Recently, Edward Furton commented on an article that we published in Health Care Ethics USA concerning the philosophical and theological anthropology informing the discussion of appropriate care for individuals with gender dysphoria and intersex conditions. We appreciate the opportunity to clarify the points we made in that article, particularly the metaphysical mechanics underlying our contention that, as part of a unified human person, the human rational soul is sexed. We hope this more in-depth metaphysical explanation shows that Furton’s concern, while (...) valid insofar as our position may have needed clarifying, is nevertheless ill-founded with respect to our contention that actually existent human rational souls are sexed. (shrink)

Opponents of conscience protections for Catholic Health Care institutions claim that, since institutions are not autonomous individuals, they are not subjects of conscience. Therefore, since institutional conscience does not exist, it does not deserve protection. In this article, the author demonstrates not only that institutional conscience exists but that it is an activity that pervades all human institutions. He provides a metaphysical sketch that illustrates how institutions are organic outgrowths of human social nature which mitigate the natural limitations of human (...) individuals. Consequently, the activity of conscience is inherently a component of the life of human institutions. (shrink)

Catholic healthcare institutions live amidst tension between three intersecting primary values, namely, a commitment of service to the poor and vulnerable, promoting the common good for all, and financially sustainability. Within this tension, the question sometimes arises as to whether it is ever justifiable, i.e., consistent with Catholic identity, to place limits on charity care. In this article we will argue that the health reform measures of the Affordable Care Act do not eliminate this tension but actually increase the urgency (...) of addressing it. Moreover, we will conclude that the question of limiting charity care in a manner that is consistent with the obligations of Catholic identity around serving the poor and vulnerable, promoting the common good, and remaining financially sustainable is not a question of if, but of how such limits are established. Such limits, however, cannot be established in light of one overriding moral consideration or principle, but must be established in light of a multitude of principles guiding us to a holistic understanding of the interrelatedness of the moral dimensions of Catholic identity. (shrink)

Some bioethical commentators argue that protection for the institutional conscience of Catholic health care providers should be discarded because the notion is conceptually flawed and conflicts with the demands of medical professionalism. This paper argues in defense of the concept of Catholic institutional conscience. The arguments leveled against the concept of institutional conscience are based on an unsound definition of conscience, assume the validity of a definition of conscience that is amenable to the concept of institutional conscience, and indeed assume (...) the validity of the concept of institutional conscience in order to argue against the conceptual validity of the consciences of Catholic health care institutions. National Catholic Bioethics Quarterly 12.3 (Autumn 2012): 409–420. (shrink)

In this essay, some of the signatories to “Medical Intervention in Cases of Maternal–Fetal Vital Conflicts: A Statement of Consensus” respond to “The Placenta as an Organ of the Fetus: A Response to the Statement of Consensus on Maternal–Fetal Conflict,” both recently published in this journal. The response examines Bringman and Shabanowitz’s claims and assumptions about the morally relevant pathologic condition in some cases of peripartum cardiomyopathy complicated by a subsequent pregnancy, the moral status of a normally functioning placenta, and (...) the use of the principle of double effect in these cases. The signatories’ response sets out to demonstrate how Bringman and Shabanowitz do not engage the essential points of the statement of consensus and how their argument is premised on false assumptions. National Catholic Bioethics Quarterly 15.2 : 241–250. (shrink)

In recent articles, Daniel Gannon argues that, according to Catholic morality, morally good decision making about life-sustaining treatment is intrinsically based on in-the-moment circumstances. Measured against this moral criterion, Gannon finds physician orders for life-sustaining treatment to be morally unacceptable and proposes his own medical order form. The authors argue here that Catholic moral teaching and tradition do not reduce the role of circumstances to those in the present moment and that such a reductive criterion undermines many of the sources (...) of morality, including conscience, prudence, and moral principles such as the principle of ethically proportionate and disproportionate means. The authors also show that Gannon’s criterion and form generate conceptual and practical contradictions, that POLST is not intrinsically evil, and that when properly implemented, POLST can be morally acceptable. National Catholic Bioethics Quarterly 15.1 : 53–61. (shrink)

