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CODE OF ETHICS OF THE HOSPITAL OF ST JOHN & ST ELIZABETH PREAMBLE


1. This Code of Ethics presents general ethical guidelines for medical and nursing practice in the Hospital of St John and St Elizabeth. The Hospital, holding fast to a distinct vision of what is in the in terests of human persons, cannot offer its patients, non-Catholic or Catholic, a ra nge of procedures routinely accepted by many in modern secular society. This C ode is intended to ensure that all practising within the precincts of th e Hospital are aware of those ethical requirements which must be met if the Cat holic identity of the Hospital is to be respected. 2. This Code deals with a range of ethical i ssues which may arise in facilities within the Hospital, its precincts or its ownership. The principles relevant to those issues are necessarily stated in summary and c ondensed form. The practice of medicine in hospitals touches on many other issues ; their omission from this Code should not lead to the conclusion that they are considered unimportant. 3. While the Code is specifically Catholic in inspiration, its basic principles are

drawn from the Judaeo-Christian tradition, which is concerned to maintain respect 2 for fundamental human values and observance of the norms which ensure that respect. 4. It is accepted that, with th e progress of medical science and the emergence of new problems, this Code may period ically need to be revised. 5. The Hospital has an Ethics Committee, wh ich will be appointed by the Board of Directors, who will define its terms of reference. In general, when doubts exist about the interpretation of the Code, or about the applica tion of principles enunciated therein, those doubts must be referred to the Ethics Committee.

A THE HOSPITAL
1. The Hospital of St John and St Elizabeth is a Catholic Hospital which aims to witness to the Christian Faith by caring for the sick, the disabled or the dying in a manner which acknowledges their dignity and destiny and by making special provision for the terminally ill. The Hosp ital shall strive to maintain in all departments the highest pr ofessional standards both of clinical care and management. At the same time it will demonstrate an unreserved commitment to ministering to the spiritual needs of pa tients facing disability, illness or death. 2. Chaplains or other ministers who provide for the spiritual needs of patients will have the support and cooperation of all in the Hospital in the carrying out of an effective spiritual ministry. Appropriate information, particularly concerning the 3 terminally ill, will be made availabl e to them. Contact information about chaplains and other ministers who serve the

Hospital is to be made available to all patients and staff of the Hospital. 3. No person may use any facility within th e Hospital, its precin cts or its ownership for any operation, procedure, treatment, te st or research, which is inconsistent with the Hospitals Code of Ethics, or for any consultation directed towards or involving a referral for any such operation, pr ocedure, test or research.. Cases in which there is some doubt about whether wh at is proposed is consistent with this Code must be referred to the Ethics Committee. The Committee will have access to whatever information, suitably anonymi zed to preserve patient confidentiality, it deems necessary to satisfy itself th at a proposed procedure is ethically acceptable. In the event of any difference of opinion arising as to these principles or their application the question is to be submitted to the Archbishop of Westminster whose decision shal l be final and conclusive. 4. Those who accept appointments or employment in the Hospital, and those who use any facility within the Hospital, its precincts or its ownership may only do so on the understanding that they will not cont ravene any of the requirements of the Hospitals Code of Ethics, and that they will participate in a reasonable process of ethical governance. 5. The Hospital will only enter into or main tain institutional relationships with nonCatholic healthcare providers and othe r non-Catholic organizations where such relationships further the ai ms of the Hospital, wher e they do not constitute unacceptable cooperation in wrongdoing, and where they do not give scandal. In unacceptable cooperation in wrongdoing, and where they do not give scandal. In

4 the event of any difference of opinion ar ising as to the moral acceptability of a particular institutional relationship the question is to be submitted to the Archbishop of Westminster, whose deci sion shall be final and conclusive.

B PRINCIPLES OF GENERAL POLICY


1. In the Christian view, all people have the duty and right to preserve and maintain their life, physical and mental health and spiritual integrity. These duties and rights are derived from God, before whom man is the steward and custodian, not the absolute owner, of hi s life and destiny. From these basic duties and rights derive the responsibilities of all engaged in medical care, who must therefore respect each patient. 2. Medical intervention requires the expr ess, informed, free consent of the competent patient. In the case of the inco mpetent, those responsible for care shall strive to obtain the consen t of the person legally empo wered to act on behalf of the patient. It is essential to obtain the patients written cons ent to any operation which requires anaesthetic or sedation, or to any procedure which may involve risk. It is the doctors responsibility to give a full and comprehensive explanation of the effects and dangers of the propos ed procedure. In the case of foreign patients whose command of English may be poor this will require the presence of an interpreter when consent is obtained. 5 3. Medical intervention is ju stified by medical need. A procedure producing damage or other negative effects in the patient is permitted when it is judged to be a

