Human Ecology, the Common Good and other nice ideas''

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Human Ecology, the Common Good and other nice
ideas..

• The impact of recent Roman Catholic Ethics on
  Public Health Practice

Jim McManus Asst Director of Public Health,
Barking Dagenham PCT Healthcare Reference
Group, Catholic Bishops Conference of England
Wales
Public Health Ethics Conference, 2007
May 2007
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Carbon Footprints!

• To reduce our carbon footprint we have not
  provided paper copies of this presentation today
• Please feel free to email me for an electronic
  copy
• jim.mcmanus_at_bdpct.nhs.uk

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Summary

• Context of religious ethics in public policy
• Historical impact of Catholic Ethics
• Clinical Bioethics
• Public Health (Social) Ethics
• Recent conceptual developments in Catholic ethics
• Impact of these on public health
• -Impact on Catholic Lead systems
• Impact on state and other systems
• Draw some conclusions

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Context of religious ethics in Public Policy

• Arguable landscape of influence and controversy
• We dont do God
• Separation of Church and State.honest
• Catholics and same sex adoption

• New Labour and Faith Groups
• Faith Fund
• Faiths in Major Incidents
• Faith Schools
• Care not Killing Alliance

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Historical Development of Bio-Ethics

• Catholic Moral Theology shaped many important
  principles in Bio-ethics
• Double Effect
• Beneficence (justice) versus Privacy
  (personalism)
• Fundamental Option
• Well documented
• Recent trends resource allocation
• But this view of development obscures the public
  health ethics influences

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Parallel Tracks in Biomedical and Social Ethics
easy to ignore the PH elements

• Moral Theology/Bioethics Casuistry of Medicine
• Medicina Pastoralis in usum Confessariorum
• Giuseppe Antonelli, 1891
• Allocution on Relief of Pain
• Pius XII
• Humanae Vitae
• Ashley and ORourke

• Social Teaching Inequalities and Environment
• Rerum Novarum (Leo XIII)
• Mit Brennender Sorge (Pius XI)
• Gaudium et Spes (Vat II)
• Pacem in Terris (John XXIII)
• Octagesima Adveniens (Paul VI)
• Centessimus Annus (JP II)
• Social Teaching Compendium

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Recent Developments in RC Ethics

• The Fundamental Option (Optio Fundamentalis)
• The Common Good
• Resource allocation seen in light of the Common
  Good
• Duties of the State
• Ambivalence towards the Welfare State
• Human Ecology
• Arose from the application of the Common Good
• An Ockhams Razor for assessing the
  anthropological impact of social and public
  policy
• Duty of Charity or Co-operation in moral evil?
• Healthcare professionals
• HIV Prevention

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Recent Developments Vibrancy and Relevance?

• Noonan moral doctrine developing and ethics
  developing from this influence systems of
  healthcare
• Cahill influencing healthcare systems and
  systems of public policy making around Quality of
  Life and resource allocation
• The new challenge of explicitly theological
  reasoning in the public square
• Development of social teaching to broader
  concerns including globalisation, while retaining
  anthropological concern
• Continued development of health challenges
• Continued development of moral tradition

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The Common Good (GS, 26)

• The sum total of social conditions which allow
  people, either as groups or as individuals, to
  reach their fulfilllment more fully and more
  easily
• Three elements
• Respect for the person as such public
  authorities bound to respect inalienable rights
• Social well-being and development of population
  Development is the epitome of all social duties
  (CCC,1907)
• The proper function of authority to arbitrate,
  in the name of the common good, between various
  particular interests but it should make
  accessible to each what is needed to lead a truly
  human life food, clothing, health, work
• Peace stability and security of a just order

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Human Ecology as a Principle for Public Health
Ethics (Centesimus Annus)

• In addition to the irrational destruction of the
  natural environment, we must also mention the
  more serious destruction of the human
  environmenttoo little effort is made to
  safeguard the moral conditions for an authentic
  human ecology..in this context, mention should
  be made of the serious problems of modern
  urbanization, of the need for urban planning
  which is concerned with how people are to live,
  and of the attention which should be given to a
  social ecology of work (next slide discusses
  these principles and application in PH work)

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Inequalities in Anthroplogical Perspective