The metaphysical status of the placenta has bearing on several ongoing discussions within Catholic moral theology. Numerous bioethicists and theologians have touched on this topic briefly, but to date no robust metaphysical argument appears in the literature. The authors aim to provide such an analysis. First, they provide an overview of the existing literature on the topic. Second, they briefly review the anatomy and physiology of the placenta. Third, they provide metaphysical and biological reasons why the placenta cannot be a (...) part of the fetus, a part of the mother, simultaneously a part of both, the border at which mother and fetus meet, or a separate individual substance. Finally, they provide reasons that support their claim that the placenta is a quasi-substance that exists in symbiosis with mother and child. National Catholic Bioethics Quarterly 14.2 : 295–333. (shrink)

Some hold that the revision to directive 58 of the Ethical and Religious Directives for Catholic Health Care Services—which sought to incorporate the language of Pope John Paul II’s 2004 statement regarding the obligation to provide patients in a persistent vegetative state—represents a threat to patient’s end-of-life decisions. I argue this position is unfounded. The revision to the directive, and the statements that inspired this linguistic modification, do not represent a substantive change in the Church’s teaching. I support this position (...) based on two claims. First, in his statement, the Holy Father speaks of food and water and care personnel’s obligation to provide them as relative to the patient’s status as a person. That is, relative to the patient’s human nature, food and water represent a per se useful means for preserving life and, as such, should be considered ordinary and obligatory. Second, since his teaching is directed toward care personnel, John Paul II does not discuss the patient’s judgment of the means with the assumption that the Tradition has already clearly established the legitimacy of patients refusing means they judge to be extraordinary. Finally, I argue that one of the effects of the Pope’s statement is that it manages to reaffirm the Church’s teaching on euthanasia and ordinary and extraordinary means without institutionalizing a particular theologian’s vision of anthropology. (shrink)

This article critically examines, from the perspective of a Roman Catholic Healthcare ethicist, the second edition of the Core Competencies for Healthcare Ethics Consultation report recently published by the American Society for Humanities and Bioethics. The question is posed: can the competencies identified in the report serve as the core competencies for Roman Catholic ethical consultants and consultation services? I answer in the negative. This incongruence stems from divergent concepts of what it means to do ethics consultation, a divergence that (...) is rooted in each perspective's very different visions of autonomy. Furthermore, because of the constitutive elements of Catholic ethics consultation, such as the Ethical and Religious Directives for Health Care Services, the tradition needed to apply those directives, and the Catholic facility’s membership in the institutional Church, the competencies needed for its practice differ in kind from those identified by the report. While there are many practical points of convergence, the competencies identified by the report should not be adopted uncritically by Catholic healthcare institutions as core competencies for ethical consultation services. (shrink)

Abortion is the central issue in the conscientious objection debate. In this article I demonstrate why this is so for two philosophical viewpoints prominent in American culture. One, represented by Patrick Lee and Robert P. George, holds that the fundamental moral value of being human can be found in bare life and the other, represented by Tom Beauchamp and James Childress, holds that this fundamental value is found in the life that can choose and determine itself. First, I articulate Lee (...) and George’s philosophical theory and demonstrate how the fundamental moral value of their theory, personhood, is represented in the issue of abortion. Second, I examine Beauchamp and Childress’ theoretical vision and demonstrate how their fundamental moral value, the right to autonomous self-determination, is represented in abortion. Third, I sketch the theoretical and practical dynamics of the conscientious objection debate as well as each author’s understanding of conscience. Fourth, I demonstrate how abortion, which represents their respective fundamental value, shapes each perspectives’ approach to the conscientious objection debate. I conclude that because each theory finds its fundamental value represented in the issue of abortion, each perspective is bound to engage the conscientious objection debate in a way that centers on the issue of abortion. (shrink)