Essays In Pastoral Medicine

by Austin O'Malley; James J. Walsh

PREFACE

The term Pastoral Medicine is somewhat difficult to define because it comprises unrelated material ranging from disinfection to foeticide. It presents that part of medicine which is of import to a pastor in his cure, and those divisions of ethics and moral theology which concern a physician in his practice. It sets forth facts and principles whereby the physician himself or his pastor may direct the operator's conscience whenever medicine takes on a moral quality, and it also explains to the pastor, who must often minister to a mind diseased, certain medical truths which will soften harsh judgments, and other facts, which may be indifferent morally but which assist him in the proper conduct of his work, especially as an educator. Pastoral medicine is not to be confused with the code of rules commonly called medical ethics.

The material of pastoral medicine requires constantly renewed discussion, because medicine in general is progressive enough frequently to devise better methods of diagnosis and treatment, and thus the postulates of the moral questions involved are changed. This discussion, however, is not easily made. The facts upon which the ethical part of pastoral medicine rests are furnished by the physician for the consideration and judgment of the moralist—the physician educated after modern methods knows little or nothing of ethics and can not himself make accurate moral decisions. The moralist, on the other hand, is commonly a poor counsellor to the physician, because long training in medicine is needed before the physical data of the moral decisions is comprehended. The physician, therefore, is at a loss to determine what he may or may not do in {vi} cases that involve the greatest moral responsibility, and the priest is a hesitating guide because the moral theologies do not convincingly present the doctrine in these cases.

Now and then such subjects have been proposed for discussion to a group of physicians and moralists, but usually no practical conclusion has been reached because one side did not understand the other. In 1898 there was a series of articles on ectopic gestation in the American Ecclesiastical Review, in which moralists like Lehmkuhl, Sabetti, Aertnys, and Holaind, and some of the leading gynaecologists of America considered the questions but arrived at no decision. The physicians did not understand certain questions, other questions were on obsolete medical practice, essential questions were omitted, and from the data the moralists came to opposed conclusions.

We find also in moral theologies deductions drawn from false medical sources. Reasons are given, for example, to justify the use of a large quantity of alcoholic liquor at a dose in cases of great pain, typhoid fever, snake-poisoning, and other diseases, in the supposition that such doses will benefit or cure the patient, whereas the physician that would follow that treatment would be guilty of malpractice. There was recently in America a discussion on the relation of öophorectomy to the impedimentum impotentiae. One side held that a lack of ovaries constitutes impotence; the other side, that it does not. The discussion was useful because it incidentally gathered the full doctrine of the moralists on this subject, but from the medical point of view there is no connection whatever between these conditions.

A small number of books on pastoral medicine have been written by clergymen that were not physicians, and a few German books by physicians that were also moralists. Those by the physicians draw conclusions from antiquated medical practice, or they are mere popular treatises on hygiene; those by the clergymen have some value on the ethical side, but they are incomplete because the authors had not the necessary medical knowledge. The essays offered in this book by no {vii} means cover the entire field of pastoral medicine, but as far as they go we have endeavoured to offer the medical doctrine of the present day on the questions considered, and that as completely as is necessary to draw the moral inferences.

Since, then, so many of the questions of pastoral medicine are not defined, physicians are likely to follow the doctrine of the standard medical books, which without exception advise them to take the life of a dangerous foetus almost as unconcernedly as they might prescribe an active drug, or in any case to put utility before justice. There is, therefore, an urgent necessity that competent men fix that shifting part of ethics and moral theology called pastoral medicine, and these essays are presented as a temporary bridge to serve in crossing a corner of the bog until better engineers lay down a permanent causeway.

Some may think that the authors are inclined toward an exaggerated charity in suggesting the measure of responsibility for many human actions, but the physician that is brought much in contact with those suffering from mental defects of various kinds soon learns how easily complete responsibility becomes marred. Responsibility is dependent entirely upon free will; and while the great principle of free will remains solid in truth, no two men are free in exactly the same manner. Physical conditions have not a little to do with modifications of freedom of the will. To point out this fact to the clergyman and the physician has been our intention, for a proper appreciation of it will widen the bounds of charity and save many that are more sinned against than sinning from the injury of grievous misjudgment. It is better to run the risk of exculpating a few individuals whose responsibility is not entirely clear when the application of the same principles lifts many others above the rash judgment of those that can be of most help to them.

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