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The Need for Objective Methods in the Search for E
A Search for Ethical Methods
The Need for an Objective Method
by: Br. Bill Leaming+, SDV
Some philosophers today deny that there is any objective method
of arriving at ethical decisions. They argue that, although it is
possible to decide between conflicting views in the sciences by checking
the facts, in disputes over ethics it is not facts that are in question
but values, and values are simply a matter of individual preference.
Thus the statement, "Abortion is wrong" is not a statement of fact such
as "The earth is round," but simply means, "I don't like abortion," or
"Abortion is ugly." Such a theory of ethical decision is called
emotivism because it reduces ethical judgments to statements of
emotional reactions.
Emotivism as an ethical method was best defended in modern
times by the philosopher Jean Jacques Rousseau, who argued that most
people have naturally good emotional instincts, when these have not been
distorted by bad education. His views have greatly influenced American
culture. When politicians appeal to the "wisdom of the American
people," they probably mean "the emotional reactions of the majority
must be right.' In debates about medical ethics, it is not uncommon to
meet physicians who think that attention to the instincts of decent
doctors is the best way to settle any ethical question. The difficulty
with this approach is that it provides no method of public, objective
discussion but leaves problems to rhetoric and passion. Whose instincts
are sound? After all, some people feel that all blacks and Jews should
be wiped out. Consequently, it is important that we try to find an
objective and logical method of settling what is right and wrong, even
though this method may not be fool-proof.
Deontological Methodologies
Probably the most common ethical methodology rests on the
principle that an action is right when it conforms to laws or rules
laid down by legitimate authority and wrong when it violates these laws.
Such a method is called legalism because the ultimate standard of right
and wrong is the law. It is also called voluntarism because it considers
that a law obliges because it is the will (Latin voluntas) of the
legitimate lawgiver. Finally, it is called deontologism (Greek deontos,
duty), because it conceives ethical behavior as dutiful, obedient, and
law-abiding.
There are, of course, various kinds of lawgivers and various
kinds of law. If we believe that the ultimate appeal is to the authority
of the state (or of our peer group), this is legal positivism. For
example, many people considered abortion wrong when it was still
forbidden by state laws but right after the Supreme Court voided these
laws. The total inadequacy of such a view is evident from the fact that
Hitler was careful to act legally, but it was he who made the
laws! It would never be possible to argue for the abolition of a law as
unjust, unless there were some higher standard than the law of the
state.
Consequently, throughout history people have appealed to a
"higher law," namely, divine or eternal law, the will of God, since God
is the supreme authority whose will is always righteous. How are we to
know God's will? One way is through revelation, which Jews believe is
embodied in the Hebrew Torah and oral tradition based on it. Christians
believe it is in the Bible, and Muslims believe it is in the Quran. An
appeal to these scriptures (which in ethical matters have much in
common) involves problems of interpretation. Protestants, for example,
rely on a personal, sometimes very literal, interpretation of the Bible;
Catholics believe the Bible must be interpreted authentically by the
living tradition of the Roman Catholic Church under its pope and
bishops. Another way, accepted by Catholics, of knowing God's will is to
begin with the divine law revealed in the Bible, but to supplement this
by using natural law (i.e., human reason and experience used to
determine what actions best serve true human welfare) to apply the
biblical law to many detailed questions, such as those arising in modern
medical practice, and also as the basis of objective discussion with
non-Christians for whom the Bible lacks authority.
In the eighteenth century another form of deontological ethics
arose among the so-called Enlightenment philosophers, who rejected
Christian revelation but were not inclined to adopt Rousseau's
subjective emotivism. The chief thinker of this school, who is still
influential in medical ethics, was Immanuel Kant, who proposed a kind of
deontological method known as formalism. According to this our emotional
preferences, which provide us with values, must be checked against
certain rational standards of a purely formal kind. The principle
standard is the categorical imperative, namely, that any choices we make
must be such that we would be willing for everyone else to make the same
choices (universality). For example, if I were to choose to lie for my
own benefit, would I really be willing that others lie to me? Since I
would prefer they not lie to me, I must not lie to them. Kant thought
that this method was advantageous because it made no appeal to any
standard except the individual's own conscience (that is it was an
autonomous ethics not a heteronomous one depending on the authority of
another). Nevertheless, it is open to serious criticism because it is
purely formal and has to rely on emotivism to establish any concrete
values or practical rules.
Because of the weakness of this formalism, a number of recent
ethicists have tried to modify Kant's system by postulating a number of
general rules, such as the principles of fairness and beneficence. These
are proposed as needing no other justification than that they help us
settle ethical questions in a consistent way. Such a method, however,
still is open to the objections that (1) it does not provide concrete
rules and (2) consistent behavior does not always mean consistently
good behavior. There are consistent liars and crooks.
Teleological Methodologies
The weakness of any deontological system is that it does not
give any ultimate reason why the will of the authority itself is right
or wrong. We ought to question whether we ourselves are righteous. Often
the state is obviously unjust in the laws it makes. Even God, as Job
complained, sometimes seems to be unfair. Laws are useful and necessary
guides for our ethical decisions, but still we cannot help questioning
whether some laws are just. Teleological methodologies seek to answer
this question.
