In 2018 the Congregation for the Doctrine of the Faith issued a responsum ad dubium, addressing the question of whether a hysterectomy is morally licit in cases wherein miscarriage is foreseen with medical certainty if the woman were to conceive. The CDF responded in the positive, explaining that “it does not regard sterilization.” The responsum provoked great controversy, with some commentators wondering at the prudence of issuing the teaching, and others questioning whether it represented a departure from the Catholic moral (...) tradition. This paper looks at a further area of concern in the reasoning of the responsum, namely that it departs from an essentialist account of the human person and of the organs and systems within the human body, and it moves toward a functionalist account of the meaning of the body and bodily systems as arising from whether they are functional. This represents a distressing shift in language from the previous hermeneutic employed by the magisterium, which could open the door to further controversy. (shrink)

The National Catholic Bioethics Center’s commentary on the Congregation for the Doctrine of the Faith’s 2018 responsum concerning hysterectomy fails to address the explicit reasoning that the CDF offers to justify its response. The CDF does not condone the hysterectomies in question as indirect sterilizations, justified by double effect. Rather, it defines procreation—and consequently sterilization—such that the moral categories of direct and indirect sterilization are not applicable in such cases. The CDF responsum is far more radical and consequential than the (...) NCBC commentary acknowledges. The responsum provides Catholic ethicists with an occasion for a necessary conversation that can be had only once the reasoning of the 2018 responsum is taken seriously in its own right. (shrink)

One’s understanding of compassionate care and one’s response to suffering depend on one’s bioethical framework. This paper contrasts the principlist bioethical model with the personalist bioethical model. These emphasize different principles, definitions, and understandings of concepts such as autonomy, compassion, suffering, harm, and help. The principlist model regards euthanasia and physician-assisted suicide as acts of autonomy and compassion that eradicate suffering. This perspective fails to keep in mind that autonomous patients do not always act for their own good. Conversely, the (...) personalist perspective emphasizes the integral good of the person, not just his or her autonomous choice, which is important but not unlimited. Since support for euthanasia and physician-assisted suicide often is motivated by a fear of suffering, being a burden, or depending on others, addressing the underlying factors that drive people to contemplate a hastened death is a more genuinely compassionate response than merely respecting people’s autonomous choice for a hastened death. (shrink)

Ethical concerns regarding the conceptual framework for the determination of death by neurological criteria, including several clinical and diagnostic practices, are addressed. The significance of a diagnosis of brain death, diagnostic criteria, and certain technical aspects of the brain-death exam are presented. Standard and ancillary tests that typically help achieve prudential certitude that an individual has died are indicated. Ethical concerns surrounding interinstitutional variability of testing protocols are evaluated and considered, as are potential apnea-testing confounders such as hypotension, hypoxemia, hypercarbia, (...) and penumbra effects during ancillary testing. Potential adjustments to apnea-testing protocols involving capnography, thoracic impedance monitors, or spirometers to assess respiratory efforts are discussed. Situations in which individuals determined to be brain dead “wake up,” or fail to manifest the imminent cessation of somatic functioning typically seen when supported only by a ventilator, are also briefly reviewed. (shrink)

In Evangelium vitae, Pope St. John Paul II addresses euthanasia and physician-assisted suicide by striking a balance—maintaining the inherent dignity of all persons while considering the lived experience of those struggling to see dignity amidst suffering. Subsequently, a debate about the word dignity has led to clarifications from the President’s Council on Bioethics regarding different uses of the word. This essay relies on the work of the council, especially an essay by Edmund Pellegrino, to provide a basis for reflecting on (...) John Paul II’s approach to dignity in Evangelium vitae in terms of concept and lived experience. To further develop these insights, an alternative framework is proposed for thinking about dignity in the practical setting. (shrink)

Genetic engineering is a rapidly evolving field of research with potentially powerful therapeutic applications. The technology CRISPR-Cas9 not only has improved the accuracy and overall feasbility of genome editing but also has increased access to users by lowering cost and increasing usability and speed. The potential benefits of genetic engineering may come with an increased risk of off-target events or carcinogenic growth. Germ-line cell therapy may also pose risks to potential progeny and thus have an additional burden of proof for (...) safety. Persons responsible for evaluating the ethics of genetic-engineering research programs or clinical trials should do so in light of the nature, integrity, and totality of the human person. Recent news of the implantation and birth of genetically engineered human embryos is just one example of increased rogue science. Health care institutions should consider what steps can be taken to prevent or slow this trend. (shrink)

