Hospice Patients Alliance: Patient Advocates




Man in the World




(Part of the Ethics of Life Series)



by Ron Panzer

April 17, 2013

Part Five of Ten



Justice


Those of us who hear the call to service ask, "What is right to do?" "What is just to do in this situation?" Yet, what determines whether an act is based upon justice or not?

Justice as a virtue within a man "is a habit by which a man" regularly wills to, and does, give everyone what is rightfully his, what is "due to" him in any specific situation. Justice is the virtue in a man which enables him to regularly respect the rights of other men, human rights. It perfects the will, because our free will is rightly used.1

When the just man looks upon others, he realizes that all of us are equal before God, created equally human by Him and therefore, equally deserving of respect and care. For this reason, there can be, and never will be, an elitist attitude within the just man. We are all equally bound to obey the law and are equally punishable for transgressions of the law.

There are two paths in life: the just way of life and the unjust way of proud man that leads to death. The way of life ultimately leads us to taking into ourselves and accepting that which the Tree of Life gives: eternal life (Genesis 3:22, John 3:16). The way of death leads us to take in what the Tree of Death has to offer, pride, rebellion, confusion, division and hatred. The way of life nurtures true justice in man's relationship with others, establishing the culture of life, while the way of death, breeds injustice, evil and the culture of death.

The Tree of Life that yields eternal life is nothing other than the dear Lord (John 14:6). As Jesus said:

"I am the resurrection and the life.
He who believes in Me, though he may die, he shall live.
And whoever lives and believes in Me shall never die....    - John 11:25-26

"... I am the bread of life. He who comes to Me shall never hunger,
and he who believes in Me shall never thirst."

"... this is the will of Him who sent Me,
that everyone who sees the Son and believes in Him
may have everlasting life; and I will raise him up at the last day.    - John 6:35,40

There is no adherence to truly just ways of acting and no respect for human rights without acknowledging Him, accepting Him, and following the divine and the natural moral law. In a secular culture of death, however, an unjust man will not even consider these. He will look upon others and see all the differences that divide us, treating himself and his elite friends preferentially and others prejudicially, to their harm.

In the case of a patient in need of care, authentic justice demands that the physicians, nurses and other healthcare professionals provide that care which is due him, the care which lovingly promotes healing or comfort. Justice demands, as the great physician Hippocrates taught, that we do no harm in our healing ministry — for that is what healthcare is, a ministry of love guided by right reason and the collective body of medical knowledge.

To do no harm, we must make the effort to practice our healing arts with dedication, with care, and acquire the knowledge to provide the best care possible to those we serve. In healthcare, we must act precisely, guided by the standards of care that have the effect of law within our field.

In healthcare, in order to do no harm and justly provide for our patients what is due to them, we must act guided by the ethics of life. And in this setting, we must be humble enough to hear and learn from the feedback of those who would correct us as needed, so we may develop our skills and understanding in our chosen field of practice.

It is easy to see that if we are to successfully consider what to do, and then will to and actually do the right, we must do more than mechanically and legalistically follow a rule (Matthew 23). It helps to have been raised properly within the family and community environment, or to have had experiences that we positively responded to and used to develop a properly formed conscience.

We must be educated in our field, in order to understand what is right in each setting, and to increasingly and habitually practice what is right in our choices and actions in this world. More than that, we have to be receptive to Him to find the way (Psalm 143:8).

If we are receptive, we become aware of His presence in our lives, and following the law becomes more natural to us. Though it becomes more natural to us, we are still imperfect men and women and certain to make mistakes at some point or another. Recognizing our imperfection, we make a habit of striving to make sure we perform our tasks rightly, even those that seem insignificant. For the dear Lord told us:

"Whoever can be trusted with very little can also be trusted with much,
and whoever is dishonest with very little will also be dishonest with much.    - Luke 16:10

If man was utterly good and honest, there would be little need for law, but because man is not, he needs the law to guide him. For this reason, God gave the divine law, the Ten Commandments, to the people. But, as man's tendency to do the wrong increased, and the divine law was ignored and disobeyed, there was need for more laws.

Proud man chooses to follow a way that fulfills his short-term selfish desires, contrary to God's way, and then ends up harming himself and others, as well as committing all sorts of crimes. It is due to man's degraded nature that he commits an endless variety of crimes which in turn require innumerable laws to deal with each of them.

