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THE following are representative examination questions that have been used in midterms and final examinations for this course in the past.
You are the Catholic chaplain at Parkland Memorial Hospital when a young man named Donald Cowart is admitted with severe burns (review Dax’s Case, Essays in Medical Ethics, pp. 1-12 to refresh your memory). Donald’s physician, Dr. Charles Baxter, asks to speak to you. He says that “Donny” has been asking to be allowed to refuse treatment and thus to die. Dr. Baxter tells you that with treatment Donald will certainly survive (with severe physical limitations); but that the treatments will be very painful.
1) Although neither he nor Donald Cowart are Catholics, he has decided to ask your advice. Dr. Baxter tells you he is uneasy with the situation. His own (Baptist) church does not have a long history of guidelines for ethical decision-making and he asks you if you know whether the kind of issue he is struggling with has been raised by Christians in earlier times.
2) He then asks you what the present position of the Catholic Church is in regard to Donald’s request to be allowed to die. [In addition to other sources, please make reference to the Vatican Document on Euthanasia (Jura et Bona) in answering this question.
3) After your explanation of the Church’s position, Dr. Baxter asks you “Is there anything else I ought to be doing to help this young man?” What do you tell him?
You are the pastor of a parish in the San Fernando Valley. The Supreme Court is preparing to rule on whether the law severely restricting abortions in South Dakota is constitutional, and tempers in the parish are flaring. While you are sipping coffee after the 10:00 am mass on Sunday a woman whom you dimly recognize as a professor at UCLA comes up to you and demands: “Father, isn’t it true that early abortions were permitted in the middle ages, and that this total rejection of abortions by the Church is a modern restriction?”
4) You preceive that she is intelligent and competent in history. How do you respond to her? What do you recommend she read? [please summarize what she will find in any reading you recommend]
5) You are the pastor of a large parish in Los Angeles. One of the nurses in your parish requests permission to give a presentation at a Wednesday-evening Adult Education program on the subject of “advance directives”. She plans to describe the Durable Power of Attorney for Health Care; and at the end of her presentation she plans to encourage participants to fill out an advance directive for themselves.
The Director of Religious Education hears about this and becomes highly agitated. She says that the Durable Power of Attorney encourages euthanasia by inviting people to consider withdrawing or withholding nutrition and hydration, “which the pope has forbidden”.
What do you say to the D.R.E.?
6) You are the pastor of a parish in the San Fernando Valley. One of your parishoners has been diagnosed with Lou-Gehrig’s Disease (a.k.a. Amyotrophic Lateral Sclerosis; Motor Neuron Disease) and wants your advice. He is 32 years old, an active parishoner, unmarried, and is the principal of the elementary school in your parish. He has been told that his disease is incurable, and will result in a slow, progressive paralysis, beginning with his feet and legs, eventually (perhaps within three to five years) making it impossible for him to breathe without mechanical assistance. He is trying to decide what decisions to make in regard to his health care. He has several questions:
A) He has been told that many patients with his disease decide never to allow a ventilator (respirator) to be used: that is, when the paralysis becomes so severe that a ventilator is medically recommended, they refuse to give their permission. He asks you whether the Church permits this.
B) He also wants to know whether the Church would allow him to take drugs that would make him unconscious when it becomes difficult for him to breathe. He wishes to donate his organs, and he has been told that he may be a “non-heart-beating” donor-candidate; but in this situation it would be necessary for him to allow a ventilator to be used for a short time, then turned off in the operating room where his organs would be removed after his heart stops beating. He wants to be given drugs that will make him unconscious as soon as he finds it hard to breathe; but he does not care what happens to him after that, as long as he is not conscious. The representative from “One Legacy” (the organ-procurement agency) has told him that this can be arranged. He wants to know whether the Church would allow this.
What do you tell him, and what pastoral recommendations do you make?
7) You are the pastor of a large parish in the San Fernando Valley. One of your parishioners comes to you tearful and apprehensive. She is a 35 year-old Chinese-American, whose 70 year-old mother recently discovered a lump in her breast. Her mother recently immigrated to Southern California from Taiwan, and speaks English fairly well, but prefers Chinese: her daughter describes her as “very traditional”. The mother was reluctant to visit the doctor; and returned from the visit to his office angry and silent.
The mother will only say that “the doctor was very rude;” and she now wants nothing to do with western medicine. She is presently seeing an “herbal healer” who is treating her with acupuncture and Chinese herbs.
The daughter says she has spoken to the doctor, who maintains that he “simply tried to obtained informed consent” for a biopsy. He further explained that the mother needed to give consent both for the biopsy and for a mastectomy (surgical removal of the breast) if the lump proved to be cancer. But while he was explaining all this to the mother, she became silent, refused to talk further to the doctor, and left the office.
What do you think is going on? What would you say to your parishoner (the patient’s daughter)? What would you suggest to the doctor if he also asked your advice on what to do?