Life Issues, Medical Choices: Questions and Answers for Catholics

By Janet E. Smith and Christopher Kaczor

Medical and technological advances over the past decades have left millions of Catholics grappling with tough issues―and these dilemmas will only increase with complexity as medical advances escalate. In this updated and expanded edition, Life Issues, Medical Choices provides clear answers to difficult questions based upon fundamental principles to help concerned Catholics make morally sound choices for themselves and their loved ones.

New issues explored in this book―questions pertaining to health care, organ transplants, adoption, elective surgeries, and other important issues―make this essential reading for anyone concerned about protecting and respecting human dignity.
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• Language: English
• Publisher: BookBaby
• Release date: Jan 17, 2023
• ISBN: 9781635823042

Book preview

PREFACE

Bioethics is an ever-changing field. New questions arise with new laws and government policies, technological developments, and culture changes. In this third edition of Life Issues, Medical Choices, the authors take up several new questions that Catholics face today.

At the time of our writing, all of the legal issues surrounding the Affordable Care Act (sometimes called Obamacare) have not yet made their way to the Supreme Court. But regardless of what the court decides, the Affordable Care Act raises important moral questions. Question 61 of this book asks whether Catholic employers can morally cooperate with the HHS Mandate requirement to pay for health-care insurance plans that cover contraception. This important question has given rise to different opinions among Catholic moral theologians and philosophers, and we venture to state our own view here.

Other laws raise other issues of importance for Catholics, such as laws protecting health-care workers who conscientiously object to providing abortion or contraception. Some people say that such laws should be abolished, since health-care workers have moral obligations to provide these services. We argue that conscience protections for health-care workers are of vital importance, both for the individual health-care worker and for society. We explore this issue in Question 62.

Some people think that giving birth is more dangerous than aborting, so doctors should be forced to perform abortions, even against their conscientious objection. Using empirical evidence as well as ethical principles, we explore the issue in Question 11.

The use of in vitro fertilization and donor/vendor sperm and eggs has led to new ethical issues in terms of the relationship between children and their biological parents. In Question 20, Do children have a right to know their biological parents? we explore the responsibilities that biological parents have toward their children and what biological children are entitled to know about their origins.

Also in the area of parental responsibility, does the overwhelming evidence of the benefits of breastfeeding make this practice morally obligatory for mothers? See Question 37 for our response.

We have added a new section on moral considerations concerning treatment of the body. The Olympic champion Bruce Jenner's announcement that he would now like to be known as a woman and called Caitlyn brought new visibility to the issues of transgender identity and sex-change surgery. Can people change their sex? Are such (attempted) changes morally acceptable? We look at this issue with Question 64, Is sex-change surgery ethically permissible?

Another new question considered in this edition is the moral considerations attending tattoos (Question 65). Should tattoos be considered intrinsically evil because they alter the body? We don't think so, and yet we also believe that tattoos raise significant moral issues. For instance, what motivates the decision to get a tattoo? Is the tattoo itself likely to offend God or other people?

Vaccines are invasive procedures done to prevent disease, but some fear that they may also cause harm. For instance, some parents have raised concerns about vaccines as possible causes of autism. We address the right of parents to refuse vaccines for their children in Question 66.

The practice of organ donation has become more common, as both donating and receiving organs have become remarkably safe. The demand for organs is ever increasing. With Question 63, we explain why the Church finds organ transplants morally permissible and also look at some considerations to take into account when agreeing to be an organ donor.

Our final question takes up an issue recently debated by bioethicists: Is circumcision moral? On most issues, the authors of this book agree with one another, but on this one, only Janet E. Smith felt sufficient certainty to offer an answer.

Janet E. Smith

Christopher Kaczor

INTRODUCTION

The primary source of truth for Catholics is Jesus Christ. He is the fullness of truth and the teacher of the truth. He is the foundation of our faith and should guide our actions and intentions.

But the slogan What would Jesus do? does not provide all the guidance that decision makers need about complex bioethical issues. Yes, Jesus always did the loving thing, and that is what we should do, too, but it is not always easy to determine what the loving thing is. Is it loving to provide artificial nutrition and hydration to a patient in a persistent vegetative state, or is it loving to withdraw it and allow the patient to die? Is it loving to use human embryos to try to find a cure for Alzheimer's?

Fortunately, Christ teaches not only through his words and actions but also through the gift of reason and through the Church. While Catholics depend upon the explicit teachings of Christ as recorded in Scripture and the guidance of the Holy Spirit, we also use our reason to discover natural truth and the full meaning of the theological truths relevant to ethics.

The Catholic Church has immense respect for the power of human beings to discover truth simply through experiencing reality and thinking carefully about it. God gave us our ability to think to enable us to discover truth. Thus the Church has fostered intellectual inquiry of every kind: philosophical, scientific, artistic, as well as theological. Indeed, the first universities were Catholic, and they were marked by a lively interest in all facets of human life.