The word teleology has as its root the Greek telos, or goal. A
teleological method in ethics seeks to justify or reject an action by
determining whether it is an effective or a self-defeating means to the
goal of true human fulfillment in the community. Some persons choose as
their goal in life some kind of illusory self-fulfillment which, even if
it is achieved, leaves them miserable, such as the man who devotes all
his energies to financial success only to discover he is rich, lonely,
and afraid of death.
Utilitarianism
Teleologists are divided into two very different schools of
thought whose debates are responsible for many of the hottest
controversies in medical ethics today. One of these schools is so
popular that many identify the term teleology with it, supposing there
is no other kind. This is utilitarianism (or consequentialism).
Utilitarians believe that the goal of human life is maximum satisfaction
or, in other terms, one which produces more satisfactory consequences
than unsatisfactory ones.
Some utilitarians are act utilitarians, who say that there are
no universal ethical rules but that every action must be judged in its
unique context. Some Christian ethicists call themselves situationists
or contexualists and adopt act utilitarianism. The pioneer medical
ethicist Joseph Fletcher argued that there is only one general ethical
rule: "Do what is most loving in the circumstances." He was never able
to define what "most loving" means in practice. Most utilitarians,
however, favor rule utilitarianism, which accepts general ethical rules
such as "Thou shalt not kill" as prima facie rules that are generally
obliging but admit exceptions in some circumstances. Also, to avoid
reducing their system to the subjective preferences of emotivism, they
contend that the supreme principle of ethics is not merely my maximum
satisfaction in life, but the greatest good for the greatest number.
The weakness of utilitarianism is that it can be used to
justify almost any action because it provides no objective way of
measuring the good and bad consequences of an action. Jeremy Bentham,
the English philosopher famous for his defense of this system, believed
it possible to establish a "unit of satisfaction" and thus measure
satisfactions much as we weigh economic values in units of dollars and
cents. But how can we find a common quantitative unit of measurement for
the very qualitatively different kinds of "satisfactions" that make up a
truly fulfilled life? Can I weigh the price of friendship, success in my
work, and good health one against another? Can we sacrifice the life of
one innocent person to save the lives of 10 others?
Proportionalism
Another form of teleological ethics which has been put forward
by a number of Catholic moralists and which is to be found in a good
deal of current writing can be called proportionalism because it seeks
to reduce ethical decisions to a single fundamental principle of
proportion, which can be stated as follows:
An action is morally good if the premoral values that it promotes
outweigh the premoral disvalues it promotes; otherwise it is morally
evil.
Premoral values are physical, psychological, or social values
considered prior to their moral evaluation. For example, nutritious food
is a human value, yet morally considered it is a disvalue for a person
who needs to diet. Proportionalists admit that there are some abstract
moral norms, such as "Do good and avoid evil" and "Love your enemy"
which are absolute; that is, admit no exceptions for any purpose or in
any circumstances. They also concede that we can state concrete moral
norms, such as "Do not murder" and "Do not fornicate," which also are
absolute. The very terms in which they are formulated imply a moral
judgment, since "murder" and "fornicate" imply that such an action is
ethically unjustifiable.
They do not admit that concrete norms stated in value-free
terms such as "Thou shalt not kill" and "Thou shalt not engage in sex
outside marriage" can be absolute, but maintain that all such concrete
norms stated in value-free terms admit, at least in theory, of
exceptions in certain circumstances. Thus the norm "Thou shalt not kill"
is prima facie (generally speaking) valid, but in certain circumstances
and for certain purposes it does not hold: one can kill to defend
oneself, or as punishment for a capital crime.
How, then, do we know when we can ethically make an exception
to a generally valid concrete moral norm? For example, when can we make
an exception to the general norm that to kill an unborn child is wrong?
Proportionalists argue that the criterion in making such legitimate
exceptions is the principle of proportion. If the values achieved by the
act outweigh the disvalues or harm caused, then the act is moral, even
if it violates the generally valid concrete norm. Thus it is not
murder to kill an enemy in self-defense because the value of my life
outweighs that of my attacker; since I am innocent and he is a criminal.
Similarly, the interests of a woman who has been raped may outweigh the
value of the life of her unborn child.
Proportionalism is a popular theory even among Catholics
because it seems both to maintain the prima facie validity of
traditional Christian norms, such as those which forbid homicide,
abortion, extramarital sex, and lying, and at the same time to permit
exceptions in difficult cases where the insistence on such norms seems
to be inhumane. Nevertheless, proportionalism as a methodology is open
to serious theoretical and practical objections and seems very difficult
to reconcile with the Bible or the teachings of the Catholic Church. It
is sufficient here to point out two of its weaknesses.
First, we must ask proportionalists how they are going to
measure or weigh the relative values or disvalues of a human action?
Caiaphas used a proportionalist argument in arguing for the death of
Jesus: "Can you not see that it is better for you to have one man die
than to have the whole nation destroyed?" (Jn 1:49). But how do we weigh
the value of one human life against another? Or how can we decide that
the happiness of one individual is of more or less value than the life
of another? Proportionalists have not been able to give any practical,
objective answer to how this proportion is to be determined fairly
without simply lapsing into utilitarianism or situationism.
Second, if we are to weigh values and disvalues, there must be
some values that are nonnegotiable or absolute against which other
values are weighed, such as the right of an innocent person to life. To
violate such nonnegotiable values is to do something intrinsically evil
that cannot be justified by any circumstance or good intention. That is
why in our justice system we recognize the right of a person to be
considered innocent until proved guilty. Therefore to deny there are any
exceptionless concrete moral norms amounts to saying that it is
sometimes permissible to do evil for the sake of good, or that the end
justifies the means, views which have always been rejected by
Christians.
