IN A FREE SOCIETY PATERNALISM CAN INFRINGE ON PERSONAL FREEDOM

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There is an old saying that the devil can quote scripture to his advantage.  Perhaps.  But there is no doubt that advocates of the culture of death can quote papal documents to their advantage by taking quotes out of context and applying the quotes in support of their Third Path proposals.  The Third Path encompases all those belonging to the culture of death who formerly were enthusiastic supporters of “death with dignity”, “assisted suicide” and “right to die” organizations.  The Third Path has abandoned those slogans as outmoded and has embraced “palliative care” as the best way of imposing death on very sick patients.

Before Christmas Joe Kral published two articles that attacked the opponents of Senate Bill 303 that died in the last session of the Texas Legislature.  On January 13, next week, the 2015 session of the Texas Legislature begins and Joe Kral’s articles were probably written as the opening shot of the battle that will be waged in this next session over life/death issues.  Joe Krals articles reflected the position of the staff of the Texas Catholic Conference staff and Joe Poejman of Texas Alliance for Life.  This Blog posted an excellent rebuttal to Joe Kral by Peter Amos before Christmas and now that the holydays are behind us Peter Amos has complemented his first article with a further refutation of the views of the pro-culture-of-death people.

– Abyssum

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Paternalism is the interference of a state or an individual with another person, against their will, and defended or motivated by a claim that the person interfered with will be better off or protected from harm. The issue of paternalism arises with respect to restrictions by the law such as anti-drug legislation, the compulsory wearing of seatbelts, and in medical contexts by the withholding of relevant information concerning a patient’s condition by physicians. At the theoretical level it raises questions of how persons should be treated when they are less than fully rational [e.g. comatose].

– Stanford University

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Unnatural Paternalism

by Peter Amos

 

A Texas ecclesiastic at a recent conference in Houston employed the Holy Trinity as a model for the relationship amongst the patient (or representative) – the doctor –the ethics committee: these three form a medical trinity of sorts. While I will not guess at the theology behind it, the analogy is useful because all three persons are essential, and no one can be eliminated. Similarly, pro-life opponents of SB 303 hold that all three – the patient, the doctor, and the ethics committee – are necessary to form, to alter, and to implement a Medical Plan of Care.

 

Pro-life opposition to SB 303 is NOT because we are vitalists, NOR because we have an all or nothing opposition to incremental advances in policy: we oppose SB 303 because we think hospitals should not be able to eliminate the patient from the process of forming a Medical Plan of Care regarding late in life decisions – even if there is some general consent to hospital policy obtained through POLST forms or other. In other words, the dispute is not necessarily over general principles regarding overzealous or ordinary and extraordinary care. The dispute is over who determines whether and which general principles apply in end of life medical decisions. For this reason, the Texas Catholic Conference is misleading in promoting “Vatican Documents that Supports Concepts in SB 303 here: http://www.txcatholic-advance-directives.org/#!terms-of-use/cz5r. These general concepts support the opponents of SB 303, as much or more than they support the Bill itself.

 

SB 303 stated that we ought to be able to depart from the “medical trinity,” and that the doctor and hospital can without the patient determine a Medical Plan of Care, if the patient (or representative) disagrees with their advice. For this reason, SB 303 resorts to the non-democratic, paternalistic model of medical decision making from early in the 20th Century (as previously described by Abysum). In short, SB 303 is a small, but important, step in an overall trend of empowering institutions to violate human autonomy – the new form of absolutism: unnatural paternalism. What is both sad and laughable is that a pro-life group – Texas Alliance for Life – is portraying this absolutism as respecting human dignity, while simultaneously advocating for the violation of dignity and comparing the patient’s request at the end of life for extraordinary care to the request for medical care from a hypochondriac, as did Kral.

 

Opponents of SB 303 hold to the medical trinity: all three — the doctor, the hospital, and the patient — are necessary in medical decision making. But there must always be a primacy given to the patient in the case of his own health care. If the doctor and hospital think the patient ought to accept the Plan of Care they propose, then they must take it upon themselves to educate the patient. Education is the answer, not SB 303’s legal elimination of autonomy or self-governance by what amounts to a declaration of incompetence. It is morally wrong to alter someone’s Medical Plan of Care without his/her informed consent, consent that is a necessary but not sufficient condition for bioethical action.

 

I had looked forward to Joe Kral’s second and final installment because he promised to discuss the “intricacies” of SB 303 in it. I was disappointed when he did nothing of the sort and, instead, argued that Wesley Smith is a vitalist whose misunderstanding of the teaching of the Church and of Saint John Paul II jeopardizes the future of conscientious objection, citing the same passage he had previously from Evangelium Vitae to justify his position. Kral/TAL are afraid that a doctor may disagree with a Plan of Care and not be able to absent himself from it. Their absurd response is to empower the doctor/ethics committee to disregard the patient’s will, and to try to ram it down our throats by (mis-)citing Catholic principles. SB 303 is not about protecting life, but about the indemnification of the doctor and hospital. TAL is merely the pro-life mask worn by the Texas Catholic Conference and the Texas Medical Association.

 

 

 

About abyssum

I am a retired Roman Catholic Bishop, Bishop Emeritus of Corpus Christi, Texas
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One Response to IN A FREE SOCIETY PATERNALISM CAN INFRINGE ON PERSONAL FREEDOM

  1. Kassi Marks says:

    Another very excellent post, Mr. Amos. Thank you again!

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