Empirical evidence has led some philosophers to question total brain death, because a brain-dead patient’s body remains integrated; it can still grow and age. Catholic philosophers have based arguments for and against TBD on Thomist principles of hylomorphism. Given such principles, the arguments against TBD appear stronger. Blessed John Duns Scotus provides an alternative set of principles. Specifically, Scotus is a pluralist regarding substantial form. However, his pluralism is distinct in that he denies a substantial form to the body as (...) a whole and instead speaks of part-substances that are integrated with each other by efficient and final causal chains. Scotus’s hylomorphism, unlike St. Thomas Aquinas’s, can both defend TBD and adequately describe the physical characteristics of the totally brain-dead patient. (shrink)

An unquestionably important biological question is whether human beings are the product of chance or of purpose in the evolutionary process. Charles Darwin did not accept purpose in biological evolution, a view not shared by his colleague Alfred Russel Wallace. The controversy has remained ever since, and while many experts argue against purpose in biological evolution, many others defend it. This paper reflects on this biological and ethical problem, relating it to the possible existence of a plan that governs and (...) shapes the evolution of living beings and that is ultimately responsible for the development of Homo sapiens. (shrink)

In the sphere of end-of-life care, the fear of being a burden on loved ones is a significant factor in patients seeking assisted suicide or euthanasia. The claims of altruism and love that support such decisions are misplaced, and the possibility of being a burden must be reimaged within a proper anthropology. Allowing oneself to be a burden is a significant aspect not only of loving human relationships, but of a human nature that is essentially dependent and created in the (...) image of God. (shrink)

The Fathers of the Second Vatican Council recognized that the doctrine of the Incarnation is specifically concerned with the coming of Christ to free mankind from bondage to both original and personal sin. Original justice and original sin also can be examined through the dogma of the Immaculate Conception. By considering these concepts through the original moment of Mary’s conception, we gain a better understanding of the moment that each person is conceived. Thus a proper understanding of the Immaculate Conception (...) will help us develop a better definition of human conception. (shrink)

Despite great interest in the field of gene editing, sparked by the advent of CRISPR/Cas9-mediated applications, the personhood of tripronuclear zygotes has not been addressed appropriately. 3PN zygotes are discarded as medical waste, and their use as models for human genome editing is becoming increasing common. 3PN zygotes possess an extra set of chromosomes, which often leads to severe genetic abnormalities; they are dismissed as “nonviable embryos” and treated as an ethically acceptable alternative to human embryonic research. However, given the (...) development cycle of 3PN zygotes and the qualifications for human personhood assessed, there is compelling evidence that 3PN zygotes are indeed human persons. Although genetically disadvantaged, they deserve the same respect as do genetically normal human zygotes. (shrink)

Voluntary stopping of eating and drinking is an increasingly popular method by which patients are choosing to hasten death when life feels unbearable. This formal act of suicide often leads to distressing symptoms, for which patients then seek palliation by medical professionals. The intentional act of hastening death is always an evil act. A Catholic physician must understand the moral implications of participating in any phase of the patient’s planning and execution of the VSED process, including cooperation in evil and (...) scandal. The Catholic physician must strive to develop a well-formed conscience and then be prepared to exercise his or her right to conscientious objection while offering an example of true compassion for the sick, the suffering, and the dying. (shrink)

According to David Benatar’s asymmetry argument, the transition from nonexistence to existence is always a harm, and procreation always a pro tanto wrong. This argument fails to reach its anti-natalist conclusion if we maintain the view that there is no temporal relationship between our worldly lives and our afterlives. On this view, since anyone who will be freely procreated has an existence in the afterlife that is atemporal with respect to worldly time, procreators do not move those they procreate from (...) nonexistence to existence and so do not harm them. This view provides a reason to reject Benatar’s stringent “life worth starting” criterion for procreation. (shrink)

