Chapter — Gury-Ballerini, Compendium of Moral Theology (8th ed., 1884)
Chapter VII. On the Obligations of Physicians, Surgeons, and Pharmacists
- They are bound above all under grave obligation 1º to have sufficient knowledge and skill; 2º to employ diligence proportioned to the gravity of the matter which is committed to their care. But if they are deficient in these things, they are bound concerning all damages which follow from this.
Moreover, they must furnish their work gratuitously to the poor who are in necessity 1, as was said above, n. 11, about advocates.
1 Say the same if they receive a stipend from the Community; although not every reception of gifts is on this account forbidden to them. Nevertheless care must be taken that in this matter they do not conduct themselves in such a way that it is now commonly established that from the bestowal of gifts depends that diligence in healing which otherwise, by reason of the stipend, is to be employed toward the sick.
But in curing the sick they must observe the following rules:
I. They are bound to follow opinions of physicians that are safe and secure, at least ordinarily, because the danger of the sick person cannot be removed by probability.
II. When it is certain that some medicine will be profitable to the sick, they are bound to employ it, doubt being set aside; but if certainty is lacking, they ought to prefer the more probable.
III. When no hope appears concerning the health of the sick person, and there is no remedy present except a doubtful one, or one concerning which it is doubted whether it will be profitable or harmful, it seems that it must be employed 2. - St. Ligorius, n. 291.
2 In what sense this can be admitted, see in the following note to n. 34.
Hence a physician sins gravely: 1º if without sufficient capacity he undertakes to cure a grave disease. 2º If, when a grave and unusual disease occurs, he does not expend special work. 3º If he employs untested medicines for the sake of testing. 4º If, the nature of the disease not being well understood, he rashly prescribes dangerous remedies, especially with risk of life or of grave injury. 5º If, when the danger of the sick person has been recognized, he is not present opportunely, visiting him by day and night if there is need, and does not employ all means suitable for driving off the disease. 6º If he does not permit other physicians to be called when it would be fitting, or if, calling others for the sake of consulting, he attends rather to friendship than to skill. 7º If, on the contrary, without necessity he calls other physicians with useless expenses to the sick person, or if against his conscience he adheres to their counsels. 8º If he prolongs the cure for the sake of gain, needlessly multiplies visits where a wage is demanded for each one, or if he demands an excessive price. 9º If, to favor friendly pharmacists, he prescribes superfluous medicines. 10º If he counsels abortion, or the means of procuring it, or executes it himself. 11º Finally, the physician sins gravely, indeed most gravely, if he does not forewarn concerning the grave danger of the sick person, so that the Sacraments may be conferred upon him. - St. Ligorius, n. 291, and Bk. 3, n. 182.
- Pharmacists, if you except a few things, sin almost as physicians do in the cases just set forth, especially by employing old medicines, by selling useless ones, by supplying to pregnant girls means for expelling the fetus, by not faithfully executing the mandates of the physician, for example by giving one medicine for another, etc. - St. Ligorius, ibid.
- Questions. - QUESTION 1º. To what is a physician specially bound with regard to the soul of the sick person whose care he has undertaken?
Resp. He is bound of himself under grave obligation to admonish him concerning the grave danger in which he is placed, and concerning the necessity of receiving the Sacraments, lest he die without absolution, Viaticum, and Extreme Unction. It is clear 1º from natural law, or from the precept of charity. It is clear 2º from the very well-known Decretal of Innocent III, confirmed and renewed by other subsequent Supreme Pontiffs. It is clear 3º from the general Lateran Council, year 1245 (chapter Cum infirmitas 3, 13, De Poenit. et remiss.). - Yet it is not always necessary that the physician himself admonish the sick person concerning the proximate danger of death. Sometimes it suffices that he take care that he be admonished by relatives or friends, so that he may kindly admit the Priest and be induced to receive the Sacraments. If the sick person has a known Confessor, it will be enough if he is warned about the state of his penitent; for then by visiting him he will be able more efficaciously to move him to provide for the salvation of his soul. But let the physician beware lest he allow the admonition to be deferred too long. For he ought not prolong it until the danger of death is certain; but he is bound to this office when he notices that the danger is gravely imminent. If physicians observed this custom, sick persons would not so greatly dread the admonition, nor would they be seized with terror at mention of confession.
