This article has two purposes. The first is to show how one can know in a simple way what is an ordinary and obligatory means to care for a person with a serious illness. Using the information at hand, one must be able to answer yes to each of these three questions: “Is this the ordinary, usual, or valid way of treating this illness?” “Is it working?” “Is it within the capacity of the patient to undergo and of the caregivers (...) to administer?” The second purpose of the article is to show the moral validity of these questions, using a historical overview of theological and magisterial teaching and a systematic analysis and moral testing of the three questions. (shrink)

Cardiopulmonary Resuscitation is the default response for persons who suffer cardiac or pulmonary arrest, except in cases in which there exists a do-not-resuscitate order. This default mindset is based on the rule of rescue and the ethical principle of beneficence. However, due to the lack of efficacy and the high risk of potential harm inherent in CPR, this procedure should not be the default intervention for cardiac or pulmonary arrest. Although CPR is a lifesaving medical intervention, it has limited positive (...) results and the potential for multiple harmful consequences. Given the limited potential of CPR as a medical procedure, clinicians and patients must be educated regarding its limited potential, and procedures must be developed to help determine when it is appropriate as a medical intervention. (shrink)

Secular culture often advocates for the liberation of human libido and views Christian morality as a source of damaging restrictions. However, closer examination of Church teaching reveals a depth of understanding of human nature not found in contemporary secular culture. One Church father in particular, St. Augustine, offers a keen understanding of human sexuality and its importance not only as a means of promulgating the human race but also as a means of fostering the sort of spousal unity that improves (...) life in general. Studies of neurochemistry seem to confirm much of what Augustine claimed about human sexuality over fifteen hundred years ago. (shrink)

The Texas Advance Directives Act stipulates the process by which physicians may withhold or withdraw life-sustaining treatment contrary to the wishes of the patient or medical proxy. Hundreds, perhaps thousands of families and clinicians have faced this personal and distressing dispute. Catholic teaching offers a rich tradition for assessing the ethics of life-sustaining treatment and analyzing disputes over its administration, yielding the conclusion that a Catholic defense of the Texas Advance Directives Act is untenable. Two objections rooted in patient harm (...) and physician conscience fail. A solution that fairly respects the patient’s moral right to choose life-sustaining treatment is offered. (shrink)

Ars moriendi, or The Art of Dying, was a highly influential fifteenth-century text designed to guide dying persons and their loved ones in Catholic religious practices at a time when access to priests and the sacraments was limited. Given recent challenges related to the coronavirus pandemic, there is a heightened need to offer additional forms of guidance related to death and dying. This essay examines the content of the Ars moriendi and considers how key principles from the work apply to (...) the current context. The Ars moriendi, in its direct approach to the salvation of souls and thoughtful treatment of struggles faced by dying persons, offers a much-needed supplement to typical approaches to death and dying today. (shrink)

Organ donations after cardiac death account for about 20 percent of all vital-organ transplantations in the United States. This article evaluates DCDs in light of the Catholic moral tradition. Certain premortem interventions commonly associated with DCDs are morally impermissible even though the injuries they inflict on the patient are ostensibly inconsequential. More importantly, the criteria used for expeditiously assaying circulatory death—criteria which enhance the effectiveness of DCDs—do not always guarantee that the donor is actually deceased. Unless DCD protocols attend to (...) these ethical problems, Catholic hospitals are obliged to abandon the practice. (shrink)

Catholic Social Teaching, in considering economic and patient justice, calls for “participating in patient care.” Corporations often are accused of not paying their fair share, which in turn has led to demands for government regulation to lower drug prices in the United States. Meanwhile, the millions of dollars spent by pharmaceutical foundations to help lower-income patients is not seen as corporations’ taking such responsibility to assist patients. The view that CST demands lower costs for prescription pharmaceuticals from corporations that make (...) excess profits misapplies CST principles and does not consider the pricing structure for drugs on a global scale. While a preferential option for the poor is needed, there needs to be a better definition of the poor. This paper looks to broaden the view of CST in regard to corporations and the preferential option for the poor when applied to the current cost of pharmaceuticals. (shrink)

