Preface: I wrote this post several months ago, and am finding now the right life-work balance to draw attention again to this project, in particular since as of late I have been personally involved in a number of situations that involve issues covered by medical ethics.
Introduction:
Over the course of ten articles, I plan to give an introduction or primer if you will, in particular for Catholics like myself who work in a health care profession -- be they doctors, nurses, pharmacists, physical therapists, etc. -- to the critical and timely subject called Catholic Medical Ethics.
Pope John Paul II once wrote that our contemporary Western Civilization has become overtaken by what he called a "Culture of Death." In his sermons, exhortations, and various encyclicals, in particular Evangelium Vitae, Donum Vitae, and Veritatis Splendor, the pope explained how a wholesale culture, that violates the dignity and sanctity of human life, and therefore the supreme dignity of the Creator, has become accepted, legalized, institutionalized, inculturated, and coerced upon the public. He identifies the enemy as being materialist, secular progressives in government, the apostates in the Church, and especially anti-life authorities in the health care industry.
This Culture of Death is seen in the following practices, which I plan to discuss in detail in each article, according to the natural law principles they violate, in light of the critical medical details necessary to understand these topics:
Outline:
Article #1: The Natural Law
Article #2: Surgical Abortion
Article #3: Abortifacient mechanism of the "Pill"
Article #4: Artificial Birth Control
Article #5:: Natural Family Planning: its legitimate uses, and abuses
Article #6: Beginning of life care of child and mother
Article #7: Euthanasia and Physician-Assisted Suicide
Article #8: End of Life Care
Article #9: Artificial Reproductive Technologies, Stem Cell Research, Genetic Engineering
Article #10: The Catholic Philosophy of Health Care. Resources.
My Background:
I myself work in a health profession. Besides my health science professional degree, I have a Bachelor of Science in Biology, which I once used to teach high school biology, chemistry, and physics, including a self-designed course I called "Medical Studies."
I also have a Masters degree in Catholic Philosophy from a seminary college, with an emphasis on the writings of St. Thomas Aquinas, with courses including moral philosophy, sexual ethics, and medical ethics, from a period in which I had discerned the Catholic priesthood. In addition, I have worked for one year after college for a Catholic pro-life organization in the area of education, giving conferences on college campuses.
Therefore, this subject, Medical Ethics, is something I believe I am basically qualified to discuss and share with passion about, at least on an introductory level, that I think can help many of my fellow Catholic, health care workers. I have been a practicing, believing Catholic all my life, continuously learning more about the Catholic Faith.
First, what is Catholic Medical Ethics?
Ethics is a subject in the larger subject called Philosophy, which the Church has embraced along side Theology, being what St. Thomas Aquinas calls "the handmaiden of theology." Ethics deals with the moral act of a human being, the virtues, the kinds of moral law, different forms of moral activity (contemplative vs. active), and the meaning of human happiness.
What distinguishes Catholic Medical Ethics as something "Catholic," that is the antidote the Church gives us to cure this "Culture of Death," and to replace it one day with a Christian "Culture of Life," as part of the Social Kingship of Christ, is that it takes as its inspiration and guide the Moral Revelations of the Catholic, Christian Faith. This Revelation is found in Sacred Scripture and Sacred Tradition, as interpreted by the Magisterium, but also taught by the Fathers and Doctors of the Church, especially the "Universal Doctor of the Church," St. Thomas. He is considered the greatest theologian in Church history, and the go-to authority for seminary training and theological consultation. Catholic Medical ethics, then, is at its core Thomistic ethics.
What is particular to Medical Ethics is that it considers the moral purpose, spirit, and outlook of health care and medicine in general, from a Catholic, philosophical point of view, while developing general and specific moral principles (i.e. "natural law principles") as they pertain to addressing ethical controversies such as abortion, cosmetic plastic surgery, or human cloning.
The Natural Law:
I would like to encourage you to bookmark the following Catholic website, that many consider an invaluable resource:
http://newadvent.org/
At New Advent.org, there is the entire Summa Theologicae of St. Thomas, for free. Click on "Primae Secundae Partis," scroll down, and consider reading the "Treatise on Law," especially the section about the natural law.
In a nutshell, the natural law is the moral law of God as written on the human heart, as Scripture describes it, meaning it is ingrained into our very human nature, something accessible to human reason itself, by the age of reasoning, using reflection and common sense. Every human being possesses the natural law, and is able to know the central moral truths of life, even if they have no knowledge of Christ or His Church, even through no fault of their own.
For St. Thomas, there are four kinds of moral law: the eternal law, which is actually in God's nature itself; the divine law, which is the Ten Commandments of the Old Testament, and the Beatitudes of the New Testament; the human law which is civil law and canon law; and natural law, which is a reflection of all moral law at the most basic, natural, human level.
Therefore, when confronting a pro-death medical establishment that does not recognize the eternal or divine law, the natural law becomes a necessary starting point and foundation in discussing complex, medical ethics issues in the work place.
General Principles of the Natural Law:
Next, I would like to articulate the core natural law principles, and discuss how they relate to countering the culture of death with a Christian, ethical form of health care.