In their article “Debate Ethics of Embryo Models from Stem Cells,” Nicolas Rivron and colleagues call for a debate on stem cell–derived human embryo models. They first ask four questions regarding ethics and embryo models, and then give four recommendations to investigators and regulators. Understanding the nature of embryo models is crucial to determining their treatment. If they are human organisms, they should be protected by existing guidelines for ethical research. For instance, the good—which for humans includes organismal flourishing—precludes experimentation (...) on embryonic humans. However, investigators do not know with certainty whether embryo models are equivalent to embryos. Therefore, investigators must halt experiments, evaluate data, and engage in debate before continuing with research. (shrink)

Fifty years of debate have strengthened Germain Grisez’s 1965 interpretation of St. Thomas Aquinas’s famous article on the natural law in Summa theologiae I-II.94.2. Revisiting Grisez’s argument in light of these developments reveals that his “gerundive interpretation” of the first principle of practical reason is not only Thomistic, but essentially Aquinas’s interpretation.

Germain Grisez’s philosophical argument for respecting human life has been developed by fellow new natural law theorists and applied to a range of lethal actions, for its conclusion is vast: intending the death of any human being as a means or an end is wrong in itself. For some Thomists, the NNL view on killing is both lax and rigorist: They consider it lax because its narrow criterion for what is “intended” leaves out some acts, especially ones related to abortion, (...) that the critics consider murder. And they consider the NNL view rigorist insofar as it apparently rules out the death penalty, contrary to the Thomistic tradition and perhaps even heretically. However, the most salient philosophical arguments for exceptions to the principle against intending anyone’s death are weaker than the case for any given premise of the contrary NNL argument. Nevertheless, some NNL theorists’ arguments on life are unsound, some can be defended better than they have been, and some nonphilosophical objections based on theological authority require more exploration. (shrink)

New natural law theory holds that the basic moral principles are prescriptions to pursue the goods to which our nature orients us. Since God is the author of our nature and intelligence, these moral principles are part of his plan for creation. These principles can be known prior to knowing that God exists and prior to knowing that they are in fact directives from him. Nevertheless, since God’s plan includes our active cooperation, morally good acts cooperate with God’s providence, and (...) morally bad acts substitute one’s subjective preference for God’s truth. Thus natural law principles direct us to a unified ultimate end, namely, the fulfillment of God’s plan. Therefore God and our relationship with him have a central place in NNLT. (shrink)

Some critics question new natural law theorists’ conception of the common good of the political community, namely, their interpretation of St. Thomas Aquinas and the conclusion that the political common good is primarily instrumental rather than intrinsic and transcendent. Contrary to these objections, the common good of the political community is primarily instrumental. It aims chiefly at securing the conditions for human flourishing. Its unique ability to use the law to bring about justice and peace and promote virtue in individuals (...) may make the common good of the political community critically important. Nevertheless, it is still not an intrinsic aspect of human flourishing. Unlike the family or a religious group, membership in a political community is not an end in itself. (shrink)

The major difference between “new” and “old” natural law approaches to sexual ethics is that for new natural law theorists the moral evaluation of sex acts is always determined with reference to that basic form of human flourishing which is called marriage; old natural law theorists determine the morality of sex acts also with reference to the natural purpose of the sexual faculties. Ultimately, the old approach relies implicitly on prior value judgments to distinguish biological facts that are axiologically or (...) morally relevant from those that are not. It also appeals to values to ground the wrongness of immoral sex acts. In its pure form, the old natural law approach to sexual ethics lends itself to a misunderstanding of the unitive aspect of marriage. More broadly, an accurate understanding of new natural law does not run afoul of the correct interpretation of “nature” in natural law. (shrink)

The New Natural Law theory offers a distinctive account of the nature of intention and human action and, accordingly, of what aspects and consequences of a human agent’s performance should be considered outside the intention. In part, the distinctive features of the account follow from a methodological decision to consider human action from the perspective of the agent of that action, the first-person agential standpoint. This theory of action and intention has nevertheless been subject to considerable criticism. The view is (...) held by many to be too first-personal and to provide inadequate “constraints” on what an agent intends when his performance will inevitably and foreseeably be accompanied or followed by states of affairs in which individuals are harmed. (shrink)

