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Universal Do-Not-Resuscitate Orders, Social Worth, and Life-Years…

…Opposing Discriminatory Approaches to the Allocation of Resources During the COVID-19 Pandemic and Other Health System Catastrophes

This is an excellent article by Bledsoe et al., discussing what is, by my reading, the morally licit view of crisis rationing ethics.  The focus MUST be on the individual’s likelihood of surviving the acute illness and NOT on life-years gained/lost etc.

My only criticism of the article is that they did not cite and respond to the recent high profile paper by Emanuel, et al. wherein it is argued that:

  • “Saving more lives and more years of life is a consensus value across expert reports…”

  • “Recommendation 2: Critical Covid-19 interventions — testing, PPE, ICU beds, ventilators, therapeutics, and vaccines — should go first to front-line health care workers and others who care for ill patients and who keep critical infrastructure operating, particularly workers who face a high risk of infection and whose training makes them difficult to replace…Whether health workers who need ventilators will be able to return to work is uncertain, but giving them priority for ventilators recognizes their assumption of the high-risk work of saving others, and it may also discourage absenteeism.”
  • Recommendation 5: People who participate in research to prove the safety and effectiveness of vaccines and therapeutics should receive some priority for Covid-19 interventions.

Thank you to the Dr. Bledsoe, Ms. Sulmasy, and colleagues, and the American College of Physicians, for publishing this important article!

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Help With Coping for New Yorkers

New Yorkers can call the COVID-19 Emotional Support Hotline at 1-844-863-9314 for mental health counseling

OMH Emotional Support Line:
The Emotional Support Line provides free and confidential support, helping callers experiencing increased anxiety due to the coronavirus emergency. The Help Line is staffed by volunteers, including mental health professionals, who have received training in crisis counseling.

*** *DISCLAIMER: The Office of Mental Health’s (“OMH”) Emotional Support Line (“Line”) is not licensed or unlicensed mental health care or treatment of any type regardless of what is discussed or who provides support.  It is for emotional support purposes only.  Use of the Line does not create any confidential provider-therapist relationship of any type.  The Line not a substitute for professional health care.

If you believe you are experiencing a medical or behavioral health emergency, call your doctor or 911 immediately.

By using this Line, you acknowledge and agree that the State, OMH, any State or OMH employee(s), and/or any community volunteers involved with the Line in any manner (collectively, the “Indemnified Parties”), have no liability of any type related to your use of the Line, including but not limited to any decision you make, or a third party makes, as a result of your use of the Line, or because you were not able to access the Line for any reason.  By using the Line, you agree to fully indemnify the Indemnified Parties and hold them harmless for any and all damages or causes of action that may arise out of your use of the Line.  Without limiting the foregoing, in no event shall any of the Indemnified Parties be liable for any special, incidental, consequential, or indirect damages of any type arising from your use of the Line, or for any other reason.

The Line is provided on an “as is” and “as available” basis.  None of the Indemnified Parties shall be liable for any inability by you to access the Line, including but not limited to interruptions in the Line due to technical reasons or delays to due to a high volume of calls.

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Guiding Principles For Catholic Healthcare Professionals During a Pandemic