Throughout the Church's intellectual history, Catholic theologians and philosophers have made major contributions to medical ethics, both in its modern form as a specialized discipline and historically as a set of issues in ethics and moral theology. The Vatican has pontifical academies and councils dedicated to the sciences, the arts, and life issues, and it regularly sponsors international conferences on various bioethical issues. Catholic health-care workers have established professional organizations to advance their understanding of Catholic moral issues.

Given this understanding of reason, it comes as no surprise that pre-Christian philosophers affirm many ethical principles that the Church embraces. The proper relationship of the physician to the patient has been a concern of philosophy from the start. The Hippocratic Oath (from the fifth century bc) is one of the earliest expressions of medical ethics, and for millennia, physicians took the oath as a way of proclaiming their intention to practice medicine morally. It is important to note that the oath disallowed both abortion and euthanasia.

Fundamental Christian truths, such as the concept of human dignity and the meaning of human suffering, illuminate and deepen what our reason can discover and are invaluable guideposts for understanding reality, as well as for formulating bioethical principles. Concerned that we should live fully moral lives, the Church has developed a tradition of reasoning which includes both the natural law tradition and theological reflection based on revelation. By means of this reasoning, it has articulated fundamental principles to guide our thinking about moral issues and also applied those principles to issues that touch our daily lives. Catholic thinkers have developed some of the most fundamental principles of bioethics, such as the principle of double effect and the principle of cooperation with evil.

Some Questions and Answers

This book is an effort both to provide a basic presentation of the fundamental principles of Catholic thought and to explain how to apply these principles to specific issues. Some principles and questions require a fairly extensive discussion, whereas others we can explain quite expeditiously once the fundamental principles are understood. We hope to help fellow Catholics understand and embrace the sometimes difficult teachings of the Church on medical and moral matters. Nearly every Catholic will face difficult decisions about medical treatment, either with their own health or in the care of loved ones.

We have divided the subject matter into eight chapters. The first chapter establishes some of the most fundamental principles that undergird the Church's teaching on bioethics, including information on the different levels of Church teaching and the question of freedom of conscience.

The second chapter takes up questions on life in the womb. Most Catholics accept the Church's teaching on abortion; you will find here a thorough treatment of the topic that is intended to put to rest any remaining doubts and enable you to be effective partners in discourse with others. The discussion on embryonic research bears upon some pressing issues of our times.

The third chapter treats the very controversial issues of reproductive technologies, such as in vitro fertilization. Many Catholics have a difficult time with the Church's teachings on these issues. If life is such a great good, why does the Church condemn some of the means that help the infertile conceive?

The fourth chapter deals with another challenging area for Catholics: birth control. Here too we apply fundamental principles to explain why the Church opposes contraception and sterilization yet supports Natural Family Planning.

The fifth chapter gives some valuable guidelines for making decisions about end-of-life issues that are faithful to Church teaching.

The sixth chapter takes up a myriad of issues that relate in some way to the question of cooperation with evil. The Church teaches that we may never do evil directly, but health-care workers must often use procedures that do harm as well as good. The principles we present in this chapter can help Catholics determine when permitting some bad consequences is morally acceptable.

The seventh chapter considers treatment of the body. Since the body is a temple of the Holy Spirit, there are moral considerations that impact what a Christian does with his or her body—be it for personal gratification or for the sake of others, such as in organ donation.

In the final chapter, we apply the Ten Commandments to the actions of health-care professionals and patients as well. A final section provides a short list of helpful supplementary resources.

Pope John Paul II's encyclical letter The Splendor of Truth (Veritatis Splendor) states: "No one can escape from the fundamental questions: What must I do? How do I distinguish good from evil?" (2). These questions are often precisely the questions that trouble Catholics facing medical choices. For all the clarity and depth of its understanding on bioethical issues, the Church has not answered all questions that face us. In this age of rapid technological and medical advance, new issues regularly arise, requiring careful assessment by moral theologians. Eventually the Church may address some of these unsettled issues explicitly; this book provides guidance on how to make decisions in light of the principles articulated by the Church thus far.

It is also the case that ethical decisions involve many factual details pertinent to specific situations. While clarity may exist on the level of general truths, applying these general truths to a particular situation is the task of those thoroughly familiar with the facts of that situation. The authors of this book hope that our presentation of the general truths about bioethical issues will guide individuals in the particular decisions they face.

In 2009, we rewrote a few portions of the text. We did so primarily because the Sacred Congregation of the Faith issued Dignitas Personae, The Dignity of the Human Person, which was an update of Donum Vitae, the instruction on new reproductive technologies issued in 1987. Dignitas Personae is the first magisterial document that addresses the question of embryo adoption, so we rewrote our entry on that issue (Question 23) to reflect the teaching of Dignitas Personae and also updated other sections in accord with Dignitas Personae. We rewrote Question 1, since our previous answer veered in the direction of theology rather than staying within the discipline of philosophy.

