FRAMEWORK OF CATHOLIC BIOETHICS

Fundamental Ethics of Human Life and Aggressions Against Human Life

1) Religious Origins of Bioethics:

a) Hippocrates (5th century BCE Greek physician)
b) Sirach 38:1-2: “Honor physicians for their services for the Lord created them; for their gift of healing
comes from the Most High…”
c) Early Christian leaders rejected magical practices of healing; commended medicine as a gift of God,
even while they insisted that all healing comes from God and must serve God’s cause.
d) Jesus in the Gospels:
i) Jesus the Healer: life and health as great goods, but not the greatest, not absolute.
ii) Jesus the Sufferer: raised patient status; spurred Christian tradition of heroic care.
iii) Jesus the Preacher of Good News to the Poor: preferential treatment of sick who are poor; long
tradition of charitable health institutions.
2) Renaissance of Bioethics (1960s):
a) Medical advances prompted a series of questions:
i) Reproductive technologies, experimentation of human subjects, transplantation and definition of
death, kidney dialysis and allocation of scarce medical resources, prenatal diagnosis, genetic
counseling, etc.
ii) The questions were clearly not simply scientific moral. For all their novelty these questions led
inevitably to some very old fundamental questions: about integrity of life from beginning to end and
its sanctity, death and its dignity (or indignity), about human suffering and the appropriate response
to it, about human freedom and human mastery over nature.
b) First sources of renewal were theologians:
i) They reiterated such things as the dominion of God over all, the commitment to patients as persons
(against “medicalization” of care and reduction of persons to capacities for acting), and concern for
the poor in access to health care.
ii) The theologians were Catholic, Protestant or Jewish. The indebtedness of a mind or of reasons to a
theological tradition was not assumed to limit the relevance of his or anyone else’s normative
conclusions.
3) Secularization of Bioethics (1970s):
a) Public policy and pluralism concerns (etc.) made theological traditions suspect.
i) Moral principles had to be universal, compelling quite apart from any specific loyalty or identity,
and they had to be impartial, unbiased by any particular narrative that a community remembers or by
any vision of human flourishing for which a particular community hopes.
b) The discipline came to acquire a confidence in unqualified reason and the progress of science, to
celebrate individual autonomy against the authority of priest (religion) and king (gov’t and physician),
and to insist on autonomy with no care for ensuring its responsible exercise
4) Discontent with Secularism:
a) Lamenting the absence of theological convictions in the public conversation
i) Religious persons want to live, die, give birth, suffer, give care with religious integrity, not just with
impartial rationality.
ii) MacIntyre’s challenge: [1] What difference does religious tradition make in morality? [2] What is
religious critique of secular morality? [3] What bearing do the above have on particular bioethical
questions today?
b) Callahan warns of secularism’s triple threat:
i) Morality (about human ends and goals to pursue) is too easily confused with legality (what not to
do).
 ii) Secularism deprives us of the accumulated wisdom of religious traditions [which] illuminate the
meaning of humanity… and fails to teach us about courage, patience, hope and gratitude.
iii) Secularism requires us to disown or disregard particular convictions and loyalties that give us our
moral identities and passions—for the sake of moral discourse.
c) Genuine pluralism itself will be served by the candid articulation of a particular point of view.
5) How are health care and theology related?
a) Religious Origins of Bioethics: affirmed healing and wellness as God’s gift.
b) Renaissance: led by theologians, tackled age-old questions raised by medical innovations.
c) Secularization: marginalized religious insight in the name of pluralism and progress.
Discontent with Secularism: rediscovers role of religion in genuine pluralism.