1. The first, most over-arching principle of the natural law can be stated as:
"We must always avoid evil, and seek the good."
That is because the moral good is the most supreme goal of all human activity, which includes health care. But the term "the good" has different levels of meaning here. It also means the psychological, physical, social, economic, and cultural good of the individual. When any of those factors are seriously lacking, then illness will progress.
The health care professional then is obligated to ensure that all activities they perform, and which they involve the patient in, are absolutely and always in accord with moral truth, upholding virtue, goodness, and respect for moral law and moral authority. And more immediately, per the direct purpose of the profession of course, the "good" we must seek is the overall, holistic, mind-body, person-centered health of the individual person, which includes longevity, energy, endurance, strength, mobility, mental clarity and focus, which would be necessary for an individual to fulfill their duties of state in life, and reach their God-given potential.
Therefore, the contemporary, Western, allopathic philsophy of medicine fails to treat the whole person and clinical picture, using nutrition and wellness, but instead focuses in a fractionated way, that ultimately sets back health progression in the patient, and often directly causes disease or even premature death, on symptoms, medications, surgery, and often unnecessarily invasive diagnostic procedures.
In this first principle, we must also "avoid evil." That is evil that is intrinsically, and absolutely, always immoral, unethical, and professionally unacceptable at all times and places. For example, almost all health professions will at least admit that one can never directly, intentionally murder another human being.
Arriving at common ground consensus then is critical, if you are going to achieve a team approach that delivers quality health care, which is based in fundamental natural law principles that all people of common sense should be able to agree upon.
To achieve this, we must promote a whole person approach to health care, drawing also from other medical philosophies, such as osteopathy, naturopathy, integrative medicine, or Chinese medicine.
The point being that to "seek the good" in health care must be about treating the whole health of the person.
Health care workers are not priests, but we have serious, spiritual responsibilities to encourage the sick in their spiritual life. We must pray with them, prayers like the Our Father, offer rosaries especially to Catholic patients, encourage them to promote their full health out of respect for the body God gave them, but also for their vocation and avocations in life, in doing God's Will.
Ultimately, we should hope to at least influence our patients indirectly through our good example, and saying we are believing Catholics, so they will experience as well conversion. This is the whole approach Catholic health care takes in "avoiding evil, and seeking the good."
2. A second core natural law principle says that:
"We must always act in accord with nature."
The reason God dictates this to our human nature, is that He did not create us separate from physical creation, or the cosmos, but as having a central, integral place in it. Just as the design of a car is based on engineering, which is based on the laws of physics in nature, so the design of a human being is based on the natural order of the cosmos, and Earth, which is the medium for human, moral action. Therefore, all moral action must be in harmony with the natural, created order.
Modern medicine, in so far as it is rooted in modern, empirical science, tends also to be derived historically by extension from modern philosophy, which tends to place man in a position of "Man vs. Nature," as if we are spirits above or separate from the created, physical word, and that world is not something that God uses to govern us, but that we become self-determined gods, mastering and manipulating the forces of nature like a mad scientist.
The Catholic, Christian spirit instead directs man to act in accord with the Creator, and therefore according to our place inside the cosmos, to do so indirectly first by acting in accord with the order God designed in Creation.
The health care professional or worker then, has great respect for nature, as a gift from God. They will seek to know the exact nature of individual things, in order to act more precisely in accord with specific natures, including in the design of the human body.
For example, prenatal human development by its nature is inside the reproductive tract of a female human. It would be a violation of nature, and therefore the natural, moral law, to try and implant an artificial womb into the pelvic floor of a male, so that men can carry children to term instead of women. It would also violate the nature of "maleness" and "femaleness."
The Catholic health care professional, when basing their clinical decisions necessarily on health science and human biology, must first development a Christian appreciation of natural science and natural philosophy, in light of the Christian faith. Health science then always seeks to "act in accord with nature."
3. A third natural law principle states:
"We must always act in accord with human nature."
If we must always "act in accord with nature," and if "human nature" is part of the larger category of "nature," then it this third precept logically follows. God gave us a very specific design and created nature, not a mere material animal, and not an angelic spirit. We are embodied souls, gifted ultimately with the powers of intellect and free will, which make us in the "imago Dei," or "image of God." Whereas a dog or tree have no free will, or spiritual soul, it is only a human being within the physical realm, that is a rational soul instrinsically bound to a physical body.
Therefore, it is a moral imperative to treat the human body, and the person of the patient, exactly as God created it. The patient is not just a body, so their spirit and mind must be treated as well, to likewise benefit the body. Likewise, if a patient is in spiritual distress, as any person can fall into, by treating illness of the body, we indirectly alleviate pain, worries, and anxieties, and therefore we health care professionals, in support of the priests, indirectly help the spiritual life of the patient.
When we examine very complex new technological developments in treating illness, or even augmenting artificially human abilities, one example being new forms of leg prostheses that enable a patient to run at very high speeds, we have to ask "are we acting in accord with human nature." Since God created us in a very specific way, with an awesome, beautiful nature that reflects God's own nature, we still must realize the boundaries and limits of that nature. God did not design us to run 50 miles per hour, or have four arms, or computerized brains augmented by advanced AI software.