Some of the pharisees and sadducees of Biblical times who knew the letter of the law in great detail but did not put into effect the spirit of the law, demonstrated that dry, intellectual knowledge alone, even great knowledge of the law, philosophy and theology, is completely inadequate to help man obey the law or apply the ethics of life and to please God. Those who were proud in their learning hated being corrected (Proverbs 9:8). The same is true today as in any day.

If we would do right and treat others justly, we need to listen to our conscience informed by right reason and the law, but also informed by the spirit of love. The dear Lord explains that "the more important matters of the law" consist of "justice, mercy and faithfulness," and true justice, mercy and faithfulness cannot exist without love (Amos 5:24; Matthew 23:23).

Those empowered to dispense justice, whether kings, judges, or others, must be unbiased and intellectually honest in order to prudently size up a situation and know what is right to be done. In other words, there is something about the person rendering justice that enables him to actually be just.

That characteristic is prudence, the ability to know how to act rightly, and in these situations, the actual habit of acting and ruling justly. In one who must judge, prudence results in accurate evaluation of the acts alleged to have been done by the accused as well as the determination of an appropriate punishment.

It is often due to a lack of justice that the people cry out to those in power. When they fail to obtain justice from those in power, the people cry out to God in anguish. The thirst for justice exists within every man's heart, but it is how we seek it that makes all the difference, for we, ourselves, also must be just.

If we are just, we give generously to those in need what is right and appropriate for their specific need, guided by a spirit of mercy and faithfulness to our role as servants to all who come to us in need. If we are just, we act with faithfulness to God, that we would not be ashamed before Him for what we do. In so doing, even when surrounded by those who may treat us unfairly, we seek to live blameless lives.

If we are to live justly, we have a duty to give to each person what is rightfully theirs. We have a duty to ourselves and those around us to do that which will allow us to most perfectly fulfill our purpose in life. Therefore, we have a duty to diligently study, learn, work and deepen our understanding of the Law which sets forth the ethics of life which infuse a charitable spirit into all we do.

Physicians often think about their duty to heal when their skills can help the patient to heal, and to at least provide comfort when they cannot. Many today forget, or have never learned, that to practice medicine justly, they also must act in a way that affirms and respects the life of their patient.

If we are to live justly, we have a duty as man to reverence and adore2 God (Deuteronomy 6:13), since that which is right to give Him is our adoration. We can look to the many examples given to us by that true Man who was called Yeshua (Jesus), who showed us in so many ways what it means to live a righteous life! If we are to act justly, we must follow in His footsteps, as best we can, and practice sacrificial love.

When we think of how the dear Lord served and healed those who came to Him for help, we know we are to act justly by humbly serving, comforting, and promoting the healing of those in need. He forgave those who sinned yet repented, and we, too, are to forgive those who may have harmed or hurt us in any way. He was merciful, and so also should we be merciful to those so desperately in need.

When the hungry and poor came to Him, He fed them. So also should we be generous to others. When others were about to kill the helpless and accused, He defended and protected them (John 8:2-12). We also must protect life.3

Mercy


When authentic religion becomes part of our lives, we lovingly remember our Lord, and there is nothing we can do with regard to others than be merciful and kind. The dear Lord told us that "the more important matters of the law" are "justice, mercy and faithfulness" (Matthew 23:23).

It is not possible to fulfill any one of these without involving the others: they go together. An act that is cruel and unmerciful cannot be just. An act that is unjust is not merciful, and acting unfaithfully will never lead to mercy or justice.

Throughout His life in this world, the Lord acted mercifully toward those who were suffering, acting to relieve that suffering, to comfort those who mourn, to heal those who were sick, and to bring peace to those who were in distress. In healthcare especially, we need to keep the Lord's example before us at all times.

Any system of "ethics" that neglects to include mercy, justice and faithfulness will lead to the commission of evil and harm many. This is exactly what the prevailing secular bioethics used in healthcare today accomplishes: it "justifies" harming others, "justifies" killing the vulnerable, and "justifies" depriving patients of food, water and other appropriate and necessary care.

Mercy is what all of us seek when we experience the anguish of a suffering that will not go away. Mercy is what we seek when found guilty of a crime and are about to be given a punishment by those with the authority to decide our fate.

Mercy is what we cry out for when we finally see how low and evil our own lower nature and mind actually is. We recognize that we deserve nothing but punishment, but we hope for mercy. The grace God gives us by forgiving us for what we do wrong, for the darkness within us, is nothing but divine mercy.

When we meet the patient, those in need, with a softened heart, what can we do but care for them justly, kindly, and mercifully, providing for their needs as best we can? With a spirit of mercy, can we act unkindly or cruelly? Can we be impatient with those who are in great pain? Can we deceive them, deprive them of food and water or act to kill them when the virtue of mercy guides our actions? Never!

