A Bare Essential

by SFXparish | Apr 1, 2020 | EDITORIAL

It is now about two weeks since our Commonwealth has been operating solely on “essential services”. This unprecedented and resolute reduction in economic and personal activity for the purpose of “social distancing” was of course implemented to stop the spread of a novel strain of Corona virus.

To effect this change, a nine page COVID-19 list of essential services was promulgated by Governor Baker. Each service on the list is considered to be indispensable to the lives and functions of citizens during this pandemic. It is a comprehensive list which provides all observers of the human condition with an interesting perspective not only on the government’s priorities but on its notion of man.

Interestingly, our governor does indicate (on his order dated March 23rd) that “workers at places of worship” do provide an essential service. They can be found under the rather dull and disorderly title of “Other Community-Based Essential Functions and Government Operations”. Other essential roles deemed similar enough to be in this category with church workers are: election personnel, weather forecasters, hotel workers and laundry services. This would actually be humorous except that “workers at places of worship” is the last item noted in this jostling jumble of jobs. It is at the very bottom of the list.
Now something is seriously amiss in the deliberations of any government-of-the-people when it is unable to think of even one essential service to place under a heading titled “Religion”, especially when, as is the case with our state leadership, it is quite able to come up with three services under the heading “Hazardous Materials”. Yet truly, what should we expect from a state government that excludes the Church from the role of adoption provider for deeming male and female parents as “essential” to the raising of children.

Now state and church both exist for man. The former is natural to man; the latter supernatural. Yet both are providential in the will of God. Each has its source in God. As such, both are meant to agree on the essentials for man. In times when reason and faith are both held high and in accord with each other, state and church will agree on what is essential to man. Sadly, this is not the case in our times.

In fact, any statist government that sees religion as a solely private affair meriting no say in civil matters has already failed to grasp the essential nature of man. Mundane man (male and female), man who has one ear planted on the earth and the other ear blocked to heaven, is not complete man and therefore will know and understand only some of his own needs. He will follow mostly his inferior needs thinking these to be essential.

This is the situation we find ourselves in now, since for example while religion has become barely essential to the public welfare, abortion has become one of its bare essentials. Andrew Beckworth, President of Massachusetts Family Institute. recently informed its supporters in an email of how the Department of Public Health in Massachusetts exempted abortion from its list of non-essential elective surgeries during this pandemic, therefore (essentially) declaring abortion to be an essential service. Considering former moral decisions and acts of our governorship and the department of public health, Massachusetts citizens should not find this surprising. However, if we are to be thoughtful citizens and grasp what is going on we must put on our thinking caps and consider the very meaning of the term “essential”.

“Essential” comes from the Latin essentia, meaning “in the highest degree”. Essentia (English “essence”) has deeper roots in the Latin term esse meaning “to be”. Thus, when we speak of essentials we are speaking of those things that we need because they fulfill our human nature, that is, those things or activities or powers that make us what we are.
This is why it is all the more disturbing that states such as Colorado, Massachusetts and Washington, which have stopped all elective surgeries to conserve their in-state medical protective equipment, have at the same time exempted abortion from their stop order. Yet our purpose here is not to examine the political debate over these decisions but rather to examine the philosophical undertones and fallout over, for instance, the National Abortion Rights Action League’s (NARAL) colluding position that surgical abortions, including all elective surgical abortions, ought to always be considered “essential”.

NARAL, Planned Parenthood and various other feminist organizations have consistently taken the public position that abortion is an essential service to women’s health. However, they cannot call abortion “essential” without exposing their foul presumption that abortion goes to the very essence of womanhood! When we say that food, shelter, clothing, freedom of movement, social association, and religious worship are all essential to man, we are saying that that these things are necessary for man to be man. By comparison when the feminist and her feminist allies say that abortion is essential to women, they are saying that abortion is necessary for women to be women! They are saying that women need abortion “to be” what they are, i.e. to fulfill their gender.

Back in October 2015, in a piece for The Nation, feminist writer Katha Pollitt penned an essay entitled “Gender Equality Is Not Possible without Abortion”. Now we have neither the space nor the time to debate that obfuscating term “gender equality”. Suffice it to say that to make the claim that abortion is essential for female equality is to make the claim that abortion is essential for the female to be who she is meant to be; to achieve her essence.

Some feminists might shiver at the claim that women cannot be women without the right to destroy their own child in the womb (however most are stone cold believers of this)! This is the principle they stand for and act upon: abortion as equalizer, as fundamental right, as essential need; abortion atrociously authenticating the very essence of womanhood.