necessary and proportionate means of remedying or containing a diseased condition. 4. Medical intervention can sometimes involve what amounts to mutilation of the patient. Such mutilation can be jus tified only on grounds of proportionate necessity. Gender reassignment, female circumcision and direct sterilization cannot be justified on grounds of necessity and are therefore not to be attempted. This principle excludes any interventi on aimed at gender reassignment that renders a healthy sex organ dysfunctional or that removes it or mutilates it. It also excludes procedures related to gender reassignment preliminary to or subsequent to such interventions, procedures such as hormone treatment and reconstructive surgery. Hormone treatment or surgery ma y be given to correct or ameliorate ambiguous sexual physiology only with th e prior approval of the Ethics Committee for each case. 5. The obligation of professional secrecy c overs not only information on a patients documents (however preserved) but also matters learned in the course of professional duty. It should be noted that this applies to all staff , whether medical or ancillary. Moreover, the documents must be duly safeguarded against inspection by those who have no right to see them. 6. No person, in any circumstances, may be requ ired to participate in any way in an operation, procedure, treatment, test or re search to which he has a conscientious objection. 6 7. Users of facilities within the Hospital, its precincts or its ownership not only must not carry out therein operations, procedures , treatment, tests or research excluded

by the requirements of the Code of Et hics, but must not formally cooperate therein in any such operations, procedur es, treatment, tests or research. One formally cooperates in any such activity by recommending that it be carried out elsewhere, arranging for it to be carried out elsewhere, referring a patient to someone elsewhere with a view to it be ing carried out, or making any preparatory arrangements precisely with a view to it being carried out.

C LIFE AND DEATH


1. The work of the Hospital is dominated by respect for human life and for the dignity of the person. Respect for life cannot be separated from the special respect for the process of transmitting life, whic h, in the Christian view, involves human persons in Gods creative activity. 2. Since the inseparability of the unitiv e and procreative meanings of human sexuality is to be respected, interventions on human procreative processes inconsistent with such respect are not permitted (for example: AIH, AID, GIFT and IVF). This also means that the insert ion of IUDs or the prescribing of drugs 7 for contraceptive purposes is not permissibl e in facilities within the Hospital, its precincts or its ownership. 3. The human person, at every stag e of life, is entitled to protection. Since life is particularly vulnerable at its beginning and end, it is esse ntial that the moments of conception and death be as closely defined as medical science will allow, and that these definitions be accepted. 4. Since the embryo or foetus has a right to protection, the use of amniocentesis or chorionic villus sampling can be justified

only in cases of pro portionate necessity. The risks involved in their us e, especially in early pr egnancy, cannot be ignored and it is never justified to use them mere ly for indications of malformation with a view to deciding whethe r to have an abortion. 5. Direct abortion, that is th e administration of any drug or the carrying out of any procedure the direct purpose of which is to prevent the implantation of the embryo, to end its life, to attack its body or to remove it from the womb before it is viable, is gravely wrong. 6. Operations and treatment which are dire ctly on the mothers body and necessary for the cure of serious organic pathologi cal conditions from which she is suffering and, which cannot be postponed until the fo etus is viable, are permitted, even though the death of the foetus may result. This principle applie s to extrauterine pregnancies. 7. Euthanasia, that is the directly intended termination of a patients life, by act or omission, even at his or her own re quest, is always morally wrong. The administration of analgesics or narcotics, necessary for the purpose of relieving 8 pain, is permissible in principle, even if loss of consciousness or some shortening of life may result. Patients are to be s upported and comforted in their dying and retain their right to personal care until death. 8. There is a strict obligation to provide or dinary means of pres erving life, that is, ones which promise benefit and are

not unduly burdensome. There is no obligation to use extraordinary means of prolonging life, that is, ones which are likely to be inefficacious or in some way unduly burdensome.

D OTHER ISSUES
1. The use of experimental surgical, medical or pharmacological procedures raises special moral issues. The Hospital has overall responsibility for the ethical conduct of such procedures. No experiment al procedure may be instituted without the prior agreement of the Ethics Co mmittee. All experimental procedures, including those carried out solely for the purposes of research, require the informed and free consent of the patient. 2. In organ transplantation one must have rega rd for the interest of both the recipient and the donor. Transplantation can be just ified only if it is r easonable to expect substantial benefits to th e recipient. The interest of the living donor must be protected. The donation must be made fr eely and willingly and without improper inducement. The risks and other effects of donation should be fully and comprehensibly explained to him or her and written consent obtained. The 9 intrinsic difficulties of organ donatio n from minors will require special consideration. 3. In the case of cadaveric donation, vital or gans are not to be removed until death has been ascertained with certainty to have taken place. When it is proposed to remove organs from a cadaver, the me dical teams responsible for the dying patient must be distinct from the medi cal team responsible for the recipient. 4.

Procedures the direct purpose of which is to correct or prevent a seriously diseased organic condition are permi tted even though they induce sterility.

E SUMMARY
The following are therefore not permitted in any facility within the Hospital, its precincts or its ownership and may not in any such facility be the subject of referrals with a view to obtaining them elsewhere: a. Euthanasia i.e. directly intended te rmination of a patients life by act or omission (see C7). b. Direct abortion (see C5). c. Artificial insemination either by husband or donor (see C2). d. In vitro fertilisation and embr yo transfer (see C2 and C3). e. Procedures the direct purpose of which is contraceptive sterilization, whether male or female. (This would include va sectomy and tubal ligation.) (see B4). 10 f. The insertion of IUDs for contraceptive purposes or any other intervention or prescription for such a purpose (see C2). g. The use of amniocentesis or chorioni c villus sampling without proportionate necessity (see C4). h. Female circumcision (see B4). i. Procedures aimed at gender reassignment (see B4). j. Organ or tissue donation from minors, w ithout due and careful consideration (see D2). k. Medical procedures or investigations

without proper consent (see B2). l. Disclosure of confidential information (see B5).

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