Proportionalists attempt to answer this last objection by
saying that they do not maintain that it is permissible to do moral evil
for the sake of good, but only to do premoral (or ontic) harm when the
good achieved is greater than the premoral harm caused. This answer,
however, revives the first difficulty already discussed. To say that a
value is premoral means that it is unrelated to the good of human
persons, since any value which is a human, personal value has a moral
character. Thus the command, "Thou shalt not kill" in the Bible does not
mean that killing, in the abstract, is wrong; but it does mean that to
kill an innocent, nonaggressive human person is always wrong. If killing
a human person in self-defense can be justified, it is not because the
premoral benefits of killing outweigh the premoral harm done, but
because the aggressor has by his own harmful actions forfeited the
absolute moral right to life, which innocent persons possess in all
circumstances.
Prudential Personalism
Another form of teleological methodology that avoids these
difficulties and is more consistent with the teaching of the Catholic
Church is adopted in this article . Prudential personalism is based not
on the principle of proportion but on that of moral discrimination,
which will be explained later. Prudential personalism agrees with
proportionalism that in every moral decision we must take into account
not only prima facie concrete moral norms but also the circumstances and
the purposes of the actors; but contrary to proportionalism it maintains
that some basic human values, corresponding to the basic needs of the
human person, are nonnegotiable, that is, they can never be violated.
Thus some (but by no means all) concrete moral norms are valid
in all circumstances and for any purpose. For example, it is always
wrong to kill innocent human beings, it is always wrong to commit incest
or rape, and it is always wrong to perjure oneself. Such actions strike
at the nonnegotiable values of human life on which all human society is
based, and they are contradictory to our love of neighbor and therefore
our love of God. This methodology, therefore, is prudential because it
takes full account of the circumstances and purposes of human actions,
but it is a personalism because it protects the dignity and basic rights
of the person against violation by anyone or by society.
Christian Principles of Ethical Action
How do Christians reach decisions concerning specific concrete
issues? They apply Christian principles to particular cases. By a
principle we do not mean a priori rules that are deduced from more
abstract value statements, which in turn have been deduced from broad,
metaphysical axioms. Nor do we mean mere postulates or assumptions
accepted for the sake of consistency in behavior. Rather, we mean
practical generalizations derived from human experience of our basic
human needs and confirmed by the Gospel.
Adultery is not wrong merely because it violates some ideal
model of marriage, but because human experience tells us adultery
involves a serious breach of trust which destroys or weakens marital
love that is a basic human need. This experience was confirmed by Jesus
in the Sermon on the Mount (Mt 5:27-30). Thus moral decisions are not
automatically deduced from general principles because actual decisions
depend on wide and rich experience, good will, and sensitive, normal,
and disciplined emotions as well as good logic. To make good moral
decisions we must be good persons who have a realistic understanding of
what it is to be fully human.
Christians realize that because of the widespread wars,
poverty, ignorance, hatred, cruelty, and waste of human talents, what
it is to be truly human is not always clearly evident. In all times and
cultures people have been able to see the difference between those who
are "human" and decent and those who are "inhuman" and evil.
Nevertheless, what some people admire appears contemptible to others.
It is only in Jesus Christ that Christians see the true and
complete picture of what it is to be truly a normal human being:
truthful, courageous, compassionate, wise, unselfish, forgiving, and
faithful. Consequently, it is to his example that we look to define
moral principles in their precise meaning. At the same time we know that
his example can be appreciated not only by Christians who declare
themselves his followers, but by people of all faiths who have learned
about his life. Thus Gandhi, a Hindu, kept the New Testament on his
bedside table because he recognized in Jesus a supreme model of human
goodness.
Christians, however, believe that Jesus is much more than a
model. Because he is truly the Son of God, he is the source of the power
of grace by which it becomes possible for us all to grow in likeness to
him. This following of Jesus is not merely something individual; we need
to live it as members of the community he rounded and in which he
continues to live spiritually??the Christian Church, whose visible
unity is to be found in the headship of the successor of St. Peter, the
Pope. This Church is made up of both saints and sinners, but they work
together that all might become more like Jesus. Through the Bible, which
the Church has preserved, and the living tradition by which the Church
correctly interprets the Bible, as well as by the support and example of
fellow Christians, we members of this community are helped to keep the
life and teachings of Jesus clearly before our eyes. When controversies
and disagreements arise about what is the Christlike thing to do, we can
arrive at a clear and sound decision of conscience through the guidance
of this community, the Church.
The great disciple of Jesus, St. Paul, taught us that the
actions by which we follow Christ must be motivated by faith, hope, and
love (l Co 13). Faith, hope, and love work toward the satisfaction of
our deepest human need, the need to live in the community of persons
centered in the three-personed God. Our unison with God and neighbor
through Christ is Christian love. Christian hope is the dynamic movement
toward the realization of this community that is God's kingdom, even
here on earth. And the conviction that God has called us to this kingdom
and is willing to give us the power of the Holy Spirit by which we can
attain it is Christian faith. Christian prudence is faith in its
practical aspects as it enables us to be open to the guidance of
Christ's Spirit, who alone knows the way to God through the many
illusions and dead ends of life in a sinful world.