CHAPTER ONE

Fundamentals

Question 1: How would one argue, from a philosophical point of view, that human life has intrinsic value?

The question, Why does human life have intrinsic value? might be rephrased as, Why do human beings have dignity? Or, Why should we accord rights to people? Or, Why should we hold that human beings (as opposed to other beings) have moral status?

Some philosophers hold a view of the value of human life that is very nearly identical to that of Catholicism, the view that life has infinite value. Indeed, some secular philosophers even speak of human life as being sacred. Catholics believe that the truth about the value of life comes to us not only through revelation but also through natural law or reason. Human reason, even apart from revelation, can discover the dignity of the human person. Thus it is no surprise that the ancient Stoics, Plato, Aristotle, Immanuel Kant, and most Western political traditions have recognized that human life has intrinsic value or dignity.

Another indication that we naturally know that human life has intrinsic value is the fact that the laws of virtually all nations reflect the nearly universal belief that no one should kill innocent human life intentionally. Sometimes reverence for human life is expressed in terms of rights. We find a marvelous expression of the right to life in our own Declaration of Independence: We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. The U.N. Declaration of Human Rights recognizes that all human beings have rights: Recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world.¹ Article 3 of the declaration proclaims: Everyone has the right to life, liberty and security of person.

To speak of the right to life as being self-evident, as does the Declaration of Independence, means it is a truth that should be obvious to all who can reason. It is, however, possible to offer some philosophic justification for this self-evident truth.

The philosophic claim for the intrinsic dignity and value of human life flows from the recognition that human beings are rational and free or self-determining creatures. That which is by nature free should not be used or treated as an instrument of use by others. Kant's categorical imperative, that we should never treat persons simply as means but always respect them as ends in themselves, captures well the principle that human beings have intrinsic value.

Other philosophers, such as Aristotle, have noted the more excellent nature of the human person. His argument is fairly straightforward: human beings differ in many ways from rocks, plants, and other animals. Indeed, there is an ordering of beings. Plants are more excellent than rocks, since they are alive and can grow. Animals excel plants, since they are not only alive but have the senses of sight, hearing, taste, touch, and smell. Human beings excel all these lower animals, since they can understand their world, reflect on their place in the world, and freely engage in the world.

It makes sense to treat things in accord with what they are. Since human beings excel nonliving beings, plants, and animals, they should be treated in accord with their more excellent nature. Although some human beings cannot think rationally—for instance, the severely mentally handicapped—and some human beings, like those in surgery under anesthesia, cannot consciously sense the world around them, they do not thereby lose their dignity. These human beings still possess a human nature ordered to rationality, although it cannot be fully manifested because of some physical defect or malady, whether permanent or temporary. Although newborns cannot think rationally, we treasure them because they belong to the human family.

There is yet another way of making the argument that all human beings have infinite value, even if they cannot exercise their distinctive human capacities. Many non-Christian Western philosophers have held that we can know on the basis of reason that human beings have immortal souls (for more on this point, see Question 42). Aristotle, for instance, thought all members of a species had the same essence or form and that the form of the human being was the soul. If we have immortal souls, we have as a part of our being something that is quasi-divine. And since the soul is the principle of life, any living human being possesses a human soul and thus has infinite value. The popular Western doctrine that all human beings have certain fundamental rights finds a good foundation in the claim that we all share the same essence or form.

Another way to approach the question of the value of life is to observe that we recognize that our own lives are valuable and that it would be wrong for someone to murder us. Consistency requires that we treat all other human beings as we would wish to be treated. Although we differ from other human beings in many ways—in terms of intelligence, health, freedom, and moral goodness—these differences do not change the fact that, like us, these other human beings also have lives that are valuable.

Still another way of considering the question begins with the notion of equality. Most people believe in equal human rights, such as equal treatment under the law or equal rights to liberty. But the equality of human rights cannot be based on any characteristic that is not equally shared by human beings. Human beings are not alike in terms of race, gender, class, religion, health status, or disability. If human rights were based on autonomy or intelligence or moral excellence, since these characteristics come in degrees (we are more or less able to exercise our freedom, more or less intelligent, more or less ethically good), our rights should also be matters of degree. Since no two people are identical in terms of these degreed characteristics, each person would enjoy rights to a different degree than every other person. If we are to secure equal rights for all human persons, the basis for rights must be something shared equally by all human persons, for example, human nature. Therefore, the sound basis for attributing equal rights to any subset of human beings provides a basis for providing equal rights to all human beings. Since no other right, including the right to property or liberty, can be exercised without the right to life, the right to life is the basis for all other rights and is enjoyed by all human beings.

Thus philosophers have various reasons for holding that life has intrinsic value. As we have seen, the authors of the Declaration of Independence held the right to life to be a self-evident truth; others, such as Aristotle and Kant, grounded their conviction of the