SOME KEY BIOETHICAL PRINCIPLES (Fundamental Ethics of Human Life):

1) Sanctity of Life; Dignity of the Human Person:
a) Meaning of “Sanctity of Life”:
i) “Sanctity of life” is a core presupposition of the Church, a kind of overarching principle for the
immense value of human life based on the inherent dignity of the human person. Life has to be
profoundly respected and defended.
ii) Human life is sacred because from its beginning it involves ‘the creative action of God,’ and it
remains forever in a special relationship with the Creator, who is its sole end. God alone is the Lord
of life from its beginning until its end: no one can, in any circumstance, claim for himself the right to
destroy directly an innocent human being. [CDF, Donum Vitae, Introduction 5]
iii) In “Gospel of Life” (Evangelium Vitae, 1995), John Paul II sketches a grand Christian vision as a
further articulation of the Church’s commitment to the “Sanctity of Life.”
(1) The Church affirms the Sacredness and Inviolability of Human Life: The life which God bestows
is much more than mere existence in time. It is a drive towards fullness of life; it is the seed of an
existence which transcends the very limits of time.
(2) Our life is inviolable, outside of human dominion or control, entrusted to us as a treasure.
(3) Therefore, all have equal right to life; the Church’s mission is to proclaim this Gospel.
b) Qualified Value of Human Life:
i) St. John Paul II acknowledges exceptions to the respect for human life demanded by the Gospel of
Life:
(1) God may ask that the life of the body be given up for a greater good (e.g. martyrs).
(2) Legitimate self-defense.
(3) The right of the state to use capital punishment (although it must be extremely rare).
ii) Five contexts which limit our obligation to preserve life:
(1) Martyrdom, “where witnessing to the faith is at stake.”
(2) “Conflict between human lives,” where some but not all lives can be preserved; e.g. killing in
self-defense (or waging war), rationing access to medical treatments when resources are scarce,
and capital punishment.
(3) Respect for individual autonomy persuades us to justify many instances of refusing medical
treatment.
(4) “Quality of life” is understood with respect for autonomy (as when nursing homes refrain from
force-feeding conscious patients who are increasingly unable and/or unwilling to eat).
(5) Medical futility convinces us to end or forgo treatments that do not reasonably extend life.
c) Implications of “Sanctity of Life”:
i) The protection of persons:
(1) Dignity of persons is not earned but given by being created in the image and likeness of God.
(2) Dignity of persons is inalienable: cannot be lost or taken or given away (only God has
dominion).
 ii) Persons must be appreciated not simply for instrumental value (capacities and contribution); they
cannot be a means to an end; cannot be possessed or owned or objectified.

iii) The equalization of persons:

(1) Value/worth is incommensurable, incalculable, immeasurably infinite and therefore cannot be