Thus faith, hope, and love, because they make us Christlike and
thus fulfill our deepest human needs, are the ultimate principles of
Christian ethics. Prudence (in the sense we are using here) does not
signify mere caution or compromise as it often does in common
parlance. Rather it means the ability to assess the circumstances of an
action and determine the best way to reach the goal to which God has
called us in Christ. Thus prudence often involves daring and courage and
always requires a practical wisdom that gets the job done.
Non-Christians who seek to develop ethical norms may agree that
faith, hope, and love are important human values, but they may differ in
the emphasis they give those values and they may not understand them in
a Christocentric manner. Thus faith, hope, and love are common to many
value systems, but in an analogical way. This does not imply that
non-Christians never experience the realities to which the terms faith,
hope, and love refer. Catholic theology admits that non-Christians may
be living by grace, but when they experience these realities they do not
name or understand them in the same way as Christians. Christians
claim no monopoly in the true God or his grace, but only that the
gracious God has made himself fully, explicitly, and intimately known to
humanity in Jesus Christ. Thus these three Pauline terms of faith, hope,
and love serve as a way of classifying a set of ethical principles that
are explicitly but not exclusively Christian and that can be applied to
bioethical issues. In the remainder of this paper, we will formulate
and briefly explain 12 such principles which play the major role in
bioethical decision.
Principles of Christian Faith
Christian faith, which enables us to understand not only our
natural needs but, more important, our deeper needs awakened by God's
grace, is a kind of knowing, a light that guides our way in life. Hence
the principles of faith instruct us how to form a prudent conscience,
because forming a prudent conscience is fundamentally (but not
totally) a process of knowing and a strengthening and deepening of
human insight and reason. Christians are aware that in forming their
consciences they depend on the Holy Spirit to overcome the prejudice
and blindness of sin (Rom 1:18-20). With this assistance and the light
of faith we are guided in making prudent decisions by six principles. If
our faith is to be practical, we must take care to inform our own
conscience (principle of well-formed conscience) and enable others to
do the same (principle of free and informed consent). We must then apply
this information to our actual decisions (principle of moral
discernment), taking special care when our actions, although good in
themselves, may involve bad side effects (principle of double effect) or
involve us in cooperation with others who do something we would prevent
if we could (principle of legitimate cooperation). In particular, as
professionals we must respect the right of others to privacy when they
confide their own moral problems to us (principle of professional
communication).
1. Principle of a Well-Formed Conscience
To attain the true goals of human life by responsible actions, in
every free decision involving an ethical question, people are
morally obliged to do the following:
a. Inform themselves as fully as practically possible about the facts
and the ethical norms.
b. Form a morally certain judgment of conscience on the basis of
this information.
c. Act according to this well-formed conscience.
d. Accept responsibility for their actions.
2. Principle of Free and Informed Consent
To protect the basic need of every human person for health care and
the person's primary responsibility for his or her own health, no
physical or psychological therapy may be administered without the
free and informed consent of the patient, or, if the patient is
incompetent, of the person's legitimate guardian acting for the
patient's benefit and, as far as possible. in accordance with the
patient's known and reasonable wishes.
The principle of free and informed consent is unquestionably
one of the most important in medical ethics because it is at the heart
of the physician patient relationship and will be discussed in detail
later on. It is a corollary of the principle of well-formed conscience.
If I have an obligation to inform my own conscience, I must also enable
those who request my professional advice to do the same. Responsible
consent to therapy must be informed consent, that is, the patient must
be told the nature of the proposed therapy, its probable benefits, its
possible risks, and other possible treatment choices. Moreover, consent
must be free, that is, the patient must be permitted to make decisions
without undue pressure of time, emotional upset, confusion, persuasion,
or threat.
The information must be given in terms understood by the
patient and preferably with feedback from the patient to make sure that
he or she has understood correctly. The professional should not feel
excused from this principle merely because the patient seems
uncooperative, ignorant, or unable to speak English well; he or she is
obliged to do what is possible to communicate the information
adequately. It is true, of course, that such communication is often
difficult and in emergencies may not be perfectly achievable, but a
serious effort must be made.
For so-called proxy consent the legitimate guardian should
always act not for the guardian's interests but for the patient's
benefit and should respect the patient's known or probable wishes,
provided these are reasonable. If the professional has good reason to
think that the guardian is not acting in this responsible way, an effort
to protect the rights of the patient must be made, by legal action if
necessary.
3. Principle of Moral Discernment
This principle, which distinguishes prudential personalism from
other forms of theological ethics, maintains that,
To make a conscientious ethical decision, one must do the following:
a. Proceed on the basis of a fundamental commitment to God and
the authentic dignity of human persons, including oneself.
b. Among possible actions that might seem to be means of
fulfilling that commitment, exclude any which are in fact
intrinsically contradictory to that commitment.
c. Also consider how one's own motives and other circumstances
may contribute to or nullify the effectiveness of the other
possible actions as means to fulfill one's fundamental
commitment.
d. Among the possible means not excluded or nullified, select
one most likely to fulfill that commitment, and act upon it.
