MEDICAL ETHICS: SOURCES OF CATHOLIC TEACHINGS. By Kevin D. O'Rourke, O.P., and Philip J. Boyle. Fourth Edition. Washington: Georgetown University, 2011. Pp. xx + 332. $39.95.

Medical care - its administration, allocation and funding, technological advancements, and heartbreaking treatment decisions - remains the focus of great moral debate in our time. In this new fourth edition, O'Rourke and Boyle, drawing directly on formal Roman Catholic teachings, present a timely and comprehensive guide to many subjects in medical ethics. A central perspective throughout is that from the Christian view "health envisions optimal functioning of the human person to meet physiological, psychological, social, and spiritual needs in an integrated manner" (7). Three chapters in Part I explore theological and normative bases of church teaching - the God-given dignity of the human person being at the center of this moral vision. Here O'R. and B. consider the mysteries of illness, suffering, and death and offer a wise Christian way of considering them in the health-care context. In places the reader may feel "left wanting more" as Part I is brief and summary. Yet, these early chapters carefully present important normative principles of Roman Catholic medical ethics. Included is discussion of the principle of double effect, legitimate cooperation, scandal, informed consent, the principles of totality, subsidiarity, and others.

Chapter 3 closely examines the important role of properly formed moral conscience and notes that mistakes here are often common in the medical area. O'R. and B. observe that "the process of forming and following one's conscience is the touchstone of morality and human fulfillment" (29). The Catholic teachings are seen to represent "the distillation of centuries of faith experience" (32) and positively contribute to faithful conscience formation. Part I also considers leading subjects in Roman Catholic social thought in relation to health care, including discussion of the preferential option for the poor, subsidiarity, the principle of participation, solidarity, justice, and other topics.

Part II, the heart of the book, presents an excellent and extensive selection of formal Catholic teachings on 75 topics (expanded from 61 in the third edition) alphabetically arranged. Included are church teachings on advance directives, assisted hydration and nutrition, intracytoplasmic sperm injection, in vitro fertilization, embryo and stem cell research, cloning, genetic therapies and testing, physician-assisted suicide, withholding and withdrawing life support, organ donation and transplantation, and others. A wide-variety of sources reveals the rich depth and breadth of the tradition. The teachings include selections from papal encyclicals and addresses, Roman-congregation documents, pastoral letters, documents of Vatican II, statements of bishops, the Catechism of the Catholic Church, and other sources. The collection draws often on teachings of the United States Conference of Catholic Bishops, in particular from the Ethical and Religious Directives for Catholic Health Care Services. This edition also includes timely new material that considers Catholic teachings on health care organizations and the Catholic identity of these institutions. It is tremendously useful to have this large selection of teachings in one volume and so easily accessible. This valuable collection will continue to be widely consulted by medical professionals, ethics committees, health care administrators, and scholars, among others.

While perhaps beyond the scope of the book, the authors in future editions might consider expanding the moral interpretation and informed commentary on important issues treated in Catholic teachings. There are, of course, many challenging "hard cases" in medical ethics today, and some new questions remain only partially settled in moral terms. In some areas these may still be developing in the formal Catholic teaching tradition. In the endnotes O'R. and B. occasionally offer helpful suggestions "for further reading," but perhaps it may be possible to direct the reader to additional leading scholarly interpretations and commentaries. While not the specific aim of a book that so extraordinarily well presents formal church teachings, an effort to include further interpretation and commentary may increase the usefulness of the collection to scholars and healthcare professionals.

This fine book is primarily about the sources, both theological and moral, of Catholic moral teachings. The reader will find a clear and practical guide that informs faithful and serious moral thinking about important medical choices. This sensitive and careful work is grounded on two fundamental questions: (1) how do we best think about the profound dignity of the person created as imago Dei, and (2) how do we make the best possible medical-moral decisions in light of the Christian meanings of health, illness, suffering, death, and hope for resurrection? While these deep mysteries of faith are always part of our inquiry, searching many new and rapidly changing medical technologies presents to us a delicate urgency for careful and informed moral deliberation. The Catholic teachings explored in this volume and the excellent work of O'R. and B. "provide us with an important source of wisdom" (32). This new edition of a now classic book remains a trusted resource and proven roadmap to guide us along an important and challenging moral path.

Author affiliation:

Fairfield University, CT FRANCIS T. HANNAFEY, S.J.