If we have given our hearts to God and adore Him, if we have recognized that our lives must be dedicated to Him, we realize that our lives are not our own to misuse.

We recognize that our patients' lives are not ours or theirs to misuse: they are His. We are called to serve! We are called to care! Knowing this, could we ever kill ourselves, or have others kill us? Never!

We have the rest of our lives to live for Him and those around us. Even if we are ailing, we may never know what good we might do for others through our living! Those who receive care do provide a gift to those who provide care, and those nearing the end of life may still affect those who remain.

There is no question that those who act to end the lives of the vulnerable act contrary to the spirit of mercy, justice and faithfulness. When they speak of "mercy killing," they contradict everything that defines mercy. They betray the trust given to them by the patient. We can never make a just decision, an ethical decision, if we forget to act mercifully and honor the life before us.

When a patient experiences suffering, it is natural and also our duty to seek to relieve that suffering through all available moral means. However, to sedate a patient permanently so they die and then are "relieved" of suffering is an evil. We cannot kill the one we serve in order to relieve suffering, though many are clearly tempted to do so. It is not our duty to determine the timing of anyone's death. The decision to withhold food and fluids is a decision that the patient die.

In many cultures, the sharing of food is an expression of love, and people say, "Food is love." Sharing meals is a way in which family and friends bond with each other. Sharing food is sharing life.

Breaking bread

It is significant that in the culture of death today, the most common method of imposing death is through the Third Way or "Third Path" method of killing — withholding food and fluids, often while sedating the patient permanently.

There is no expression of real love in the culture of death. There is no sharing of food and no true bonding with those considered unworthy of life. There is actual abandonment and betrayal of the patient's need for affirmation, that their life has meaning, even in the end.

The culture of death is based upon self-centeredness, self-pride, and greed, whether that of the family members, the healthcare professionals, society as a whole, and yes, sometimes, the patient himself or herself. Imposing death is not mercy. Staying with the patient and caring for them is mercy.

St. Thomas Aquinas tells us that "of all the virtues which relate to our neighbor, mercy is the greatest." Among all the things we may do in this world, the act of mercy "surpasses all others." "The sum total of" what the Lord Jesus taught us regarding our actions in this world "consists in mercy."4

It is not possible to ignore mercy and do anything that is truly ethical in healthcare or society in general. When we are concerned about acting ethically so that justice is established in society or administered in our healthcare agencies, mercy must be uppermost in our minds. In every land and every culture, those who suffer pray to God as they know Him for mercy.

Whether we give charitably, pray for those in need, or actively serve in some way, when confronted with the sorrowful, with those who suffer so terribly, if we are not touched and inspired to mercifully serve others in a way best suited to the abilities we have been given, as we are able, the love of God is not in our hearts.

Psalm 31:1-5

In You, Lord, I have taken refuge;
let me never be put to shame;
deliver me in Your righteousness.

Turn Your ear to me, come quickly to my rescue;
be my rock of refuge, a strong fortress to save me.

Since You are my rock and my fortress,
for the sake of Your name lead and guide me.

Keep me free from the trap that is set for me,
for You are my refuge.

Into Your hands I commit my spirit;
deliver me, Lord, my faithful God.

Faithfulness


When we are at our weakest and most vulnerable, when we are all alone, when we fear for our very lives as all of us do one time or another, we cry out, "Deliver me, Lord, my faithful God." (Psalm 31) It is because He is faithful, that we can take refuge in Him and rely on His grace every day of our lives.

We, who are lost, take refuge in Him, the most trustworthy of all, the God who is with us! As the prophet Moses told the people, "the Lord your God goes with you; He will never leave you nor forsake you (Deuteronomy 31:6)."

For the patient in a healthcare setting, faithfulness (or "fidelity") on the part of all healthcare professionals and caregivers is especially indispensable. It is indispensable in any field where one's act may have very serious consequences that will affect the very life of the person being served. When a physician determines the treatment that is necessary to assist in the healing or recovery of a patient, and orders that it be done, faithfulness to that order is a basic element of a successful treatment plan.

All the way up the chain of command and down to the lowest level, all must act faithfully so that their promise to follow orders is kept. Any worker who chooses to step into a healthcare setting is stating through that action that he or she will follow orders and be faithful to them. Such fidelity is assumed within the military, and it is just as much assumed to exist within healthcare. Fidelity or faithfulness is obedience to orders, to the law, to the promises and vows we have made to God and to each other.