For example, a surgeon faced with a problem of recommending a
high risk surgery to a patient will (1) guide his decision by his
overriding sense of responsibility before God for the welfare of his
patient; (2) consider possible ways of treating the patient's condition
with or without surgery, and exclude those which are so risky,
experimental, or ineffective as to be contradictory to the patient's
nonnegotiable right to life or other such basic needs; (3) also consider
whether his judgment may be prejudiced by financial considerations or
ambition to make a name for himself, and whether in the circumstances of
the patient's life and the available medical facilities, the possible
value of the surgery may be nullified; (4) among the remaining
possibilities choose and act on one that will most likely benefit the
patient and reflect a real concern on the surgeon's part for the patient
as a person.
The first of these points of commitment to God and the dignity
of the human person is the underlying motivation of the Christian life,
which should be part of all the helping professions. It connects this
principle with the principle of love, to be explained later in this
paper. The second point is the difference between prudential personalism
as a methodology and proportionalism, since the latter denies that there
are any concrete moral norms that, apart from circumstances and
intention, can absolutely exclude any type of action as intrinsically
evil. The third point is the prudential aspect of prudential
personalism, which takes into account not only the intrinsic nature of
an action but also all its circumstances. Finally, point four shows why
this principle belongs to teleological ethics: according to it, moral
decisions depend on the judgment of the relation of the action as a
means to the goal or commitment (point one).
4. Principle of Double Effect
To form a good conscience when an act is foreseen to have both
ethically beneficial and physically harmful effects, the following
conditions should be met:
a. The directly intended object of the act must not be
intrinsically contradictory to one's fundamental commitment
to God and neighbor (including oneself).
b. The intention of the agent must be to achieve the beneficial
effects and as far as possible to avoid the harmful effects
(that is, must only indirectly intend the harm).
c. The foreseen beneficial effects must be equal to or greater
than the foreseen harmful effects.
d. The beneficial effects must follow from the action at least
as immediately as do the harmful effects.
Developing a well-formed conscience with prudent moral
discernment also demands care in the possible harmful side effects we
foresee resulting from our good actions. Since it is not possible to
avoid all such side effects and at the same time to fulfill our
obligations to do the good from which they result, we need a principle
to guide us in such dilemmas. For example, to save someone's life, a
physician may perform an amputation. Although the crippling effect of
the surgery is foreseen, it is not desired or chosen as such. The
handicap is an undesirable side effect. Because the handicap is not what
is chosen, it is not a moral effect, but only a physical effect, since
morality always pertains to free choices. Thus the two "effects"
referred to in the title of this principle are not both moral or ethical
effects, Rather, the effect that is freely (directly) chosen is morally
good and the other effect is physically harmful, but it is not freely
chosen (it is indirectly chosen).
Proportionalists eliminate the first, third, and fourth of
these conditions and accept only the second, because they do not admit
that it is possible to state any concrete moral norms that are
exceptionless; that is, they do not admit that any kind of concrete
action can be judged to be intrinsically wrong (contradictory to a
fundamental commitment to God and neighbor) unless at the same time we
consider the circumstances in which it is performed. We have explained
the inadequacy of such a methodology. It is impractical and arbitrary
because there is no precise way to weigh the complex positive and
negative values involved in human actions.
Proportionalists retort that, if this is so, how can the third
of the above conditions be fulfilled? Our reply is that in a prudential
personalist methodology the first condition is the essential one, and
the other three merely suggest tests by which it can better be
determined if the first condition is actually being fulfilled.
Consequently, all that the third condition demands is not the precise,
determinative weighing of values on which the entire methodology of
proportionalism depends, but merely that an action, already determined
to be intrinsically moral (first condition), is not vitiated by
circumstances that result in obviously greater evils than the good
intended. The second and fourth conditions are required for the same
reason, to ensure that the agent directly intends only the intrinsically
good effect.
An example of the application of this principle is an operation
to remove the cancerous uterus of a pregnant woman, which will also kill
her unborn child. The physician rightly decides that this is ethical
because his direct intention is morally good (to save the woman's life
from the cancer), thus fulfilling the first condition; and he knows that
he is being honest in his decision because (1) he would save the child's
life if he could (second condition), (2) the value of the mother's life
is equivalent to that of the child's (the third condition), and (3) the
removal of the cancer is what saves the woman's life, not the child's
death (fourth condition).
5. Principle of Legitimate Cooperation
To achieve a well-formed conscience, one should always judge it
unethical to cooperate formally with an immoral act (that is,
directly to intend the evil act itself), but one may sometimes judge
it to be an ethical duty to cooperate materially with an immoral act
(that is, only indirectly intend its harmful consequences) when only
in this way can a greater harm be prevented, provided (a) that the
cooperation is not immediate and (b) that the degree of cooperation
and the danger of scandal are taken into account.
To carry out our responsibilities we usually have to cooperate
with others. We frequently foresee that this may involve us in conduct
on their part which we believe to be objectively wrong, although we
realize that those with whom we cooperate may not in their own
consciences perceive it as evil. When possible we should inform them and
try to dissuade them, but often we know this will have no effect and may
even injure them or ourselves. Must we, therefore, refuse to cooperate
with them?
We must refuse to cooperate if we would involve ourselves in
formal cooperation, that is, agreeing with, advising, counseling,
promoting, or condoning the objectively evil action of another,
because formal cooperation demands that we directly intend the evil
action itself, which is morally equivalent to doing it ourselves. If,
however, the cooperation is merely material; that is, our cooperation
is with the good that is being done and only indirectly with evil, which
we would prevent if we could, then such cooperation is permissible and
even obligatory if (1) the refusal to cooperate would result in a greater
evil than if we cooperate and (2) if the cooperation is not immediate
and is more remote the greater the evil involved. The main reason for
these conditions is to verify that one truly avoids formal cooperation.
