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Current healthcare practices are becoming increasingly threatened by technocracy, and the influence of technocratic oversight of medicine as a profession compromises good, compassionate care. A real-life case illustrating how technocratic oversight in health care threatens the practice of medicine and health care in general serves as a basis for discussing some of the common perils inherent in a technocratic model of medicine. This article suggests antidotes and concludes with alternate pathways to practice medicine amid technocratic challenges. Summary: This article discusses technocracy in current U.S. healthcare in order to raise awareness of its potentially negative effects. It then offers an overview of remedies based on Christian anthropology.

We will draw upon John Paul II's view of the human person as developed in his Theology of the Body , to introduce a perspective on medicine viewed in its essence as a healing of the body-person, with a special emphasis on the human person's dignity. At the center of this healing activity is the relationship between the healer and patient. The specific question we attempt to answer is "How does the Theology of the Body inform the physician, or more broadly, one who within the health-care world cares for the sick and suffering?"

In this special issue of The Linacre Quarterly we are pleased to present several articles which touch upon two increasingly important areas of clinical medicine and for which morally perilous circumstances exist. The two areas are geriatrics, the subspecialty focused in the medical care of the elderly, and care at the end of life. The former, in light of the aging of society, is forcing us to examine our attitudes toward the elderly. End-of-life care too, in part because of an increased number of elderly, but also because (as one of us, JMT, unimaginatively reminds his students), “humanity is associated with 100% mortality,” will always remain of great relevance to physicians. Physicians whose practice involves either area are served well by maintaining a clear view of the multiple dimensions and complexities sometimes attending the dying person, and of death itself. This may be especially important when there appears to be a perverted view of death and dying as exists within a “culture of death,” (the term coined by Blessed John Paul II in his 1995 encyclical Evangelium vitae). In many ways today, the dying process has become impersonal and disconnected from transcendent and spiritual realities. The art of dying, prominent in past times, and useful by helping individuals understand and even appreciate dying as a part of living, has been lost. We propose for consideration, the need to recover an ars moriendi: to re-capture and enhance an ethos of end-of-life care intended to recast the dying process in a way that offsets, if not frankly impedes a death culture agenda.

Amidst the current tumultuous climate of incessant debates and politicizing about health-care reform in the United States, in this issue of the Linacre, Doctor Guinan and colleagues provide information about pastoral-care practices in the Catholic hospitals within the Archdiocese of Chicago.1 Their premise, that pastoral care is an important component of Catholic health care, is correct; and their question about whether spiritual concerns may be overlooked in a changing health-care environment, especially as relates to cooperation in immoral acts and lack of protection for conscience rights of health-care workers seems to be well-founded. Although they report data based on a small sample, and a simple survey with seemingly meager methodology, it nonetheless has a potentially large and significant effect if it stimulates more thought and dialogue about Catholic identity in Catholic health-care institutions. I think it will, but I have a major question: Is enough being done?

The question of tube feeding often presents great challenges for the physician. Catholic moral teaching can be of great help to all people of good will in meeting this challenge. The Church teaches that tube feeding is, in principle, ordinary care and hence morally obligatory. How should clinicians go about deciding when to recommend tube feeding in a manner that serves the best interests of the patient and is in harmony with the Church's teaching? A PEG tube should be recommended when a patient is not eating or drinking adequately, has more than a short-term need, is not imminently dying, and has no contraindication to a PEG. This article presents a step-by-step discussion of the decision-making process to assist physicians and other health-care professionals. A decision tree is included that is clinically focused, practical, and straightforward. The authors represent a broad range of Catholic clinical experience. Practical suggestions are offered regarding how to go about discussing this difficult subject with patients and their families. The issues of patient refusal, advance directives, and physician recusal from care are addressed. A chronological reading list on the subject of PEG tubes is provided.