measured against another.
(2) “Social contribution value” is not the person’s true value.
(3) Attends to those ordinarily left in the margins (e.g. the poor).
(4) Allocating scarce resources: the wounds of conscience that derive from choosing some to live at
the price of death for others must not be allowed.
iv) The requirement of a personal response:
(1) No one may abdicate responsibility to honor dignity of persons.
v) The requirement of a structural response:
(1) Responsibility of society as much as of individuals.
(2) Structural injustice must be addressed on a structural level; e.g. engaging in public policy
debates, support for institutions, etc.
vi) The fact of being in relation:
(1) Human dignity always points us to relationship, interdependence, and covenant with other
humans and with God.
(2) Human dignity is personal but not private.
(3) A balance to the stress on “autonomy” as the overwhelming criterion for health care decisions.
2) Mastery Over Life:
a) A conundrum:
i) “Sanctity of Life” calls forth “Respect for Life”
ii) But does “Respect for Life” lead to either: (1) Unrestrained human intervention to preserve or
improve life?
or (2) Deliberate non-intervention to preserve natural (divine) course of life?
(1) Does God directly create disease? …Is the healing of disease a cooperation with or contradiction
of God’s creative plan?
(2) If what we can do (our ability) does not by itself tell us what we should do (our duty), then what
else does?
b) Nature of Human Mastery:
i) Human and divine causality: in creative tension rather than in mutual exclusion.
ii) Against dualism that sees both as separate; rather, both cannot be known apart from each other but
must be distinguished and kept in creative tension.
iii) “Separate” emphasis from inseparability of causalities:
(1) From human causality, we learn our nobility, our freedom, our creative energies, our capacities
to transform the universe, to participate in the creative energies of God.
(2) From divine causality, we learn of our limits, of our sinfulness, of the fact that we are not, after
all, God.
c) Manner of Human Mastery (“Playing God” - Aggressions Against Human Life):
i) Secularist: amazed by the power of science but is wary about the way forward; “play” is “serious”
science; God is superfluous.
ii) Religious reactionary: vs power of science; laments its intrusion into God’s domain, as if God can be
God only “in the gaps” or beyond science.
iii) Messianic: assumes being substitute God (messiah) for an absent or dead God; acts according to the
principle of utility (whatever works); humanity is maker and designer to maximize human well-
being.
 iv) Imitation: invited to imitate God, to “play God” the way God plays God; acknowledges God as in
charge; puts utility in proper place (but not as absolute measure).
d) For instance: dignity of death is not to be confused with control of death:
“What we truly need is the capacity to master our dying, which is not the same as controlling it. Mastery
requires that our interior self be in charge of itself, even when death is coming and control over the body
has been, as it must be, lost… Only a mastery of the self will do that for us, and only with great
difficulty, the fruit of a life getting ready.” (Callahan, The Troubled Dream of Life, 147)
3) Primacy of Conscience:
a) Respect for autonomy is, at minimum, accepting that person’s right to hold views, to make choices, to
act on personal values.
i) Not only non-interference but also fostering conditions for autonomy.
ii) Avoid excessive individualism: neglecting social nature of individuals and collaborative decision.
iii) Avoid excessive focus on reason: neglecting emotions.
b) Respect for autonomy is clearly expressed in seeking the informed consent or refusal of the patient (or
his/her lawful surrogate) for medical procedures that involve him/her.
c) For the Christian, autonomy translates to primacy of conscience, where patient is obliged to inform
his/her conscience as completely as possible, to judge (decide) based on this conscience, to act
accordingly, and to assume responsibility for the act.
i) Conscience-decision is made in the context of one’s relationship with God.
ii) Double-duty: (1) to form one’s conscience and (2) to follow it.
iii) Failure to follow one’s conscience constitutes sin.
4) Principle of Double Effect:
a) From a long established moral tradition (16th century paradigm cases and formulated in the 17th
century).
b) An act with two effects, one right and one wrong, can be performed when four conditions are met:
i) Object of the act: must be right or indifferent in itself; it cannot be intrinsically wrong.
ii) Intention: right effect must be intended; wrong effect foreseen but not intended.
iii) Causation: wrong effect cannot be the means to the right effect.
iv) Proportion: There must be proportionate reason for allowing the wrong effect to occur.
c) The principle affirms the central insight that, for certain situations in our ambiguous and complex world,
causing harm (or wrong effect) is regrettable but unavoidable.

References:
Health Care and Theology:
i) Allen Verhey, Reading the Bible in the Strange World of Medicine (Grand Rapids, Michigan:
William B. Eerdmans Publishing Company, 2003), 1-23 (“Christian Community as a Context for
Bioethics”).
Catholic Bioethical Principles:
ii) Congregation for the Doctrine of the Faith (CDF), Instruction on Respect for Human Life (Donum
Vitae), 1987.
iii) Allen Verhey, “‘Playing God’ and Invoking a Perspective,” in On Moral Medicine: Theological
Perspectives in Medical Ethics, ed. Stephen E. Lammers and Allen Verhey, 2nd ed. (Grand Rapids,
Michigan: William B. Eerdmans Publishing Company, 1998), 287-296
iv) Benedict M. Ashley, OP, Jean Deblois, CSJ, Kevin D. O’Rourke, OP, Health Care Ethics: A
Catholic Theological Analysis, 5th ed. (Washington, D.C.: Georgetown University Press, 2006).
v) Kevin O’Rourke, OP, A Primer for Health Care Ethics: Essays for a Pluralistic Society, 2nd ed.
(Washington, DC: Georgetown University Press, 2000).