The closer the cooperation and the greater the evil the more it requires
a serious justifying cause. In judging the evil involved, even in
material cooperation, an important additional consideration is the
scandal that may be caused or the bad example given to others.
For example, a physician who thinks abortion is wrong, yet
performs one because his patient demands it or even merely refers her to
another physician cooperates formally. A nurse who disapproves yet
takes an active part in the procedure, cooperates immediately, and her
action is not justified. Yet a nurse who cares for the patient after the
abortion cooperates only materially and remotely. Such cooperation might
be justified if her refusal would imperil her ability to continue in her
profession and scandal can be avoided. This would not justify, however,
working in a facility devoted exclusively to abortions, since this would
certainly give scandal.
6. Principle of Professional Communications
To fulfill their obligations to serve patients, health care
professionals have the responsibility to do the following:
a. To strive to establish and preserve trust at both the
emotional and rational levels.
b. To share such information as they possess which is
legitimately needed by others in order to have an informed
conscience.
c. To refrain from lying or giving misinformation.
d. To keep secret information which is not legitimately needed
by others and that if revealed might harm the patient or
others or destroy trust.
It is obvious that, if professionals are not truthful to
patients, there cannot be free and informed consent. Hence good
communication is needed between professional and patient, which is
impossible without (1) trust, (2) contact among people who have the
needed information, (3) clear formulation and expression of this
information, and continuous feedback by which failures in communication
can be corrected. Modern communication theory has shown that this work
of communicating depends first on good emotional relationships among the
communicators, since emotional conflict is a powerful barrier to
communication and brings into play all sorts of uncontrollable,
unconscious factors.
The duty to tell the patient the truth does not, of course,
dispense one from the responsibility to do it in a sensitive,
compassionate, and tactful manner and in the proper circumstances.
Moreover, professional secrecy has some limits. Although a Catholic
priest is absolutely bound by the secrecy of the confessional, the
medical professional may in some rare situations reveal confidential
matters, namely, when the patient is considering suicide, is involved in
a serious crime or serious injustice to a third party, or is seriously
incompetent.
Why Are These Christian Principles.?
The foregoing six principles are not exclusively Christian,
since anyone who is convinced that human beings have inalienable rights
should agree with them. Nevertheless, Christian faith makes these
principles clearer and more certain and uses them in a practical way
as guides to prudent decisions. Christian faith convinces us that all
human persons are created in God's image as intelligent, free, and
morally responsible. Consequently, they must strive to base their free
decisions on correct information, and must truthfully share this
information with each other, at the same time respecting the
consciences and privacy of others. In using this information they must
discern what actions are always wrong because they contradict commitment
to God and neighbor and the fulfillment of basic human needs, but they
must also take into consideration the concrete situations in which
they act and the possible side effects of their actions, even when these
are essentially good.
In the Sermon on the Mount (Mt 5-7) Jesus taught us that if we
are to keep his Father's commandments it is necessary not only to do
good but to do it from the right motives. This is why it is essential
that the direct intention of all our actions, no matter how complex or
ambiguous the situation in which we have to act, should be ethical. St.
Paul (Rm 3:8) rejects the notion that we can do evil so that good may
come from it. If we are to achieve the happiness for ourselves and
others that God wants us to have, it can only be by means that are
themselves good, because evil means can yield good results only in the
short run and even then they injure the integrity of the agent. In the
long run they are always counterproductive.
Principles of Christian Love
We have just considered the norms that guide our thinking as we
strive to make intelligent realistic moral decisions. These norms are
rooted in one of our basic human needs, the need for truth. Another
basic human need is the need for society. Our fundamental motivation is
the drive to self-fulfillment, but human self-fulfillment is possible
only through relationships with other human beings, and above all with
the three divine persons, Father, Son, and Holy Spirit. The ethical
norms that govern these relationships can rightly be called norms of
love.
Love is not only a kind of feeling, but also the practical will
that leads one person to be concerned about another and that person's
true needs. Furthermore, love motivates people to help others fulfill
these needs by sharing with another the values they themselves enjoy. In
any Christian ethics the fundamental truth is that there is a Triune
God and that "God is love" Jn 4:8). God loves us not because he has
first needed our love, but because his love for us has made us lovable.
God's love was revealed in our midst in this way: he sent his only
son to the world that we might have life through him. Love, then,
consists in this: not that we have loved God, but that he has loved
us and has sent his son as an offering for our sins. If we love one
another, God dwells in us and his love is brought to perfection in us
(I Jn 4:9-10, I2).
Three particular norms help to define the content of Christian
love: (1) every person must be valued as a unique, irreplaceable member
of the human community (principle of human dignity); (2) every person
must be encouraged to play a role in the common life and fully share its
fruits (principle of common good, subsidiarity, and functionalism); and
(3) all persons must be helped to realize their full potential
(principle of the totality of the human person).
7. Principle of Human Dignity
All ethical decisions (including those involved in health care) must
aim at human dignity, that is. the maximum, integrated satisfaction
of the innate and cultural needs of every human person, including
his or her biological, psychological, social, and spiritual needs as
a member of the world community and national communities.