Under federal law, an individual religious exemption from vaccines is valid when it is based on subjective, sincere beliefs rooted in religion but not dependent on the existence, veracity, or accurate understanding or application of denominational tenets or doctrines. Despite the subjective nature of the individual religious exemption, Catholic institutions may recognize or deny individual religious exemptions on the basis of the institution’s own religious exemptions. For example, under the doctrine of the common good, the significant risk to the community (...) presented by non-vaccinated individuals could be grounds for an institution to deny an individual’s otherwise valid religious exemption. This paper attempts to clarify the decision-making framework used by law to balance individual religious exemptions and compelling state interests, then proposes a similar decision-making framework, consistent with Catholic moral principles, for religious institutions to use when balancing individual conscience objections and compelling duties to society. (shrink)

The COVID-19 pandemic has raised questions about the just allocation of limited medical resources. In this essay, I consider four pressing moral questions raised by the scarcity of mechanical ventilators, using the guiding principle that the primary criterion should be the conviction that each and every human being has equal moral status because each has an intrinsic dignity that makes him or her inestimable and inviolable. I propose that any legitimate criteria for ventilator allocation cannot discriminate among patient populations on (...) the basis of any judgments that are not medically relevant. Instead, ventilators should be distributed solely on the basis of the likelihood that they will benefit patients and enable them to heal. (shrink)

Is it coherent to be personally opposed to abortion but to accept others’ decisions to terminate their pregnancy? This might appear to be the case if one appeals to the different situations and attitudes of pregnant women. To the contrary, only those people whose personal opposition to abortion is restricted to situations in which the pregnancy and its consequences are not very burdensome can consistently hold their IPOB position and espouse an objective ethics. The vast majority of people claiming to (...) be merely personally opposed cannot coherently sustain that position. To be logically coherent, the latter not only must be committed to condemning the abortions of others and have the moral standing to do so, but more importantly and controversially, must be committed to call for a legal ban on abortion rather than restrict themselves to being merely personally opposed to abortion. (shrink)

New natural law advocates are somewhat notorious for their loose action theory, having a track record of counterintuitive claims. In response to criticisms, advocates have entrenched, further defending their questionable action theory. This paper first rehearses the basic criticism against the new natural law action theory. It then examines four recent attempts to revive this action theory and finds these attempts wanting. Within these attempts, certain patterns arise. Given a certain means A to a goal C, a search is made (...) to determine whether any middle means B is implied by A. The standards of this search vary wildly, however. By some standards, a middle means can be found; by others, every middle means can be easily swept aside. The same author will sometimes use both kinds of standards, depending upon the situation. One great weakness of the action theory, then, is a lack of consistency in applying a universal standard. (shrink)

The effects of the novel coronavirus have raised questions about the extent to which social shutdowns are appropriate. We have a responsibility to protect the lives of others and an obligation to maintain our lives and health when possible, but there are circumstances when it is just to decline certain measures that are considered extraordinary to the situation. Measures taken to protect life must be proportionate. That is, they must offer a reasonable hope of benefit and not impose excessive burdens (...) on individuals, families, or the community. The measures enacted during the COVID-19 pandemic are not proportionate. Restrictions on family and religious activities are disproportionate to the benefit they provide, particularly to the extent that they obstruct the Church in its duty to tend to the health of souls and salvation of its members. (shrink)

The encyclical Veritatis splendor represented a renewal of moral theology in the spirit of Vatican Council II. Pope St. John Paul II emphasized Gospel teaching in light of the Old Testament, reiterating the animating role of the Holy Spirit in the New Law. Properly understood, the New Law is not a code of obligations, but a dynamic life of charity made intelligible through grace and the natural law. As a primary connection between human beings and divine law, natural law inclines (...) persons toward the good, thus providing an apprehensible link between human freedom and objective truth—enabling us to determine what is good and evil. This understanding of judgment provides a corrective for theological trends toward proportionalism and consequentialism. (shrink)

Embryo adoption, when oriented to the rescue of a dignified human person, is a merciful and morally licit response to an evil consequence of in vitro fertilization and the freezing of embryos. Those who object to embryo adoption not only misconstrue the relevant moral reasoning but exhibit confusion among the object, intention, and circumstances and between two very different potential objects. Because the mercy and charity effected through embryo adoption are at the very heart of moral action, juridical arguments that (...) undermine people’s confidence in these priorities have far-reaching, harmful implications. (shrink)