By understanding this Thomistic, natural law principle, and using human psychology and biology to precisely understand the depths and limits of human nature, we can know how to treat sick human nature, but to also know how far is too far, morally.
4. Another principle says:
"We must always act in accord with reason."
This is a really central, critical principle of the natural law. Without reason, we cannot understand the natural law in the first place. Consider that if we must "always act in accord with human nature," and that the highest part of our nature is not the body or even our emotions, but our spiritual intellect, then this fourth principle makes perfect sense.
It comes into play when health care professionals, hospital ethics committees, patients, and legislators make tough medical ethical decisions about policy. Secular medical ethics today tends to be a based on "utilitarianism" and "situation ethics." The former is the system of thought that the individual good of people must sometimes be sacrificed for the greater common good. What this usually means is that some patients right to life, proper health care, or dignity of treatment, can or must be sacrificed, yielding to socioeconomic interests. In situation ethics, the idea is that the moral good is determined not by absolute, instrinsical moral laws that apply to all situations, but that the concrete circumstances separately determine the moral correctness of action.
Both common approaches, often used simultaneously, are not based upon objective reality outside our mind, that is in a knowable, natural order outside of us we are able to conform to. Human reason then is reduced to a subjective, relativistic state, where emotional content for difficult situations dictates the right ethical course.
Specific Principles of the Natural Law:
Over the centuries, but especially during modern times, Thomistic moral philosophers, specializing in medical ethics, have developed more specific natural law principles, when considering more concrete realities in life, are necessary developments from the more general principles.
1. "We must always respect the dignity and sanctity of human life."
Here, medical ethics starts to get even more specific about what the "culture of death" is undermining. If we must act in accord with human nature (#3 above), and if we are made in the "image of God," then we must always act in accord with man in God's image, which makes our nature dignified and sacred.
This means that it is intrinsically evil to direct cause an innocent human life to die. It also means we must take care of the patient's body with the utmost respect, because it is a "Temple of the Holy Spirit." It also means that we must respect the nature of a human being as being a person with free will, such that we cannot force care without their consent, and they must always be afforded an "informed consent" (more on this to come in Article #8 to come).
2. We must always provide "ordinary care," but are never morally required, under pain of sin, or breaking the moral law, to provide "extraordinary care." In other words, "The Principle of Ordinary vs. Extraordinary Care."
This can get very complicated, depending on different illnesses and shifting criteria that are very challenging to apply to clinical cases, to decide if an intervention is ordinary vs. extraordinary. Food, water, clothing, shelter, antibiotics, and the like, are generally considered ordinary care. Artificial ventilation for a terminally-ill patient would fall under extraordinary care.
3. The Principle of Totality -- in a specific moral act involving the human body, all natural aspects of that aspect must be preserved during each performance of that act. The classic example of this is birth control separating the procreative aspect from the unitive aspect during conjugal intercourse. There are several components in the sex act that comprise the total act, that determine its moral character: a) intercourse, b) ejaculation inside the reproductive tract, c) between one man and one woman who are married, d) safeguarding modesty and privacy, e) that is open to conception, f) and that is an expression of love and support. In fact whole books on Catholic sexual ethics have been written that dissect down all these parts, to examine the moral and social implications if even one part is ommitted or violated.
4. The Principle of Double Effect -- because there are some very complex, urgent medical conditions, in which there is a tension between preserving life or health in one aspect, vs. preserving the same in other aspects, this principle can be used. While we can never justify instrinically evil acts (as situation ethics and utiliarianism does), we are allowed by Providence to compare the competing goods to make a prudential decision about which goods or health care goals are a priority. In some extreme cases then, we can perform a medical procedure that is not instrinsically evil, per se, that may or even will likely result indirectly in a serious, natural evil.
The classic example is a pregnant woman who has cancer of the uterus, who must choose whether or not to receive chemotherapy or a hysterectomy, when it may certainly, indirectly result in the death of an unborn child. She has the right to weigh the options, and even preserve her life over that of the child, but it is more heroic if she would risk her life to first bring it to term. Either case, she can morally receive the procedure, even if the child would indirectly die.
Conclusion:
Appreciating the value of Catholic Medical Ethics in our health care professions is critical in performing our duties with the utmost dignity and skill, while avoiding moral evils, and promoting the overall good of our patients. This subject can be more easily studied and practiced by first mastering an understanding of the natural law and its principles, with the help of St. Thomas.
Once we have learned to understand, love, and apply these principles, then it becomes a less daunting task to examine specific medical ethics topics like surgical abortion.
When we think of abortion, we usually think of a woman going to an abortion clinic, for the terrible, medical procedure. We have heard that since Roe v. Wade legalized abortion, there have been more than 40 million abortions. But that is just surgical abortions. Far more, many millions more, God knows the number, of preborn human lives are terminated by chemical abortion, primarily birth control pills. So the subject of abortion alone is an extraordinarily complex topic to consider.
That said, for now from this article, hopefully I have given a fair explanation of the core principles, with examples how they apply to health care. In Article #2 then, I will be applying some of these principles to the subject of surgical abortion.