Although today the unique value of every being is affirmed by
all the world religions and philosophies of life and the inalienable
rights of the person are nominally guaranteed by the constitutions of
most governments, yet these rights are contradicted by three prevailing
trends: (1) persons are swallowed up in totalitarian, bureaucratic
institutions; (2) persons who are not needed for the efficient
operations of these institutions women, the very young, the very old,
the uneducated, the defective??are treated as nonpersons; (3) even
successful persons find their happiness not in sharing their lives with
others but in private, individualistic satisfactions.
This principle not only states one basic human need but also
includes all the others. In short it sums up the true goal of human
life: self-actualization in relation to God and neighbor. Jesus said,
"Treat others the way you would have them treat you: this sums up the
Law and the Prophets" (Mt 7:12). That is, respect your own human dignity
and that of others.
8. Principle of the Common Good, Subsidiarity, and Functionalism
Human communities exist only to promote and share the common good
among all their members "from each according to ability, to each
according to need" in such a way that:
a. Decision making rests vertically first with the person,
then with the lower social levels and horizontally with
functional social units.
b. The higher social units intervene only to supply the lower
units what they cannot achieve by themselves while at the
same time working to make it easier in the future for lower
units and individuals to satisfy these needs by their own
efforts.
The principle of human dignity requires that various levels of
responsibility be established within the community. The primary
responsibility for health rests with the individual, and hence the work
of health care professionals must be conceived as a cooperative service
for individuals in their personal search for health. At the same time no
individual is self-sufficient in this search but can achieve health only
with the help of health care professionals and the support of the
community. Consequently, it is important to observe subsidiarity (that
is, to keep decision making as close as possible to the persons
concerned in the vertical organization of society) and functionalism (to
keep decision making widely spread in the horizontal organization of
society). At the same time, those who have the highest authority must
protect and promote the common good.
This principle is only a way of spelling out the implications
of the principle of human dignity by showing the respective roles of
the individual, subgroups in the community, and the total community so
that by this division of labor the dignity of every member of the
community will be fully recognized and actively promoted. It has its
source in our basic need to preserve life.
The Christian specification of this principle is given by St.
Paul in 1 Cor 12-I3. He shows that the Christian understanding of person,
based on Jesus' concern for the "little ones" and the "least brethren"
(Mk 9:33-37}, must be the principle that governs the Church, conceived
as the Body of Christ, ensouled by the Holy Spirit, and the model for
the coming kingdom of God. The conception of social authority as
service rather than domination is at the heart of the Gospel (Mk
10:41-45).
9. Principle of the Totality of the Human Person
To promote human dignity in community, every person must develop,
use, care for, and preserve all of his or her natural physical and
psychic functions in such a way that:
a. Lower functions are never sacrificed except for the better
functioning of the whole person and even then with an effort
to compensate for this sacrifice.
b. The basic capacities that define human personhood are never
sacrificed unless this is necessary to preserve life.
This principle makes explicit another aspect of the principle
of human dignity by requiring self-respect as well as respect for
others. Unless a person respects his or her own integrity, which
includes one's natural bodily and psychic integrity, and seeks to
preserve and perfect one's own gifts, that person cannot expect the
community's respect. This principle and the principle of the common good
maintain that the community and the person are complex systems of mutual
interdependence of parts of a whole. Person and community differ
radically, however, because a person is a natural, primary unit whose
parts depend completely on the whole and exist for its sake. On the
contrary, the community is a system made up of primary
units??persons??and so exist for their sake, not merely as isolated
individuals, but as sharers in a common, profoundly interrelated life.
To claim that the community ought to function like one person results
in totalitarianism, which sacrifices the person to the collective state.
Human wholeness consists in the interdependence of higher and
lower spiritual and bodily functions. Consequently, the lower functions
cannot without qualification be sacrificed to the higher functions. This
sacrifice might be to the advantage of the higher function but will not
be to the good of the whole person, since that good is essentially
complex, irreducible to the good of one part, even if that part is the
highest.
To be a complete human being, therefore, is not merely to have
the higher level of functions but to have all the basic human functions
in harmonious order. This order requires the subordination of the
lower functions to the higher functions but also forbids their total
sacrifice. Nor can this dependence be simply supplied by some means
external to the person. For example, the ability to produce babies in
test tubes does not of itself justify the elimination of the
reproductive power of humans. Nor does the possibility of intravenous
feeding justify the elimination of the human alimentary system. Human
perfection requires that people reproduce and eat in a human manner.
Substitutions of external means of life may be justified temporarily out
of necessity, but they do not improve on human nature.
Human body functions contribute to higher functions not merely
by supplying what is needed for physiological brain functions; they also
supply part of the human experience that is essential to human
intelligence and freedom. Bodily feelings (movement, eating, sexuality,
manipulation of the environment) develop one's self-awareness and
relation to the community. Thus, if a child were conceived in a test tube
and gestated in an artificial womb and then raised in a laboratory, it
is doubtful that he or she would have essential human experiences. The
following norms pertain to human integrity:
1. Primarily, human health is not merely a matter of organs but
of capacities to function humanly.
2. Generally speaking, any particular human functional capacity
can be diminished when necessary for the good of the whole
person; that is, so that the person can better exercise all
other human functions.
3. Secondary functions can always be sacrificed for more basic
ones. For example, a finger can be removed to save the use
of the hand because the capacity of action given by one
finger is secondary in relation to the capacity given by the
hand as a whole.
