The Manual of Catholic Medical Ethics has been published as an English edition to a work produced by distinguished Dutch authors in 2010. It is subtitled Responsible Healthcare from a Catholic Perspective and with some understandable limitations, it delivers this. The authors are well qualified, including perhaps the only cardinal in the Catholic Church who has both an MD and a PhD in bioethics, and at least two other authors who are active physicians as well as ethicists. They may not be well-known to American or British audiences, but the translation into English is both smooth and accessible. (A subsequent scandal involving an English translator appears to affect the reliability of the book in no way.)
From the onset, it is made clear that the intention of this book is to present Catholic teaching on medical ethical issues with an emphasis on general principles of medical ethics, based on a Catholic view of man. Philosophical as well as theological argumentation is used throughout, and Thomistic philosophy is emphasized. Philosophers, theologians, saints, as well as documents of the Church are frequently cited. The introduction even has a chart explaining levels of the Magisterium and degrees of certainty of their respective teachings.
There are seven chapters: the first addresses the fundamental assumptions of medical ethics, primarily according to Catholic principles, then concludes with a Catholic vision of health care. The second chapter focuses on developing human life with an extensive treatment of the status of the human embryo. Abortion, preimplantation and prenatal diagnostics, and embryo and fetal experimentation are then dealt with. The third chapter continues with an examination of the status of human procreation, regulation of fertility, and artificial sexual and asexual procreation. Cloning and genetic modification and sex selection are discussed.
In the fourth chapter, typical topics of medical care are reviewed, including scientific research, medical decision-making and informed consent, proxy consent, diagnostics, and therapeutic interventions. The topics seem to jump back and forth within this chapter with a long section on organ donation and transplantation, and brain death, followed by somatic gene therapy, and then an extensive section on psychiatric ethics and addiction medicine. The emphasis given to each of these specific topics may not reflect their frequency or importance in the experience of those doing ethics consultations. For instance, the sections on CPR (cardiopulmonary resuscitation) and DNR (do not resuscitate orders) as well as the section on advance directives are quite brief; and the section on informed consent is focused primarily on research, despite the fact that all these are important areas in the day-to-day ethical challenges arising in clinical care.
The fifth chapter examines nontherapeutic interventions such as plastic surgery, sex change surgery and transsexuality, and enhancements, both pharmacological and genetic. There is also a section on transcranial magnetic stimulation and brain implants.
The sixth chapter deals with issues at the end of life, including antenatal issues, pastoral care, quality of life, palliative care, and euthanasia and assisted suicide, including restrictions on nutrition and hydration and palliative sedation. Given their prominence on the Dutch medical scene, it is a shame that these topics have not been systematically updated. In the past few years, euthanasia and assisted suicide have been systematically expanded to include psychiatric patients, dementia, and children. Although the data regarding these may be changing, the fundamental moral arguments opposing these actions are well treated.
The book closes with social aspects of health care, which covers various topics from equal access to professional communication and confidentiality. Some of the latter could have been included in the previous chapters. There is also an appendix discussing the Hippocratic Oath with a commentary, an extensive bibliography, and an index, which makes the topics much more accessible.
This book will be useful to those seeking a solid Catholic approach to issues in medical ethics. Those who are looking for more specific clinical answers may not find them all here. In part, this is due to the gap between its original publication date (2010) and the present. However, there are current topics that are either treated superficially or not at all, such as futility, conflicts of conscience, the models of the doctor–patient relationship, and health-care delivery systems. This is all the more surprising, given the number of physicians involved in the production of this text. It would be a good teaching tool for moral theologians and would provide a solid background for practicing clinicians. However, at over 600 pages, it would not constitute an easy introductory text.