ETHICAL AND RELIGIOUS DIRECTIVES
FOR CATHOLIC HEALTH FACILITIES
United States Catholic Conference
1971
While most religions avoid the use of codes of medical ethics, a notable exception is the Catholic Church, which has published codes of medical ethics in several parts of the world, principally though not exclusively for use in its hospitals. These codes are considered binding not only on individuals hut also on institutions: The medical staff, patients, and employees, regardless of their religion, are frequently expected to abide by such a code.
In the United States, a set of Ethical and Religious Directives for Catholic Hospitals was published in 1949 and revised in 1954. The 1971 Directives, which are printed below, were approved as the national code by the National Conference of Catholic Bishops. Most distinctive are the directives on abortion, hysterectomy, sterilization, and artificial insemination. A concluding section on spiritual ministrations to the sick has been omitted.
I. General
1. The procedures listed in these Directives as permissible require the consent at least implied or reasonably presumed, of the patient or his guardians. This condition is to be understood in all cases.
2. No person may be obliged to take part in a medical or surgical procedure which he judges in conscience to be immoral; nor may a health facility or any of its staff be obliged to provide a medical or surgical procedure which violates their conscience or these Directives.
3. Every patient, regardless of the extent of his physical or psychic disability, has a right to be treated with a respect consonant with his dignity as a person.
4. Man has the right and the duty to protect the integrity of his body together with all of its bodily functions.
5. Any procedure potentially harmful to the patient is morally justified only insofar as it is designed to produce a proportionate good.
6. Ordinarily the proportionate good that justifies a medical or surgical procedure should be the total good of the patient himself.
7. Adequate consultation is recommended, not only when there is doubt concerning the morality of some procedure, but also with regard to all procedures involving serious consequences, even though such procedures are listed here as permissible. The health facility has the right to insist on such consultations.
8. Everyone has the right and the duty to prepare for the solemn moment of death. Unless it is clear. therefore, that a dying patient is already well-prepared tor death as regards both spiritual and temporal affairs, it is the physician's duty to inform him of his critical condition or to have some other responsible person impart this information.
9. The obligation of professional secrecy must be carefully fulfilled not only as regards the information on the patient's charts and records but also as regards confidential matters learned in the exercise of professional duties. Moreover, the charts and records must be duly safeguarded against inspection by those who have no right to see them.
10. The directly intended termination of any patient's life, even at his own request, is always morally wrong.
11. From the moment of conception, life must be guarded with the greatest care. Any deliberate medical procedure, the purpose of which is to deprive a fetus or an embryo of its life, is immoral.
12. Abortion, that is, the directly intended termination of pregnancy before viability, is never permitted nor is the directly intended destruction of a viable fetus. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo.
13. Operations, treatments, and medications, which do not directly intend termination of pregnancy but which have as their purpose the cure of a proportionately serious pathological condition of the mother, are permitted when they cannot be safely postponed until the fetus is viable, even though they may or will result in the death of the fetus. If the fetus is not certainly dead, it should be baptized.
14. Regarding the treatment of hemorrhage during pregnancy and before the fetus is viable: Procedures that are designed to empty the uterus of a living fetus still effectively attached to the mother are not permitted; procedures designed to stop hemorrhage (as distinguished from those designed precisely to expel the living and attached fetus) are permitted insofar as necessary, even if fetal death is inevitably a side effect.
15. Caesarean section for the removal of a viable fetus is permitted, even with risk to the life of the mother, when necessary for successful delivery. It is likewise permitted, even with risk to the child, when necessary for the safety of the mother.
16. In extrauterine pregnancy the dangerously affected part of the mother (e.g., cervix, ovary, or fallopian tube) may be removed, even though fetal death is foreseen, provided that:
a. the affected part is presumed already to be so damaged and dangerously affected as to warrant its removal, and that
b. the operation is not just a separation of the embryo or fetus from its site within the part (which would be a direct abortion from a uterine appendage), and that
c. the operation cannot be postponed without notably increasing the danger to the mother.