-Steve Guillotte, Director of Pastoral Services

Utility and Fidelity

by SFXparish | Mar 25, 2020 | EDITORIAL

In a recent article in The Atlantic on-line magazine (March 11) writer Yascha Mounk provided commentary on guidelines published by the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI).  Mounk explains that this document likens “the moral choices Italian doctors may face [concerning the COVID-19 virus epidemic] to the forms of wartime triage”.  Mounk describes how the document recommends the utilization of “distributive justice” and “the appropriate allocation of limited health resources.”

Mounk declares that the methodology of justice applied by the college is “utilitarian”.  This is the idea that the morally right action is the one which produces the most good.  He quotes the college’s position on distributive justice to be: “those patients with the highest chance of therapeutic success will retain access to intensive care.”

Now if you are of a suspicious nature and the hair stands up on the back your neck when national doctors’ groups proclaim themselves ethicists, then you may have already guessed correctly what comes next: “It may become necessary to establish an age limit for access to intensive care.” Just in case the physician group’s statement remains unclear here is Mr. Mounk’s full translation of it: “Those who are too old… or who have too low a number of ‘life-years’… would be left to die”. Mounk informs us further that not only age but “comorbidity” – the presence of more than one illness occurring at the same time in the same person – will also be “carefully evaluated” by the doctor to determine who might be more likely to die. However, when the decision is made as to who lives or dies based on available resources, those who “require a greater share of scarce resources” i.e. “older or more fragile patients”, would be on the top of that list.

Mr. Mounk then proceeds to make his case in support of the doctors’ college.  He does so by posing his argument in the form of question: “If you are an overworked nurse battling a novel disease under the most desperate circumstances, and you simply cannot treat everyone, however hard you try, whose life should you save?

This would seem a mind-bending question if it did not open with an entirely false assumption: that nurses, overworked or not, ought to be calculating who lives and who dies.  The problem with Mr. Mounk’s thesis is that it presupposes that doctors and nurses have, by virtue of their profession, a right to decide who to save and who not to save. They don’t.

Let us begin with triage.  Triage is not for deciding who lives or who dies.  Triage is primarily for assessing the wounded, a lot of wounded, for the purpose of deciding the order of treatment, not the order of dying.

As for “utility” and “distributive justice” the college’s use of these terms is distortive.  First of all, distributive justice is not solely about the distribution of resources to individuals based on someone’s determination, but about a guarantee to the individual that the privileges of society will be equitable and unbiased and that everyone in society will share not only in the common benefits but also in the common burdens.  Further, the “utilitarian” concept is not only concerned with the greatest good for a society; it is also concerned with the impartial good of everyone.  This is how the Stanford Encyclopedia of Philosophy explains utility: “Everyone’s happiness counts the same”.

Should there be an age limit on access to intensive care? Is this the way it really works in wartime?  Are the older, wounded officers put at the bottom of the list for emergency surgery because they are older?  Do the doctors stand around and say, “Well, this fifty-year old major is a chain-smoker with severe hypertension.  Leave him to die and bring in the private first class”!

Is the doctors’ recommendation of screening-out who lives by age and pre-existing condition so preferable to “first come – first serve” as they claim?  When an eighty-two year old man with diabetes presents with COPD needing a ventilator and three devices are still available, do you refuse him one because you are expecting a few younger COVID-19 patients to come through the door?  Their “utilitarian” approach would say so.

We readily grant that doctors and nurses have an agonizing job in times of disaster and limited resources. I believe that in such circumstances they do their best to treat everyone. However, as healers they should not be strategizing beforehand about who lives and who dies over resources, especially as this strategy does not even mesh with the ideas of utility and distributive justice that make up their strategy. Doctors must decide in times of crisis. We want to trust their decisions. Yet they appear lest trustworthy when they are wont to withhold care based on a predetermination against age and fragility.

More than one week after reading Mounk’s commentary, I watched a video of intensivist doctors and nurses working in the busiest hospital in Bergamo, the Italian province hardest hit by COVID-19.  I was impressed by the dedication of these caring professionals to treat every patient that comes to them.  They may have been forced to turn their ER into an ICU, but they have not been moved to follow the guidelines of the SIAARTI.

If this Italian college of doctors is truly concerned about justice, it should rewrite its proposal and begin with communitive justice. This form of justice regulates the rights between one person and another. As a virtue it is most suited to the patient/doctor relationship: two human beings, meeting face-to-face, not hiding behind policy.  Hence, through an honest, compassionate conversation about his terminal condition the critical care patient (or he holding proxy) may even decide to give up his just claim to a ventilator for the patient next to him, in exchange for the doctor’s pledge to try to keep him comfortable.  Then, medicine will not only be about justice and utility, but about love and fidelity.

-Steve Guillotte, Director of Pastoral Services