In the best interest of the patient. Applying this standard to healthcare decision making must be done in a community context.

Acting in the "best interest" of another implies taking certain steps or following certain rules so that the person and his or her concrete human community will survive and potentially flourish. The long-term understanding of best interest refers to the balance of benefits and burdens with respect to the ultimate goals or purposes of a community within which an individual is situated; short-term best interest refers to that balance with respect to a specific healthcare decision, without reference to the overall situation. However, considering only short-term best interest is unsatisfactory in the final analysis. Any decision to sacrifice individual preference for communal best interest should include three crucial aspects: (1) The individual must be a willing (or potentially willing, in the case of a child) member of the community, (2) individuals never lose their moral standing in the community, and (3) society can justify failure to accept the autonomous decisions of some individuals only (a) if it is impossible, (b) that failure is necessitated by attempts to meet the needs of other individuals, and (c) that decision is not based on unfair or unjust practices. Applying the concept of best interest to nontherapeutic research on children, one can conclude that the indirect benefit to the child is in his or her best interest only when the long-term benefit to the community, in terms of both survival and flourishing, is adequately considered. In addition, healthcare surrogate decision makers, acting in the best interest of a person who cannot make decisions and has not previously expressed his or her wishes, must take into account the long-term interests of the community.

Ethics in health care, Part II: The product of shared deliberation. Working within a pluralistic culture.

In a pluralistic society, ethics must be understood as "what we ought to do and become, as civilized persons, in light of who we say we are." This understanding of ethics can help hospital ethics committees produce policies and consultations that are the result of shared deliberation and respect. The ethical principles of respect for autonomy, non-maleficence, beneficence, and justice are considered, and it is shown how these principles reveal values that are central to the practice of contemporary health care. Finally, the issue of refusing medical interventions--and some of the religious, ethical, and legal values that affect this issue--are explored. Part I of this article (1) described the process and activities of typical ethical committees functioning in health-care facilities today. This article will consider some of the more substantive issues these committees must deal with and some of the ethical conclusions and insights that have arisen as a result of the shared deliberations of these groups.

Ethics in health care, Part I: The process of ethics committees.

More than 60% of hospitals now have ethics committees, and this percentage will continue to grow. Based on personal experience as a member of several ethics committees, I suggest that ethics committees have at least 10 members and no more than 25; that active physician involvement is necessary for an effective committee; and that diversity of perspective will help a committee in performing its tasks. The functions of an ethics committee are education, policy formulation, retrospective case review, case consultation, and psychological support. Ethics committees should not have to enforce their policies, and they should not be legally liable if they do not attempt to practice medicine.

Toward a just healthcare system.

The U.S. healthcare delivery system is a patchwork nonsystem full of inequities, whose symptoms include the prolongation of the dying process, a lack of preventive care, and patient dumping. What can be done to make this nation's healthcare delivery system more just? The U.S. healthcare system should be modeled on the same underlying assumptions and justice-related values as the U.S. education system, a system based on need. Americans would find such a model psychologically acceptable because they are familiar with it, even though it is not perfect. Because they have the facilities and resources at their disposal, care givers must experience solidarity with all those who need care. The unity and solidarity of all creation is an explicitly Christian theme and is an appropriate value to emphasize with regard to compassionate healthcare. To establish a fairer healthcare delivery system, providers must consider their own Christian responsibilities and those of the Church, as well as the civic responsibilities of the government. If Catholic healthcare professionals do their part to change the status quo, Americans will be able to enjoy a fair system of healthcare delivery based on need, not on ability to pay.

Catholic positions on withholding sustenance for the terminally ill.

Legislators and others are amending "life-prolonging procedure" acts to include artificial sustenance as an intervention that may be withheld or withdrawn when it serves only to prolong the dying process. Catholic teaching on this issue is summarized in this article. In the Catholic tradition, life is not an absolute value, and it need not be prolonged at all costs and in every case. The morality of withholding or withdrawing artificial sustenance hinges on the patient's perception of the burdensomeness of the treatment. Standards of a treatment's reasonableness and proportionality must govern treatment decisions, and each patient must determine the application of these standards to his or her own case. Persons should communicate their wishes and values verbally or through such documents as a "living will" so that if they become unconscious or incompetent, others may make informed decisions for them.