The concept of wrongful birth, which is based on the premise that a person would have been better off never having been born, is a serious mat­ter for Catholic obstetricians, especially in the context of prenatal screening. This principle, in conjuncture with the belief that individuals with disabilities have a decreased quality of life, has been used to promote a eugenic mentality. Consequently, prenatal screening tests often are used to identify fetuses with disabilities, who subsequently are aborted. Not only is (...) this practice ethically reprehensible, but its presuppositions about quality of life find little support in the medical literature. In fact, in the case of Down syndrome, there is consider­able evidence to the contrary: individuals living with Down syndrome have a high quality of life and are accepted by their families. These data illuminate the discrepancy between how physicians portray Down syndrome to expect­ant parents and what the literature shows regarding this condition. (shrink)

Adolescence is an important yet vulnerable period of transition from childhood to adulthood. An increasing number of studies support the traditional Catholic view, which sees teens as prone to making poor decisions when influ­enced by emotions or peer pressure but capable of thriving when guided by parents and religion. However, newer policies of medical societies undermine the traditional supports of family and faith with a permissive approach toward sexual exploration. To counter this unhealthy trend, which seems to be based more (...) on postmodern ideology than robust science, Catholic physicians should become experts in adolescent behavior and sexual health. Physicians should be sensitive to opposing viewpoints but participate only in treatments which are ethical and beneficial for their patients. Specifically, Catholic physicians must avoid contraceptives, abortion, and “gender-affirming” therapies. By using good science and emulating the models of service, Socratic dialogue, and accompaniment, physicians can guide adolescents toward a virtuous, healthy adulthood. (shrink)

The ethics of adolescent decision making is a complicated mine­field with laws that vary from state to state. The case of a fourteen-year-old girl, who simultaneously was diagnosed with cancer and discovered she was pregnant, highlights several weaknesses in our current approach to adolescent decision making in the context of pregnancy. In addition, adolescents with life-limiting conditions face similar challenges that can be examined through the framework of Catholic doctrine.

Clinical guidelines now recommend hormonal and surgical interven­tions together with social affirmation for children who experience a gender identity that is discordant with their biological sex. However, fundamental questions regarding the safety, efficacy, and ethics of these approaches remain unanswered. There is an urgent need for high-quality research to establish the overall risks and benefits of the current treatment paradigm. While acknowledging the complexity of the problem, competing interests, and logistical challenges, ethical imperatives and acceptable boundaries for scientific investigation can (...) be set by considering the ultimate good of both the individual person and society as a whole. Within established guidelines for human experimentation, alternative approaches to treatment of gender dysphoria in children can be explored without compromising the dignity and bodily integrity of affected individuals. (shrink)

Despite unprecedented medical advancements and the near eradi­cation of many serious diseases, there are growing epidemics of preventable illness brought about in part by the overemphasis on individual autonomy and the neglect of obligations to others. Insofar as these diseases develop because of individual choice, this permissiveness hampers the moral analysis of growing epidemics like childhood obesity. While society has contributed to its rapid progression, childhood obesity finds its origins in lifestyle choices implemented at home. Consequently, parents have an unparalleled (...) duty to prevent and correct obesity and unhealthy lifestyles in their children. Failure to do so undoubtedly violates a parent’s duty and suggests medical neglect. However, our current understanding of medical neglect is too narrow to be applicable to chronic, preventable illnesses. Relevant principles of tort law may broaden our understanding of neglect to better reflect the nature of parental and societal liability in preventable illnesses. (shrink)

Children and pregnant women are often excluded from clinical research. This has resulted in a paucity of evidence on how medicines work for fetuses, neonates, infants, and adolescents. It also raises bioethics, scientific, and public health concerns. For over half a century, doctors have prescribed medicines to children largely on the basis of how they work in adults, despite children’s varied physiologies and differences in how their bodies absorb and metabolize drugs. Regulations and legislation have led to an increase in (...) the number of pediatric studies and to better drug labeling. However, children at all stages of their lives often remain “therapeutic orphans” owing to insufficient evidence about how medicines work for them. (shrink)

The transition from the paternalistic paradigm of the Hippocratic tradition to the present model of shared decision making has altered the patient–doctor relationship. This change has engendered conflicts between patients and physicians, especially in pediatric medicine, where the patients are depen­dent on their parents because of their inability to consent to an intervention independently. Navigating this complex relationship can become particularly fraught when medical futility is invoked. This situation is complicated further by the divergent approaches to shared decision making among (...) physicians and the ethical perspectives these positions reflect. Catholic doctrine on the role of parents in medical-ethical decision making provides insight into navigat­ing these difficult clinical issues and ideologies. (shrink)