Obedience is an unpopular concept within today's rebellious culture. People have been taught to distrust authority, to "do their own thing," and to never listen to anyone but themselves. Yet, when the law is just, and God's divine law is perfectly just, then obeying it makes sense. Right reason confirms the perfection of His law. Following it is, therefore, much easier to do.

In healthcare, it is the standards of care and the orders of those that determine the treatment plan that guide the worker in the ways that promote health. For man, it is the divine and the natural moral law that show us the way we must live in this world and that promote harmony within society.

Faithfulness is doing what is right to be done, even when nobody else is there to see what is done. It is what makes a man possess integrity and what makes him worthy of trust. When the Spirit of God has blessed a man, though he has free will like any other, he understands that he must do that right act, or knowingly choose to betray and wound the Spirit that dwells within.

Such a man lives each day knowing that in every moment he is given the choice to choose the ways of the world or to choose the ways God has prepared for him. A pro-life and just healthcare system that may hold many lives in its collective hands requires nothing less, for patients trust that they will be cared for, and the divine and the natural moral law demand the same.

If we are faithful to God, we must obey His law. The prophets, Abraham, Moses, Elijah, and those others chosen by Him — Joseph and the blessed Mother, for example, all obeyed Him under most trying circumstances. They set the example of faithfulness and obedience that we must follow. As Mary in purity and simplicity said, "Behold the handmaiden of the Lord; may it be done to me according to Thy word (Luke 1:38)." We must also follow His ways — in our home life, in our work, and in all we do.

Faithfulness5 is a part of honesty or truthfulness, so that our acts mirror the words we speak and so that we do not deceive others in what we do. When we are faithful, we can be trusted to do His will, to love the people and serve them well. Faithfulness is demonstrated by the reliable employee who actually accomplishes what his employer has requested that he do and that he has promised he would do, even if the employer or manager is not present (Matthew 25).

As real faithfulness implies perfect honesty, and honesty implies that one is really good, it is God alone who is truly faithful (Psalm 36:5-9). He is the One who keeps His promises to His children, the One who is dependable, who we can therefore reliably look to for help (Isaiah 55).

Man, who follows the Way shown by the dear Lord, strives to be faithful to the divine and moral law, yet fails again and again. However, it is man, even with imperfect faith, who returns to the right way, no matter how many times he has strayed, and again places his trust in Him.

The actions of such a man reflect the love that bubbles up within him as the dear Lord touches him and lifts him up from defeat. The spirit of mercy and justice permeate his intent and he fulfills his duty to all: husband to wife, wife to husband, both to their children, employer and community. The faithful man in this world is a blessing to all.

In healthcare, licensed personnel pledge to follow the standards of care established for their field. They promise or vow to be faithful to carry these out to the best of their ability. Physicians used to take the Hippocratic Oath. Today, many working within the culture of death take a "Modern Physicians' Oath" that leaves out the pledge to "do no harm." A promise that does not involve the actual intent to care and protect the patient is a betrayal of that patient's trust.

The lack of reliable, trustworthy and safe care is one of the chief characteristics of the culture of death. Nurses and others may not follow physicians' orders and may even lie to a physician in order to obtain orders needed to end a patient's life. Physicians may lie to their patients about what they intend to do. In such a lawless setting, families and patients do not know who to trust or what to do when things go wrong. They seek trustworthy professionals who are faithful to the mission of caring.

When we are faithful in our work, we are careful to accomplish what we do responsibly, even considering the finest details of what is necessary to promote the health and well-being of our patients. Faithfulness to God and to our patient's trust in us demands that we actually do no harm as we work, and that we fulfill the promise we implicitly give to our patients — to care for them with every fiber of our being! This is the manifestation of the culture of life in our actions.



Next:    "Man in the World" (Part Six)



Endnotes:

  1.    St. Thomas Aquinas, "Justice," "Treatise on the Cardinal Virtues"
            Summa Theologica SS, Question 57-80 Back

  2.    St. Thomas Aquinas, "Of Adoration," "Treatise on the Cardinal Virtues"
            Summa Theologica SS, Question 84 Back

  3.    See Matthew 4:24, Matthew 9, Matthew 14:14-34, John 8:1-12 Back

  4.    St. Thomas Aquinas, "Of Mercy," "Treatise on the Theological Virtues"
            Summa Theologica SS, Q. 30 Back

  5.    St. Thomas Aquinas, "Whether All Vows are Binding," "Treatise on the Cardinal Virtues"
            Summa Theologica SS, Questions 88, article 3. Back