This essay examines St. Thomas Aquinas’s views on different types of impairment. Aquinas situates physical and moral impairments in a teleological account of the human species, and these impairments are made relative in light of our ultimate flourishing in God. For Aquinas, moral and spiritual impairments are of primary significance. Drawing on Philippa Foot’s account of natural goods, we describe what constitutes an impairment for Aquinas. In the Thomistic sense, an impairment is a lack or privation in relation to that (...) which is appropriate to the human being, known by our nature and ultimate perfection. For Aquinas, perfection lies in the transformation necessary for union with God. (shrink)

The privation theory of evil (PTE) states that evil is the absence of some good that is supposed to be present. For example, if vision is an intrinsic good, and if human beings are supposed to have vision, then PTE implies that a human being’s lacking vision is an evil, or a bad state of affairs. The mere-difference view of disability (MDD) states that disabilities like blindness are not inherently bad. Therefore, it would seem that lacking sight is not a (...) bad state of affairs. Thus PTE and MDD seem to be in tension. This essay discusses that apparent tension and explains how it might be resolved without doing violence to either view. Given the prominence of PTE in the history of Christian theology, and the wide support for MDD among disability theorists, it is worth finding a way to harmonize these two views. (shrink)

In this essay, I present a conception of physical impairment as a privation of the actualization of one or more of a creature’s natural capacities. This broadly Thomistic, non-ableist conception of impairment affirms the intrinsic dignity of the person with the impairment. As a result, it stands between the conceptions of disability as a mere difference and disability as a bad difference. Finally, I show how arguments in favor of disabilities’ remaining in heaven generally presuppose a denial of this conception (...) of impairment. (shrink)

Informed consent in research among people with intellectual and developmental disabilities presents challenges for inclusive research—some particular to the IDD community, and some shared with other vulnerable populations. This essay uses my experiences with qualitative research among the IDD community to raise questions about our understanding of consent and about the principle of justice. I draw on Franklin Miller and Alan Wertheimer’s fair transaction model of informed consent to reflect on how structural issues of injustice affect the possibility of fairness (...) in consent transactions with people with IDD. The work of inclusive research requires identifying structural and organizational avenues that can improve fairness in informed consent and assent, as well as improve justice for the IDD community more broadly. (shrink)

Meeting the needs of individuals who experience vulnerability due to cognitive impairment presents significant challenges to caregivers. Primary caregiver responsibility is often relegated to professionals in hospitals or long-term care facilities, while proxy decision-making responsibility lies with families. The complex relationship among patients, professional caregivers, and families may be further complicated by the relative cognitive capacity of different patients. While some experience diminished cognitive capacity to such an extent that they cannot make any informed voluntary decisions, others may be able (...) to express global preferences and participate more actively in rehabilitative efforts. With reference to Catholic social teaching, I briefly establish the intrinsic dignity of human persons who experience cognitive impairment and then analyze how the web of relationships and responsibilities among patients, professional caregivers, families, and communities ought to be defined. Finally, I consider how these relationships may be optimized to enhance participation in mutually reinforced caregiving and decision making. (shrink)

In this paper, I discuss prenatal screening, testing, and diagnosis, before highlighting the literature on the incidence of selective abortion after prenatal diagnosis. For Catholic health care professionals and institutions, the correlation between prenatal diagnosis and abortion is highly problematic. Several authors have discussed the concern of illicit cooperation with selective abortion in this context; and while avoiding any illicit cooperation is necessary, it is not sufficient. Given the biases against disability that exist in both medicine and society, Catholic health (...) care professionals and institutions are called to witness to the ontological and moral truths of our faith regarding the unborn and persons with disabilities by offering prenatal genetic testing and counseling in a radically transformed way. (shrink)

This essay aims to show why it is important to ask questions about the way Christians raise the question of disability. The central, animating concern has to do with metaphysically thin and philosophically problematic understandings of disability and the way that concept is inflected within contemporary Catholic moral discourse in the areas of biomedical ethics and social theorizing. The essay has three parts. First, through the lens of Gaudium et spes, the author discusses the source of our contemporary questions about (...) disability and related themes. Second, the author surveys overlapping ways of framing the concept disability, as formulated within biomedical ethics, American jurisprudence, the social critique from disability studies, and the sociopolitical subversion of the biomedical outlook from critical disability theorists. Third, given those contemporary frames and in conversation with Fides et ratio, the author sketches some preliminary considerations relevant to a faithfully Christian and distinctively Catholic account of disability. (shrink)