CMA Press Release 2020-3-27

Guiding Principles For Catholic Healthcare Professionals During a Pandemic
The Ethics Committee of the Catholic Medical Association
Catholic physicians and health care workers for centuries have led the world in the care for the most vulnerable during times of crisis. Recalling our commissioning by the Divine Physician, the Catholic Christian physician has a special calling—different from the secular world—in that he or she sees the human person as an invaluable creation of God whose individual worth should never be sacrificed—even in the midst of a pandemic. Because of this immutable truth, Catholic physicians have an obligation to lead in times of crisis and to ensure both the upholding of human dignity and the safeguarding of the public health.
Our belief in evidence-based clinical care and public health measures should be translated through the lens of Catholic medical ethics and social teaching with respect to justice and the just distribution of scare resources.
Catholic social teaching is therefore predicated on these key principles: (1) the inherent and fundamental principle of the dignity of human life; (2) the principle of subsidiarity; and (3) the principle of solidarity.
The dignity of human life is the lens through which all care for the sick—in time of crisis or not—should be viewed. God does not make man the arbiter of the value of life and in humility the Catholic health care worker recognizes that no choice should be made that sacrifices the innate dignity of the individual human person, even when questions about scarce resources arise. In short, the human person should not be forgotten in questions about the health of the human race.
The principle of subsidiarity teaches that all decisions are, generally speaking, first and best made at the most fundamental level—beginning with the competent individual and his or her family, and from there proceeding to the different levels of government. This liberty should still, provided it does not jeopardize the public health, be a fundamental principle in times of health crisis.
The principle of solidarity becomes especially important in times of health crisis—when the chronically ill, the elderly, the immune compromised, and other vulnerable populations are at increased risk; here it is imperative that the Catholic healthcare worker and administrators and policy makers continue to re-commit to the Catholic vision of the “other” as “another I,”—as St Pope John Paul II writes–a communio personarum
The Catholic Medical Association therefore proposes some guiding principles during this time of pandemic
1.     We have an obligation to support proper authorities working to ameliorate a public health crisis. The COVID-19 pandemic is a public health crisis. As Catholics committed to a social doctrine rooted in the respect due to every human person and promotion of the common good (the sum total of social conditions which allow people…to reach their fulfilment more fully and more easily)[1] we support efforts to mitigate the effects of the disease on both personal and societal levels.
2.     We recognize that an uncontrolled pandemic is a crisis situation, which can stress a healthcare system beyond its available resources. We know that material goods are not infinite, and as Catholics we should be responsible stewards of the health care resources we have available (see Ethical and Religious Directives for Health Care Services (ERDs), #4)[2]. We are also called to use our abilities to be creative and innovative in the setting of material limitations.
3.     We acknowledge the importance of the relationship between the patient and his or her caregivers, physicians, nurses, and other health care professionals. These caregivers are obligated to act at all times with professional competence as well as to enter into a relationship with patients that respects their individual inviolable human dignity.
4.     We know that persons with mental or physical disabilities, whether due to age, disease process, or injury, are to be treated no less as unique persons of incomparable worth (ERDs, #3). However we also know that these disabilities may in themselves be limiting factors to hoped-for benefits of medical interventions in the setting of a diagnosis of COVID-19.
5.     We appreciate that “the well-being of the whole person must be taken into account in deciding about any therapeutic intervention or use of technology.” (ERDs, #33) Catholic physicians are called to care for the person, not simply to treat disease. Using accepted clinical criteria, it is appropriate for certain interventions not to be used if they are not likely to benefit the patient, or for interventions to be discontinued when they are not contributing to recovery of the patient. While these decisions are made as appropriate and with respect for the individual patient, they can be assisted by studied and standardized tools, such as those utilizing objective vital organ parameters as indicating potential for survival.
