The first edition of the Ethical Religious Directives for Catholic Health Care Services was published in 1948. Since then, it has undergone two major revisions and several smaller ones. The following essay explores the history of the ERDs and the important aspects of these revisions.

Part One of the ERDs addresses the balance Catholic health care institutions must strike between their mission to carry out the healing ministry of Christ and the demands of the US health care system. Divided into two sections, the commentary begins by proposing revisions to the Part One introduction focusing on enhanced application of Catholic social teaching principles and a renewed call for robust conscience and religious liberty protections. It then proposes additions to the Part One directives designed to help Catholic health care respond with integrity to the many contemporarychallenges it faces, and to more full live out its mission and identity.

Part Two of the Ethical and Religious Directives outlines the responsibility to care for the spiritual needs of patients and residents, following the example of Christ who both healed the sick and forgave them their sins. The proposed revisions to the introduction add a more explicit focus on the dignity of the sick, the redemptive value of suffering, and the potential evangelization that takes place through institutional health care. The proposed revisions to the directives emphasize that patients and residents have a right to receive spiritual and sacramental care. Likewise, Catholic healthcare institutions, medical staff, and pastoral care personnel have an obligation to arrange and provide adequate spiritual and sacramental care.

The proposed revisions to Part Three of the Ethical and Religious Directives (ERDs)—on the professional-patient relationship—call attention to a number of timely, culturally relevant issues that require an understanding of the dignity of the human person and the true health of body, mind, and spirit. Several key issues newly discussed in these proposed revisions include transgender policies, the question of referrals for unethical clinical interventions, and triage and limited-resource allocation protocols for crisis situations. This paper draws on the theological and philosophical basis forunderstanding the professional-patient relationship, especially in light of the metaphor of Christ the physician, in order to consider how the ERDs effectively address these key issues and promote true healing in Catholic health care.

We suggest edits to Part Four of the Ethical and Religious Directives (ERDs) to help the US bishops address and clarify essential Church teachings on specific beginning-of-life issues facing Catholic health care today. As a teaching tool, Part Four must be updated so that Catholic health care professionals and the lay faithful can understand and apply Church teachings to new ethical challenges. Further, more direction and clarity from the ERDs is needed in applying general principles to assisted procreative technologies, pre- and post-viability induction of labor, ectopic pregnancies, genetic screening and diagnosis, and contraception. Catholic health care clinicians and administrators also need to receive ongoing instruction on the ERDs’ teachings as well as the theological and philosophical rationales that undergird them.

Part Five is in considerable need of revision. There have been many developments in medicine and health care that present serious moral challenges to the teachings of the Church. The recommendations below include new emphasis on palliative care and hospice, the right of Catholics to receive the sacraments and visits from the family during illness, further safeguards to protect those in a persistent vegetative state, the immorality of voluntary stopping of eating and drinking (VSED), the permissibility of do not resuscitate (DNR) orders, the limited use of palliative sedation, and the requirement that the standards for determining death be rigorously applied by medical professionals. Other minor recommendations seek to bring greater clarity to the existing directives.

This essay argues that Catholic bioethicists and moral theologians need an expanded theology of technological or technical domination. It describes five variants of the concept: (1) domination of persons over others, (2) prideful assertion of mastery over nature, (3) ambition to usurp the will of God, (4) over-emphasis on technical solutions to human problems, and (5) an ideology of utility, efficiency, and effectiveness. It is argued, however, that a sixth variant is needed in regard to twenty-first century technologies. Dietrich von Hildebrand’s observations of “the useful” can be employed to show how the instrumental rationality of technologies often gains a false motivational force. This preference for utility is encouraged by the complex, opaque, and autonomous structures of contemporary technologies.

Cervical insufficiency is present in up to 1 percent of pregnancies and is involved in a significant portion of pregnancy losses in the second trimester. The first line of treatment for most women with this condition is transvaginal cerclage. However, for some this is not sufficient, and a transabdominal cerclage must be performed. In a subset of women who receive transabdominal cerclage, there has been documented concern about subfertility. To the lay person, this may raise concerns that this approaches a contraceptive effect which would have implications on the liceity of the treatment; however, consideration of the current research on the procedure indicates that the subfertility is not a result of cerclage on its own, and ethical analysis through the principle of double effect further affirms the morality of this treatment.

In After Virtue, Alasdair MacIntyre argues that in modern ethical discourse, moral principles have been replaced by “fragments” that only partially represent their original meaning as derived from theological contexts. Today’s debates surrounding physician assisted suicide (PAS) and abortion highlight that the “fragment” of autonomy has been championed over principles such as justice, beneficence, and nonmaleficence with little justification. This acceptance of patient autonomy as the ultimate good distracts from societal ills that drive contentious medical decisions, further muddles society’s image of the human person, and subliminally redefines the medical profession. Medical professionals who oppose these practices must commit themselves to forming physician-patient covenants of trust, rather than accepting consumeristic models of patient care that foster an inappropriate focus on self-determination.