• with respect to the fundamental rights of the
  person, every type of discrimination, whether
  social or cultural, whether based on sex, race,
  colour, social condition, language or religion,
  is to be overcome and eradicated as contrary to
  Gods intent
• Gaudium et Spes
• It is essential for every human being to have a
  sense of participating, of being a part of the
  decisions and endeavours that shape the destiny
  of the world.
• World Day of Peace Message 1985
• It is a strict duty of justice and truth not to
  allow fundamental human needs to remain
  unsatisfied, and not allow those burdened by such
  needs to perish. It is also necessary to help
  these people to acquire expertise, to enter the
  circle of exchange, and to develop their skills
  in order to make the best use of their capacities
  and resources
• Centesimus Annus

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The Fundamental Option

• Post Vatican II Moral Theology
• Rediscovering of Patristic and Scholastic
  perspectives
• A fundamental option is either made or not made
  by the person, the difficulty is enacting this
• Evaluate morally or ethically against a pattern,
  course for lifecourse, if this helps not just
  against a recent action
• Analogies with health behaviour change theory are
  obvious

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Problems in Deliberate or Reckless HIV
Transmission

• Application of Different Ethical Standards
• The Murderous HIV Infected Person
• The Reckless HIV Infected Person
• The Virtuous HIV Infected Person
• Slippery Slope Arguments
• Against disclosure
• For disclosure
• Abstract Reasoning or Negotiation?
• Inventing Moral Identities of Issue

Is there an ethical issue here about fear of HIV
and people with it? What do we as psychologists
have to day on the effects of this? Thomas
Aquinas and von Balthasar on fear
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Some immediate uses.

• Conflict of Principles
• Privacy
• Beneficence
• Vulnerability Human Ecology against the
  interests of the fittest
• Slippery Slope or Step Arguments
• Does consent (implied or actual) or recklessness
  as go self-care from the person to be infected
  make a moral difference?
• Useful in arguing against slippery slope concepts

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Sources and Norms hitherto

• Psychological Ethics
• strong deontological feel to it in many cases
• deriving from professional sense of duty and
  evidence
• Heavily predisposed towards privacy
• Medical Ethics has a much stronger involvement
  of law
• Disclosure guidelines in law
• Heavily predisposed towards decision making
  process by doctor
• Strong defence

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Five Principles

• Respect for Patient Autonomy
• Beneficence promoting what is best for the
  patient
• Non Maleficence avoid harm
• Justice
• The Person with HIV is not the only moral agent

Lest you think this is all gas, all of these
principles have surfaced in one way or another in
all the legal cases so far
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Moral Agency and the Fundamental Option in
Reckless HIV Transmission

• Moral Agency of Infected Person
• Moral Agency of Partners
• Knowing and Consenting
• Implicit Consent
• Recklessness
• Non Consenting
• Moral Agency of the Psychologist
• Moral Agency of the Medics
• Dumping on the Psychologists

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Problematic of historical approach

• The Five Principles (Autonomy,Beneficence,Privacy,
  Non-Maleficience, Justice,) point to an ethic of
  prudence which does NOT take responsibility for
  the person
• Falling Foul of the Criminal Law on Disclosure
• Falling Foul of Civil Law
• Adopting the Medical Model for doing things

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Hierarchy of Principles in Reckless or Deliberate
HIV Transmission
Arguably the Model Preferred by Law
Should it depend on the situation which comes
highest? Can Moral Agency be more salient than
Beneficence at times? Is a hierarchial model
workable?
Which comes highest?
Agency of Infected
Beneficence
Non Maleficence
Moral Agency of Infectee
Autonomy/Privacy
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Dynamic Tension Model and use of the Fundamental
Option
Beneficence
A possible option for Reform of Infectious
Diseases Law?
Moral Agency Optio Fundamentalis
Autonomy
Justice
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What are the key duties

• Within the bounds of the law
• Duty to weigh up beneficence against privacy
• Harm

• Within professional duties
• Duty to client wellbeing (trust and confidence,
  outcomes)
• Duty to safeguard others (beneficience)
• Duty to safeguard self (professional self regard)

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Acting Probably

• Acting Probably is a means of protecting you
  and patient against unintended consequences
• Risks if you do not acr probably
• Prosecution by police for not disclosing
• Civil suit by victims for not disclosing
• Civil suit by client for disclosing
• Professional standards disciplinary procedures
• Public Health Consequences