6.     “We are not the owners of our lives and, hence, do not have absolute power over life. We have a duty to preserve our life and to use it for the glory of God, but the duty to preserve life is not absolute….The use of life-sustaining technology is judged in light of the Christian meaning of life, suffering, and death. In this way two extremes are avoided: on the one hand, an insistence on useless or burdensome technology even when a patient may legitimately wish to forgo it and, on the other hand, the withdrawal of technology with the intention of causing death.” (ERDS, Introduction to Part Five)
7.     We believe that persons in danger of death from illness, accident, advanced age, or similar condition should be provided with appropriate opportunities to prepare for death (ERDs, #55). This is no less true in the setting of critical illness due to COVID-19. Catholics should be provided spiritual support, and, as a general rule, they should have the opportunity to receive the sacraments in order to prepare well for death. We know that due to public health concerns and “no-visitor” policies in hospitals and nursing homes priests may be prevented from administering these sacraments. We acknowledge the mercy of God extended by the Church in her extraordinary granting of special indulgences in the setting of COVID-19[3] but also encourage consideration of the Holy See’s recognition that cases of serious need will occur and find ways to provide for communal absolution as well as the  sacrament of reconciliation in this time of pandemic, possibly including “extraordinary hospital chaplains” to assist in this ministry. In the absence of clergy, assisting the patient in making a perfect  act of contrition is part of the spiritual care of the patient.[4] Also part of such spiritual care is in helping the patient invoke the plenary indulgence (Apostolic Blessing) usually imparted by the priest after the Anointing of the Sick, when the patient is near death, but can be sought directly by the patient.[5]
8.     We recognize that some elderly and perhaps others with chronic illness would prefer not to be admitted to hospitals with the knowledge that they will have no possibility of family or loved ones to accompany them, due to “no-visitor” policies due to COVID-19, in their disease and possibly their final illness. We encourage the development of home health care specifically for COVID-19 patients, including palliative care and hospice that truly respects the human dignity of these patients.
9.     We encourage Catholic bishops, priests, and hospital chaplains to be innovative in their care of the elderly, sick, and dying and to work in coordination and solidarity with physicians and other healthcare workers for the healing of body and soul. At a time when the faithful are not able to congregate in their usual houses of worship, it is necessary for the clergy to support the faithful in safe and sincere ways. While live-streamed Mass and other on-line resources have the potential to reach many people, often these are not so accessible to the elderly and the disabled. We encourage pastors and appointed lay ministers to call sick parishioners whether at home or in the hospital to provide spiritual support.
10. We confirm that Catholic physicians and healthcare professionals may never condone or participate in euthanasia or assisted suicide in any way (ERDs, #60).
11. We believe that, as appropriate and to the degree possible, Catholic clinicians and leaders should be positively engaged in influencing the formulation of practices and guidelines concerning the just and equitable use of limited medical resources for the sake of the common good, in accord with the principles of Catholic social teaching including the prudent stewardship, subsidiarity, and solidarity.
12. We encourage all Catholic healthcare workers to use this time of solitude and social distancing to deepen their own prayer life, to recommit to their divine vocation, to be creative and intentional—not merely in scientific and clinical pursuits aimed at the control of this virus—but also in enhancing a joyful family life and in their personal vocations, always guided by a trust in Divine Providence, in the Wisdom of the Holy Spirit and in Jesus Christ, “who makes all things new.”
[1]Catechism of the Catholic Church, § 1906
[2]Religious and Ethical Directives for Catholic Health Care Services, 6th Edition, U.S. Catholic Conference of Bishops, 2018
[5] United States Conference of Catholic Bishops, Manual of Indulgences (Washington,DC: United States Conference of Catholic Bishops, 2006), n. 12.
###
The Catholic Medical Association is a national, physician-led community of 2,500 healthcare professionals consisting of more than 109 local guilds. CMA mission is to inform, organize, and inspire its members, in steadfast fidelity to the teachings of the Catholic Church, to uphold the principles of the Catholic faith in the science and practice of medicine.
Jill Blumenfeld
blumenfeld@cathmed.org
cathmed.org
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Novena Prayer for an end to the COVID-19 Pandemic