17. Hysterectomy, in the presence of pregnancy and even before viability, is permitted when directed to the removal of a dangerous pathological condition of the uterus of such serious nature that the operation cannot be safely postponed until the fetus is viable.
II. Procedures Involving Reproductive Organs and Functions
18. Sterilization, whether permanent or temporary, for men or for women, may not be used as a means of contraception.
19. Similarly excluded is every action which, either in anticipation of the conjugal act, or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible.
20. Procedures that induce sterility, whether permanent or temporary, are permitted when: (a) they are immediately directed to the cure, diminution, or prevention of a serious pathological condition and are not directly contraceptive (that is, contraception is not the purpose); and (b) a simpler treatment is not reasonably available. Hence, for example, oophorectomy or irradiation of the ovaries may be allowed in treating carcinoma of the breast and metastasis therefrom; and orchidectomy is permitted in the treatment of carcinoma of the prostate.
21. Because the ultimate personal expression of conjugal love in the marital act is viewed as the only fitting context for the human sharing of the divine act of creation, donor insemination and insemination that is totally artificial are morally objectionable. However, help may be given to a normally performed conjugal act to attain its purpose. The use of the sex faculty outside the legitimate use by married partners is never permitted even for medical or other laudable purpose, e.g., masturbation as a means of obtaining seminal specimens.
22. Hysterectomy is permitted when it is sincerely judged to be a necessary means of removing some serious uterine pathological condition. In these cases, the pathological condition of each patient must be considered individually and care must be taken that a hysterectomy is not performed merely as a contraceptive measure, or as a routine procedure after any definite number of Cesarean sections.
23. For a proportionate reason, labor may be induced after the fetus is viable.
24. In all cases in which the presence of pregnancy would render some procedure illicit (e.g., curettage), the physician must make use of such pregnancy tests and consultation as may be needed in order to be reasonably certain that the patient is not pregnant. It is to be noted that curettage of the endometrium after rape to prevent implantation of a possible embryo is morally equivalent to abortion.
25. Radiation therapy of the mother's reproductive organs is permitted during pregnancy only when necessary to suppress a dangerous pathological condition.
III. Other Procedures
26. Therapeutic procedures which are likely to be dangerous are morally justifiable for proportionate reasons.
27. Experimentation on patients without due consent is morally objectionable, and even the moral right of the patient to consent is limited by his duties of stewardship.
28. Euthanasia ("mercy killing-') in all its forms is forbidden. The failure to supply the ordinary means of preserving life is equivalent to euthanasia. However, neither the physician nor the patient is obliged to use extraordinary means.
29. It is not euthanasia to give a dying person sedatives and analgesics for the alleviation of pain, when such a measure is judged necessary, even though they may deprive the patient of the use of reason, or shorten his life.
30. The transplantation of organs from living donors is morally permissible when the anticipated benefit to the recipient is proportionate to the harm done to the donor, provided that the loss of such organ(s) does not deprive the donor of life itself nor of the functional integrity of his body.
31. Post-mortem examinations must not be begun until death is morally certain. Vital organs, that is, organs necessary to sustain life, may not be removed until death has taken place. The determination of the time of death must be made in accordance with responsible and commonly accepted scientific criteria. In accordance with current medical practice, to prevent any conflict of interest, the dying patient's doctor or doctors should ordinarily be distinct from the transplant team.
32. Ghost surgery, which implies the calculated deception of the patient as to the identity of the operating surgeon, is morally objectionable.
33. Unnecessary procedures, whether diagnostic or therapeutic, are morally objectionable. A procedure is unnecessary when no proportionate reason justifies it. A fortiori, any procedure that is contra-indicated by sound medical standards is unnecessary.
[Reprinted with the permission of the Department of Health Affairs, United States Catholic Conference.]