3 The chapter Cum infirmitas in reality is nothing other than that very well-known Decretal of Innocent III alleged by the Author a little before, and which holds the 22nd place among the Decrees of the Fourth General Lateran Council, with the title: “That the sick should provide for the soul before the body.” But most wisely the Lateran Fathers observed that this decree also serves to avoid the danger of bodily health. “This indeed,” they say, “among other things gave cause to this edict, that certain persons lying on the bed of sickness, when they are advised by physicians to dispose concerning the salvation of souls, fall into an article of desperation, whence they more easily incur the danger of death.” On the contrary, as Sylvester notes with Io. Andrea (Sum., v. Medicus 3), from the fact that the sick know that physicians say this in every illness, mortal and non-mortal, from precept, fear and danger will cease.
- QUESTION 2º. Does a physician sin gravely who in time of plague deserts the sick, lest he contract the disease?
Resp. Yes, of itself, unless there are other physicians who will furnish help to the sick. The reason is that physicians from office are constituted for the common good of society; hence in a common danger they must consult not for themselves, but for society; for a private inconvenience must yield to the public good 4. - Thus all theologians.
4 Make a distinction between physicians who, by reason of a stipend constituted for them by the Community, are bound from justice, and physicians to whom no certain stipend is assigned by the Community; for these latter are bound from charity alone, which surely does not oblige with grave risk of life.
QUESTION 3º. Can a physician apply remedies of doubtful efficacy when the sick person is despaired of?
Resp. 1º A remedy probably going to be profitable must be employed, if another more certain one is not had. The reason is that provision must be made for the sick person in the better way in which it can be done; but then he is helped without any danger of damage.
Resp. 2º A remedy cannot be applied to a sick person, even one despaired of, concerning which it is simply doubted whether it is healthful or harmful, and this for making an experiment for other sick persons. The reason is that it is altogether illicit to seek an experiment with danger to another’s life.
Resp. 3º If a remedy is certainly not going to harm and doubtfully going to benefit, it must absolutely be applied. The reason is plain: for some hope shines forth of rescuing the sick person from death, and no danger is imminent.
Resp. 4º In mere doubt whether the remedy is going to benefit or harm, outside the case of a sick person despaired of 5, it is not to be furnished, but one must wait that nature, with God helping, may raise herself up. - Thus St. Antoninus, whose words are these, p. 3, tit. 7, ch. 2: “If he, the physician, doubts about a medicine, whether it ought to harm or benefit, he does badly by giving it, because in doubt he ought rather to leave the sick person in the hand of the Creator.”
5 The Author in this place seems to except the case of despaired-of health, although in the preceding response 2º he denies that a remedy concerning which it is simply doubted whether it is healthful or harmful can licitly be applied even to a sick person despaired of. But this apparent contradiction will vanish if you understand the second response of negative doubt, so that the phrase “it is doubted” is equivalent to “it is unknown,” as St. Alphonsus has it more clearly thus (Bk. 1, n. 46): “It is certain 2º that it is not lawful to apply to a sick person, even one despaired of, a remedy concerning which it is unknown whether it is healthful or harmful, for making an experiment on the sick person.” But the final response will be understood of a remedy which some reason suggests can benefit the sick person. Yet concerning this case St. Alphonsus sets down a twofold opinion, one denying that this remedy is licit, the other affirming; and of this opinion the same St. Alphonsus judges thus: “The second opinion, however, which is sufficiently probable, and perhaps more probable, affirms that it is licit; because when the sick person is despaired of, it is more conformable to prudence and to the will of the sick person, especially if he expressly consents to this, to apply to him a doubtful remedy than to omit it with certainty of death.”