.1b Medical Virtues and Vices
 Seven Medical Virtues  Seven Medical Vices
1.Compassion
1. Coldness
2.Mercy
2. Cruelty
3.Professionalism
3. Quackery
4.Integrity
4. Corruption
5.Collegiality
5. Rivalry
6.Justice
6. Injustice
7.Prudence
7. Carelessness
2.2 Consequences: A Christian perspective
1. Purpose: promote health interests of patient
2. What will consequences be for:
1. Ethical, religious, legal, economical, social and technical
aspects? (? also aesthetic, linguistic and cultural aspects)
2. Preventive, curative, palliative + terminal care?
3. Health and well-being of involved parties?
3. Consider these rules regarding consequences:
1. Proportionality (benefit / burden analysis)
2. Subsidiarity (least drastic / burdensome / expensive)
4. Consider the scope of the consequences:
1. Micro (personal), meso (institutional) and macro (whole
field)
2. Short term, long term, eternal
2.3 Duties: A Christian perspective
1. Christian duties
1. Medical Duties
1. Pro-shalom; not kill on purpose
2. Marriage as safe circle for
intercourse, conception and
raising children
3. Respect responsibility and
freedom of choice of patient
4. Repair of disease as safe circle for
genetic manipulation
5. Respect property of another
2.
6. Respect created sexual identity
1.
2.
3.
4.
5.
6.
7.
8.
Care
Respect for life
Beneficence (do good)
Non-maleficence (no harm)
Justice
Confidentiality
Trustworthiness
Informed consent
Hippocratic Oath
2. The Law: What does the Bible say? 3. Medical ethical codes
4. Protocols, standards
1. Ten / two commandments
5. Professional responsibilities +
2. Law suited to humans
position description
3. Love is fulfilment of the law
3. Determine preferred course of action
 Dialogue with relevant parties regarding possible
courses of action; discuss virtues / consequences and
duties of each possibility
 Use feedback to improve quality of problem solving
 Develop criteria for evaluating the possible courses of
action: what is acceptable / exemplary / unacceptable
 Which criteria will count the most?
 Build convincing argumentation for your choice; refer
to virtues, consequences and duties as well as the
criteria for evaluating the courses of action
 Seek to reach consensus about the preferred course
of action. Use negotiation / mediation if required
 What protocol to follow if no consensus is reached?
4. Deploy planned course of action
1. Plan: Make a good plan re course of action:
1. Consider implications on care plans, treatment
protocols, institutional plans and procedures
2. Who does what by when?
3. Who is responsible for supervision of which part
of the planned course of action?
4. How will the implementation of the planned
course of action be evaluated?
5. What will consequences be of the evaluation?
2. Do: Implement the plan
5. Deployment evaluated and
appropriately handled
1. Check: Evaluate the course of action as
indicated in the plan
2. Act: Use information from evaluation to
take appropriate steps towards a better
future together
Overview of the process
Step
1
2
3
4
5
Virtues
Consequences Duties
Overlap / different interpretations between
doctor / patient
Virtues
Consequences
Duties
What happened with the patient who
requested euthanasia?
 Patient satisfied with adequate pain relief and
excellent care; withdrew euthanasia request
 Condition later deteriorated seriously; this time took
advice from successor doctor to get pastoral help
 As a consequence:
Reconciliation between patient and God
Reconciliation between patient and lost son
Gratitude expressed towards successor and staff
Patient died in peace just after this
Faith
 Belief, trust, fidelity, loyalty, conviction
 Faith: trust God at His Word
Hope
 Desire, expectation, reliance, belief
 Hope: certainty of better future based on
God’s promises
Love / Charity
 Generosity, benevolence, helpfulness,
mercy
 Love: desire, choose and act for highest
good
Fortitude
 Strength, courage, endurance,
resoluteness
 Fortitude: perseverance in integrity;
strength of mind to endure adversity
steadfastly; perseverance in facing
danger for the sake of principle
Temperance
 Moderation, restraint, self-mastery,
frugality, sobriety
 Temperance: Self-control
Justice
 Impartiality, fairness, equity, rightness,
dispassion
 Justice: regard for fulfilment of
obligations
Prudence
 Wisdom, vigilance, carefulness,
thoughtfulness, discretion
 Prudence: due regard for one’s own
welfare; habitually careful to avoid error /
danger
Pride
 Pride is excessive belief in one's own abilities,
that interferes with the individual's recognition of
the grace of God. It has been called the sin from
which all others arise.
 Thomas Aquinas said of Pride "inordinate selflove is the cause of every sin (1,77) ... the root of
pride is found to consist in man not being, in
some way, subject to God and His rule."
Envy
Envy is the desire for others' traits, status,
abilities, or situation.
Thomas Aquinas said of Envy: "Envy
according to the aspect of its object is
contrary to charity, whence the soul
derives its spiritual life... Charity rejoices in
our neighbour's good, while envy grieves
over it." (2, 36, ad 3)
Gluttony
Gluttony is an inordinate desire to
consume more than that which one
requires.
Thomas Aquinas said of Gluttony:
"Gluttony denotes, not any desire of eating
and drinking, but an inordinate desire..."
(2, 148, ad 1)
Lust
Lust is an inordinate craving for the
pleasures of the body.
Anger
Anger is manifested in the individual who
spurns love and opts instead for fury. It is
also known as Wrath.
Greed
 Greed is the desire for material wealth or gain,
ignoring the realm of the spiritual. It is also called
Avarice or Covetousness.
 Thomas Aquinas said of Greed: "it is a sin
directly against one's neighbour, since one man
cannot over-abound in external riches, without
another man lacking them... it is a sin against
God, just as all mortal sins, inasmuch as man
contemns things eternal for the sake of temporal
things." (2, 118, ad 1)
Sloth
Sloth is the avoidance of physical or
spiritual work.
Thomas Aquinas said Sloth is
"sluggishness of the mind which neglects
to begin good... [it] is evil in its effect, if it
so oppresses man as to draw him away
entirely from good deeds." (2,35, ad 1)