Academic medical ethics must be a bulwark against a disturbing trend toward post-truth cultures. Activism of course has its place in massive cultural debates like abortion. The fact that so many people care so deeply about these debates is part of what makes them so important. But especially when coming from clinicians, academics, and others to whom we entrust the care of our public discourse, interventions into the debates must be disciplined by a thoroughgoing commitment to engage with the available (...) data to back up the central claims even when those claims seem like common sense—perhaps especially when they seem like common sense. (shrink)

There is no paucity of academic studies, medical literature, or media attention given to concerns about gender ideology and being transgender. When reporting their findings, however, some researchers and practitioners working from a purely secular perspective overstep medical observations to make metaphysical pronouncements. This causes considerable confusion and stifles dialogue that could occur if the line between medicine and philosophy were clearly delineated. Properly understood, transgender describes an observable distress due to incongruence between one’s birth sex and gender identity. Conversely, (...) gender ideology is a metaphysical conclusion, which argues that a person’s gender is fluid and open to personal choice. Clearly distinguishing between these can help families, clinicians, and society provide medically appropriate and culturally competent care to those with gender dysphoria, especially children. (shrink)

Body identity integrity disorder is experienced by a small percentage of the population, whose idea of how they should look does not match their actual physical form. The most common manifestation of BIID is the desire to have a specific limb amputated. In a small number of cases, the desire is not for the removal of a limb, but to be blind or paralyzed. There has been a lot of discussion regarding the possible physiological, neurological, or psychological etiologies of BIID. (...) This paper examines the ethical implications of the different approaches to help those with BIID. These approaches and the dilemma that doctors face in cases of BIID are the subject of the final section, which offers some tentative ethical conclusions regarding this disturbing disorder. (shrink)

Contemporary mental health professionals exhibit interest in integrating spirituality into the services they provide to clients. This clinical integration raises questions about both the goals of mental health services and the professional relevance of mental health providers’ spiritual competency. Drawing on the Christian anthropology of St. Thomas Aquinas, Benedict Ashley’s approach to psychotherapy differentiates psychopharmacological, psychotherapeutic, and spiritual approaches on the basis of the different domains of a client’s personality. These domains are the focus of different professions, and Ashley’s account (...) suggests that mental health providers who lack additional spiritual-moral training should adopt a clinical model that recognizes their work is spiritually oriented but not spiritually directive. (shrink)

An exchange between Christopher Tollefsen and Steven Jensen highlights the contrast between a theory of natural law that relies purely first-person account of intention and one that relies more on elements from the physical world. Tollefsen, a proponent of New Natural Law theory, argues that the fetus’s death in the Phoenix case was an unintended side effect of saving the mother’s life. Jensen criticizes NNL generally and particularly for this conclusion. He argues that facts outside the agent make this procedure (...) immoral. This essay provides a more neutral perspective on the debate by laying out each argument clearly and identifying the fundamental issues present in the discussion. A fundamental and probably irreconcilable difference involves whether certain intentions should be included in the species of an action or characterized as fairly or unfairly accepted side effects. Nevertheless, the differences between these two accounts are not as great as they initially appear. (shrink)

Physically enhancing brain–machine interfaces communicate elec­tronically with the patient’s mind in both directions. They present significant opportunities to improve a patient’s health and to restore his or her physical function, but they also present problems for the patient’s sense of agency and self. This is exacerbated by notions of extension and enhancement that are not grounded in an authentic human anthropology that describes the inherently dignified person as an integral union of body and soul.

Female genital mutilation/cutting is a multifaceted, culturally entrenched issue. In response to the United States Conference of Catholic Bishops’ resources dealing with the issue of FGM/C, this paper explores what resources sexual ethics can provide Catholic hospitals facing this issue, specifically with regards to the request for reinfibulation. FGM/C ought not to be treated as a univocal medical practice; rather, in natural law evaluations of the act, the practice of reinfibulation ought to be separately acknowledged. Reinfibulation cannot be properly considered (...) a mutilation in the same way that other types of FGM/C are. Thus reinfibulation should be performed in Catholic hospitals for those women who request it, as part of delivering culturally competent care, justifiable through the principle of material cooperation. (shrink)