• Demonstrate you act in accordance with a body of
  sound professional opinion which has taken the
  law into account
• Document and evidence this
• Ensure you have taken reasonable steps to inform
  yourself of what the body of opinion is saying
  and continues to say
• Consult superiors and supervisor
• Take legal advice
• Act Consistently

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Acting Prudently

• The Law is a source and a norm for your conduct
  whether you like it or not
• The Optio Fundamentalis helps preserve autonomy
  while evaluating actions in consonance with other
  principles
• Avoid Consequentialism in Ethics on this issue

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When to Disclose?

• Intransigence/Refusal to Disclose
• Proximate Harm to Others
• Deliberate Intent
• Recklessness
• Indifference?
• Distal Harm to others?

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When Not to Disclose?

• Accident?
• Recklessness, or clearly implied consent by other
  parties
• Bug-chasers
• Optio Fundamentalis
• There is a real desire to do what is best, but
  this has to be negotiated round some very
  difficult circumstances

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Implied Ethical Duties before disclosure

• Autonomy - Give the person due notice and a
  chance
• Non-Maleficence - Advise them to seek legal
  advice
• Beneficence What could happen if you disclose
  too readily?

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Harm Reduction as an exercise in Charity

• The Body and its place in anthropological
  perspective
• Legal tradtion
• Theological traditions
• Health traditions
• These all have some common wisdoms about the
  body
• Injecting drug use and other behaviours which
  harm health have been seen as hostile to the duty
  to treat the body with dignity
• Some have suggested a harm reduction approach is
  formal co-operation in moral evil
• Recent use of Optio Fundamentalis, Human Ecology,
  and re-interpretation of the principle of Charity
  has lead to a number of different conclusions

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Harm Reduction as an exercise in Charity

• Australia
• Order of religious sisters providing harm
  reduction services including addiction
  counselling
• Decided to provide shooting galleries
• Theological rationale provided in The Furrow
• Balancing Act of Co-operation in Moral Evil vs
  the demands of Charity
• This principle has been further developed in HIV
  and AIDs casuistry to support policies of harm
  reduction (safer sex) in HIV at population and
  individual level
• This approach has influenced ethical discussions
  of HIV prevention and some work on barebacking
  culture

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Whats the Impact of all this? (Good? ill?)

• Catholic Church Funded Systems
• 25 of AIDS care globally
• Largest single hospital provider in developing
  world
• D
• Catholics active in healthcare in other settings
• Italian Cardiology system
• Amercian option for the poor systems
• Policy Network Approaches in UK
• HIV Criminalisation
• Resource Allocation
• End of Life Care

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Environment and Health Promotion

• Rome Symposium 2005
• Environmental Ecology and Human Ecology
  principles meet
• Environment seen as essential for human
  flourishing
• Back to the whole system approach of The Common
  Good
• Direct impact on environmental and health
  activism within Catholic Church agencies

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Human Ecology and the Policy Process

• Policies and processes which take a holistic view
  of the human conditions for development
• Informed objections to industrial development
  which harms health
• Lobbying for an ecological approach to health as
  a key consideration within development of public
  health policy
• The German Bishops statements on the Common Good
  and Social Welfare, and their statement on Health
  Systems
• The Australian and New Zealand church approach to
  planning for a pandemic

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Human Ecology and Resource Allocation

• Policies assessed against these principles
• Quality of Life debates currently being looked at
• Linking into virtue ethics
• In turn into positive psychology

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Conclusions

• The project of Public Theology is here for some
  time
• PH Ethics has to find a way of incorporating
  religious ethical discourse
• it is not exempt from same challenges others
  have
• Religious ethics needs to find a way of engaging
  in the public square
• Recent Catholic PH ethics show promise in
  this regard
• Public Health is an obvious place of
  engagement/battlefield
• Rules of Engagement
• Risks -
• Benefits equity? Cohesion? Quality of decisions?

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Contact Details

• Jim McManus
• Asst Director of Public Health
• Barking Dagenham PCT
• The Clock House
• East Street
• Barking IG11 8EY
• www.CatholicsinHealthcare.org.uk
• jim.mcmanus_at_bdpct.nhs.uk