voidably be saying what he or she would want to be (what kind of life), not what kind of life they could come to live with God's grace and sufficient supports were they terribly deprived. Second, the tiny infant has no background, no history, no biography of aspirations and perspectives against which we can make a judg­ment. And third, therefore, the kind of judgment we make about defective newborns is in principle applicable to all babies. It is generalizable.  That means that all babies are at risk in our quality­of4ife judgments about instigation or withdrawal of treatment at this time.

On the other hand, I am in agreement with Dr. Judson C. Ran­dolph (surgeon in chief, Children's Hospital National Medical Center, Washington, D.C.) when he states, "I think it is well within the guidelines of right and wrong to make certain qualita­tive judgments about human life...." Dr. Randolph continues:  "If a severely handicapped child were suddenly given one moment of omniscience and total awareness of his or her outlook for the future, would that child necessarily opt for life? No one has yet been able to demonstrate that the answer would always be 'yes.' "4 In  judgment, the perspectives of the Christian tradition on life and its meaning would suggest that in some instances the an­swer would be "no." Our main task as reasonable persons is to dis­cover where the line is to be drawn and why. Our temptation as adults in a highly function-oriented and comfort-biased world is to draw it in terms of adult perspectives on comfort and func­tionability. What we are likely to forget--and therefore what is eminently part of our responsibility for health--is that these deci­sions are terribly anguishing, terribly risky, and utterly final. Moral responsibility demands sensitivity to this and a corresponding hu­mility.

 

4J. G. Randolph, "Ethical Considerations in Surgery of the Newborn," Contemporary Surgery, 7 (1975), 17.

 

VI

In reflecting on "man's moral responsibility for health," we may easily forget any number of things about the notion of morality. The first thing we are tempted to forget is the distinction between "moralism" and "morality." Moralism is that attitude or mind-set that approaches human problems with a dominating, perhaps even exclusive concern, for the prescriptive and proscriptive, for the permissible and the nonpermissible, the do's and the don'ts.  This is particularly the temptation of the Anglo-Saxon mind, which thinks of law as being the answer to all problems, the only answer, and a fully adequate answer.  When this attitude enters the realm of moral discourse and reflection, it becomes preoccu­pied with norms and rules.

Now, there is nothing objectionable about norms and rules-indeed, they are utterly essential. But they are basically general­izations on the significance of human conduct.  If that is the case, our first task is always to understand the significance of our con­duct. It is only then that we are positioned to formulate and apply norms. Preoccupation with norms is moralism, and the problem with moralism is that it bypasses and therefore effectively subverts the processes leading to understanding.  Without adequate under­standings fully informed as possible by all the disciplines that can enlighten the human-we fall into education by edict, which is no education at all. And we fall into practice by conformity, which neglects important human aspects of conduct. This hap-pens all too often in the area of sexual morality, where our preoc­cupation with the rights and wrongs hurries us over the very un­derstanding that alone yields the true rights and wrongs.

In the area of health care, there is, I submit, an enormous amount of moralizing going on-a phenomenon that can block the development of a genuine morality, thus subverting our moral responsibility for health care. For instance, the morality of care for the dying is often popularly framed in terms of "pulling the plug" or "not pulling the plug." We discuss whether there should be a law controlling DNA recombinant research. We wonder whether a patient may elect to forego hemodialysis. We ask whether the incompetent retarded person may be protectively ster­ilized. We conduct long discussions about the moral propriety of in vitro fertilization. And so on. These are all important issues, of course. But their resolution must occur within a much broader context if we are to avoid moralism, the context of profound de­liberation about human and Christian being and end, about who we are.

            It is conversation about who we are that is so often bypassed in contemporary discussions about health care. But it is precisely who we are that will inform us about the shape of our health-care responsibilities. (For a fuller treatment of those issues see Chapters 6 and 7.) For the moment, however, let me take but a single exam­ple. It is axiomatic that we are social beings, that we move and lit­erally have our being not as atomized individuals, but as in­terrelated beings. We exist in relationships and are dead without them. This is not surprising to those who believe that man is created in the image and likeness of God, for the more we know of God, the more we know that He is relation, that His very being is "being in and for another." As man comes to know more about himself through psychiatry and clinical psychology, it should not be surprising that his Godlikeness becomes more obvious, that he sees that he is made for relational life, and that everything in his makeup (including instincts and emotions) conspires to relational possibility or, as undeveloped, hinders it.

          The ultimate meaning of this relational constitution of the human person is love. In Christian perspective, we could put it as follows: The great commandment, in a sense the only command­ment, is the love of God and of neighbor for God's sake. All other Christian duties are simply specifications of this command. But not only is this a command; Cod's commands are also affirmations about ourselves. In telling us that the great commandment is love of God and neighbor, Christ was actually telling us what is good for us and what we are. He was saying that our own completion and fulfillment are to be found here, hence that ultimately our eternal happiness depends on love and is love. If one is to find life, one must lose it-in the divestment of self that is love.

            Now, what is interesting here is that just as my ability to love God is His gift to me, so our ability to love each other is our gift to each other. The greatest human need is to be loved; for unloved, I remain unloving, withdrawn, self-encased. But when I am loved in a full human way, selfhood, personal dignity, a feel­ing of security, a sense of worth and dignity are conferred upon me-the very things that enable me to respond to others as per­sons, to love them. Thus it is clear that because my greatest fulfillment is the other-centeredness of love, my greatest human need is for that which creates this possibility-that is, love from others, their acceptance of me as a person. Similarly, my greatest

Some Neglected Aspects of Moral Responsibility for Health  43 gift to them is my self-donation to them7 because this is also their greatest need. Modern psychology, in uncovering the growth proc­ess that leads to the ability of self-donation in interpersonal relationships, has not only described a capacity, it also has at once de­scribed a need. And in doing this it has painted in bold colors the ultimate meaning of any concrete act of charity, justice, fairness toward men.

            What has all this to do with responsibility for health care? The following, I would suggest: Unless prevention, cure, and care are experienced as extensions of genuine human caring and love, they are less than they could be. They do not touch the whole person; rather, they minister to a body. They may heal a body, but we long for and need a deeper healing from each other as the body is healed, or even at times if it is to be healed. That is one good reason why persons of deep faith and religious consecration should be in health care, for in our time, it is far too easy for health care to be reduced to only bodily care, in a very impersonal way. That is why there is a profound difference between physicians, para­medical personnel, and a hospital with a self-image of vocation, on the one hand, and those with a self-image of only "being in business" on the other. This difference manifests itself in subtle but very important ways. Unless we are aware of this, we drift to­ward moralism, the extension into the moral sphere of a merely technological assessment of man.

            What I am driving at is that moralism, and excessive preoccu­pation with "problems" and the rights and wrongs of omissions and commissions, too readily leads us to overlook the human qual­ity of care and cure-that which we need no matter what our con­dition. I believe we are likely to forget this in discussing moral re­sponsibility for health. The New York Times recently reported the remarks of a surgeon whose kidney-transplant recipient was undergoing anxiety and depression after his transplant: "Well, I gave him a good kidney; I can't help what's wrong with his brain."5

 

5New York Times (May 11,1977).

 

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