Admission to and Removal from Intensive Care: a Personalist Approach

Abstract

Over the past twenty years or so, a consensus has gradually emerged in the Western world concerning the moral and legal appropriateness of forgoing certain medical treatments in some circumstances. This consensus is based first on a recognition that not all treatments which prolong biological life are humanly beneficial to the patient, and, second on the general agreement that there is a moral difference between killing, euthanasia, and allowing to die. In the American legal system, these two views have been combined with the legal concepts of autonomy, privacy and liberty. These views reflect the distinction, between morally ordinary (or mandatory) and morally extraordinary (or optional) means of treatment (see, Wildes) and the distinction between killing and allowing to die. In this essay we hope to develop current understandings regarding the interplay between concepts of ordinary and extraordinary care and the Roman Catholic Church’s view regarding justice in the fair distribution of health care resources and apply these to the issue of developing criteria for admission to and removal from intensive care. In all of this, our explorations will focus on the specific problem of what criteria should determine whether a patient is to be admitted to or removed from the benefits of intensive care. Our approach will be personalistic, which means that we will develop a relational structure of the medical profession and thereby avoid an extremely individualism often found in the American approach.