Never forget or doubt the power of prayer!
Please join us in this Novena!
Novena Prayer for an end to the Coronavirus Pandemic
Diocese of Syracuse, NY
O Mary, full of grace, Patroness of this nation and Mother of the Church, in this time of illness and worldwide need we seek your intercession for the human family before your Son’s throne of grace and mercy. We ask for strength in adversity, health in weakness, and comfort in sorrow. Help us, O Blessed Mother, to be filled with confidence and trust in the tender compassion of our God. Let us not be afraid, like our own Saint Marianne Cope, who entrusted her life and ministry among the outcasts of society into the care of our Divine Physician. Continue to watch over all who are sick as well as those who care for them and give wisdom to all who are seeking a cure.  We ask this through Christ, our Lord.  Amen.
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Words of Hope – FLG President’s Note

19 March 2020
Solemnity of St. Joseph, Spouse of the Blessed Virgin Mary

Dear Friends

My wife and I were talking last night about…everything…and as often happens, she provided me with some excellent insights.  I’d like to share just a few thoughts today.

  1. Shortages.  The pandemic is causing a lot of stress and anxiety; I know I feel it daily.  A large part of my stress is related to those empty store shelves.  Last night I got to thinking about the things that are not in short supply, including: water, electricity, natural gas, gasoline, produce, and dairy products.  This is of course a partial list, but it really got me to thinking how fortunate we are to have such dedicated people working hard in the face of his pandemic to keep the water, trucks, gas, and electrons flowing!  Please join me in praying for them!
  2. Public Masses.  The suspension of public Masses has been a huge point of controversy.  I will leave the arguing to others.  I may be a little slow on this, but it finally dawned on me last night that while I would not choose this, it does present a wonderful opportunity for my family to grow closer together in our spiritual lives.  We already live our faith daily.  We pray together, etc…and…now that we are deprived of attending Holy Mass we can explore ways of compensating as best we can.  Things we are going to try/add include praying the Divine Office as a family, performing Acts of Spiritual Communion, praying more rosaries together (check out this challenge, BTW!), and I’m sure more will come to mind.
  3. Public Masses…me or God?  Don’t get me wrong, I will be very happy when I am again able to attend Holy Mass.  My distress over being unable to has, however, forced me to asking myself, “Am I upset about being unable to attend Mass because I’m going to miss it, or because I will be unable to participate, in person, with the Holy Sacrifice of the Mass because God is Good?”  In other words: Is this about me or God?  Is my disappointment selfish?…yes (at least in part)…and I’m working to root that out!  Please pray for me in this effort!
  4. There’s Still a Lot of Good Out There.  I learned last night that Black Button Distilling, based here in Rochester, has committed to making ethanol-based hand sanitizer and providing it to healthcare organizations at cost.  This will be a wonderful service to our local community and it a great example of people coming together in a time of crisis.  Thank you to everyone who will have a hand in this, and a special thanks to Jason Barrett, Black Button’s President!

There is much more I could say, though I think Fr. Mike says much of it quite nicely.

Please join me in praying for an end to this pandemic.  And, in the meantime, let’s all work to keep ourselves, families, and neighbors physically, emotionally, and spiritually healthy!

In Christ,
Tom Carroll
FLG President

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Lifespan – Home Grocery Delivery

Lifespan, a wonderful organization in the Rochester area, is now offering delivery of groceries and medications to anyone in need over 60 years old.

If you or someone you know is in need of this you can contact them by calling 585-244-8400.

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President’s Address – COVID-19

17 March 2020
Memorial of St. Patrick, bishop

Dear Friends,

As President of the Finger Lakes Guild and in light of the current COVID-19 pandemic, I want you to know that the Guild is here to support our community however we are able.  I know that this is a stressful time for everyone, especially for those directly affected, their loved ones, and the members of their medical teams.  Please know that I, and my fellow Guild members, are praying for you!

As this pandemic evolves over the coming weeks and months I anticipate that questions will arise among faithful Catholics regarding any number of issues.  While I hope and pray that the “worst case scenario” does not come to pass, important questions regarding Church teaching may certainly come up, including the moral acceptability of a vaccine (that will hopefully(!) be developed) against COVID-19, morally licit distribution of scarce resources in the midst of a crisis, and the like.

The Guild encourages anyone with questions about these or other important topics to contact us here, reach out to your parish priest, the Catholic Medical Association, the National Catholic Bioethics Center, Catholic Answers, or any other reputable source of on the Catholic Church’s teachings.  Please remember that responsibly engaging in “social distancing” does not mean we are alone.  We must support each other…and…we always have recourse in prayer to our Savior, His Blessed Mother, and all the saints and angels for help!

As this crisis continues to progress it was with a heavy heart that I read yesterday of our Dioceses’ decision to suspend public Masses until further notice.  I know that this only adds to the burden we all already feel.  The the most Blessed Sacrament in the Holy Sacrifice of the Mass is as close as we can come to Heaven this side of the veil and to have it unavailable at a time like this seems almost cruel.

Nevertheless, given the exponential rise of cases in our country, which is now beginning to affect our local community, I fully support Bishop Matano’s decision to suspend Masses and appreciate his leadership on this gravely important matter.  I also appreciate his reminder that this is a temporary suspension of public Masses and that the faithful should take heart in knowing that our faithful and holy priests will continue to celebrate private Masses for their scheduled intentions and for the current pandemic.

Please also keep in mind that individual churches are allowed to remain open for private prayer and that St. John of Rochester continues (as of the time of this writing) to offer Perpetual Eucharistic Adoration in their chapel.  You can check on the status of this wonderful offering via the live stream feed here.  Please remember that even in the absence of Holy Mass we can still encounter our Lord and Savior anytime in prayer, and in a special way in the Most Blessed Sacrament, whether in the monstrance or the tabernacle.

In closing, again, please know that the members of the Finger Lakes Guild are here to support our community.  We will continue to pray for you and we stand ready to care for any and all who fall ill in this time of crisis, whether of COVID-19 or any other ailment.  We ask that you pray for us and that God’s most Holy Will be done.

St. Patrick, PRAY FOR US!
Our Blessed Mother, Comfort of the Afflicted, PRAY FOR US!

In Christ,
Thomas Carroll, MD, PhD
President, Finger Lakes Guild of Rochester