Making Medical Decisions With A Person's Best Interests In Mind

The legal system is often at odds with the medical profession. At least, that is the way it seems. Most recently, Alfie Evans, the young English child, became a victim of the courts. A judge declared all life-support devices be removed and Alfie be allowed to die. Alfie’s parents objected. Many individuals around the world offered support in one way or another. Even Pope Francis expressed the willingness to provide a medical evacuation to a hospital in Rome. All this was to no avail.

The judge made his decision feeling he was acting in the best interests of the child, whom may have had a terminal illness (a precise diagnosis was never established.) Somehow he felt the legal system could function better than Alfie’s parents in determining what was best for the child. According to this judge, this child was better off forfeiting his life than maintaining present therapies.

I recall a case, many years ago as a medical student, of an infant in the intensive care unit desperately in need of a blood transfusion. The parents refused on religious grounds to allow the transfusion. The doctors felt this infant would die and since the child was not at an age where a personal decision could be made and honored, the doctors sought and obtained a court order to proceed with the transfusion thus overruling the authority of the parents. The child lived.

In the case of Alfie Evans, the legal system caused his demise; in my case, mentioned above, it saved a life.

One of the first tenets taught to doctors and healthcare workers in general, is do no harm, primum non nocere. With this in mind the practice of medicine is intriguing on one hand and quite disturbing on another. There is the power to determine for the patient what is burdensome based on what is known of the disease being treated and its prognosis. The legal system may give validity to medical decisions based on the desires of the patient, or allow an action considered to be in his or her best interest. An example is physician-assisted suicide, which is legal in a handful of states.

But how does validity play out in the setting of a medical decision that goes against the moral and ethical teachings of the Catholic Church? Should we accept a medical treatment as a patient or prescribe a medical treatment as a healthcare provider that runs up against the moral teachings of the Church just because it is promoted as being done in the best interests of the patient and has a legal basis?

I believe that more than any other institution, the Church maintains the best interests in our being. In any given circumstance, what is important is to recognize our humanity and the intrinsic dignity attached to that humanity. No matter the state of development, the degree of illness and its subsequent prognosis – or the subjective desires of the patient, the medical professional, or the legal system acting as a decision-maker – the dignity of the human being must first-and-foremost be upheld.

This is the answer to the polemic on how best to care for those in need. It is the answer to the subjective desires of patients or healthcare providers, and the objective reality or endpoint of any course of action. Care must be taken to approach each medical decision aware that any solution failing to count the dignity of ourselves cannot be considered as being in our best interests.

The Church can’t and won’t practice medicine. But it can certainly provide guidelines offering a solid foundation with which to make appropriate medical decisions.