Utilitarianism Impacting Care of those with Disabilities and those at Life's End.

Society's understanding of the nature of suffering impacts the development of health-care public policy, having a significant impact on care of the elderly and those with disabilities. With scientific advances comes a societal expectation that one can have "the perfect life," not just for one's self, but also for one's offspring. Thus extinguishing the imperfect life, at its earliest or later stages through physician-assisted suicide, becomes an accepted recourse. The Catholic tradition is rich in providing meaning to those who suffer and their families, particularly those at the end-of-life or those with disabilities. The Ethical and Religious Directives for Catholic Health Care Services address the importance of advanced directives to assure that the health-care wishes of patients, no longer able to express them, are respected. However, such directives cannot anticipate all of the health-care scenarios that could arise. Thus the role of a health-care agent (surrogate), who through extensive discussions knows the will of the patient and the mind of the Church, is critical. However, increasingly public policies, especially as they pertain to the allocation of costly resources such as health care, are impacting the health-care choices available to patients, their families, and the health-care provider. Consistent with the utilitarian ethic, state sanctioned killing of those deemed to have "lost their dignity" is hailed as a "good." This essay explores the challenges for all of us who are members of a profession once entrusted with protecting the most vulnerable among us.