4. Primary or basic functional capacities, however, cannot be
destroyed to promote even more important capacities except
when it is the only way to preserve the life of the whole
person. For example, the capacity for emotional feeling must
not be sacrificed to the power of scientific thinking. The
capacity to think humanly cannot be sacrificed in order to
think more technically.
Why then is it sometimes permissible to sacrifice one of these
basic human capacities to preserve life? Because in this case it is not
a question of sacrificing one basic capacity for another, nor for the
better functioning of all other human capacities, but of sacrificing one
function so that the whole person should continue to function at all.
Only in such extreme necessity does basic integrity yield to the good of
the totality.
The great importance of this principle for medical ethics is
that it establishes a norm for setting priorities when one human value
must be subordinated to another. There is a hierarchy of values in terms
of the biological, psychological, social, and spiritual dimensions of
human personality. The spiritual and social values have higher priority
than the psychological and biological values, but such priority must not
be understood dualistically as if the lower can simply be sacrificed to
the higher values.
The specific character of this principle arises from the
Incarnation in which the Word of God became flesh as Jesus of Nazareth,
lived a bodily life, died, and was resurrected in the body transformed
in glory. Consequently, Christian anthropology, while admitting a
certain polarity in the person because of a commonality with the animal
and earthly world and a spiritual intelligence, freedom, and openness to
God, yet opposes any kind of dualism that would deny the dignity of
Christ's body, human resurrection, and that persons are the "temples of
the Holy Spirit" (1 Co 3:16). This principle is well expressed by the
writer of Ephesians (5:21-33) when he makes the analogy between Christ's
love for the human race, a man's love for his wife, and one's love for
one's own body.
Principles of Christian Hope
After discussing the norms of faith and love, let us now
consider what theologians call the eschatological aspect of ethics
(looking to the final coming of Jesus Christ in the fully realized
kingdom of God). The person and the community are not structures of
static relations but are dynamic loving, growing, developing, and
evolving. This is why we have opted for a teleological, goal directed,
means-ends ethics. Furthermore, human goals are not always clearly
envisioned in advance. The kingdom of God, on which Jesus centered his
preaching, is a goal so mysterious that he could express it only in
terms of parables.
Recently, Christian theologians have developed theologies of
hope and theologies of liberation to bring out the many ways in which
the Gospel is not merely a declaration that heaven is better than earth,
but a call to transform the earth as we journey heavenward. In this way
they are finding areas of agreement with humanism and Marxism which
teach that to be human is to work for the future. In health care this
sense of hope is the source of all healing, so that to be a health care
professional is constantly to affirm the possibility of turning
suffering into a victory over disease and death.
Three ethical norms relate in a particular way to Christian
hope. Our hope enables us not only to endure the sufferings of life
courageously, but to grow as persons through this experience (principle
of growth through suffering). Hope also enables Christians to entrust
themselves to another in the lifelong commitment of marriage and to look
forward to sharing this gift of life and love with a family and the
future (principle of personalized sexuality). Moreover, not only do we
have hopes for our families but for the whole of human society and the
good earth which is its home (principle of creative stewardship).
10. Principle of Growth Through Suffering
As bodily pleasure should be sought only as the fruit of the
satisfaction of some basic need of the total human person, so
suffering and even bodily death when endured with courage can and
should be used to promote personal growth in both private and
communal living.
In any teleological ethics the ultimate criterion of morality
is true happiness. An action is morally good because it leads to
happiness for persons. People sometimes fail to take into account,
however, that in the actual conditions of human existence not all that
appears to be happiness is really so. The only authentic happiness is
one which satisfies the whole person in his or her deepest and most
ultimate needs and does so permanently. Thus it is quite possible for
persons to think they are happy because they have achieved goals that
are partial, superficial, and unstable. On television we witness the
extravagant joy of winners in giveaway contests, knowing that in fact
such happiness will quickly fade and prove to have been utterly fake.
It is also possible for persons to have really achieved goals
that are encompassing, profound, and lasting and yet to be in a state of
great suffering because circumstances do not yet permit the full
experience of satisfaction. A great writer who has completed a
masterpiece or a scientist who has achieved the discovery of a lifetime
or a statesman who has successfully carried through a great reform may
feel for a time exhausted, torn by inner conflict, and depressed. Yet
such persons are to be envied because ultimately they will realize they
have reached the goal of their whole lives.
Thus, from an ethical point of view, it is essential to
understand that true human happiness cannot be measured merely by
pleasure, comfort, or freedom from anxiety, tension, and guilt. Normally
pleasure, comfort, and peace are the consequences and the signs of the
achievement of authentic human goals and the fulfillment of the true
human needs, and hence they are good and desirable. But they are
secondary signs and not the proof or measure of real human achievement.
Relevant to ethical questions, therefore, people need to look
at the deeper and more total need and not to measure good and bad merely
in terms of pleasure and pain. Short-range goals, that is, immediate
satisfactions, have to yield ethically to long-range goals. Yet we
cannot live without some shortrange, moderate pleasures, and strains
and pains cannot be endured too long. A work ethic by which life is
simply striving for a far-off, never-attained goal is a bad ethic.
Authentic fulfillment, however, is not to be found by the maximization
of sensual pleasure (as hedonism insists), but rather by intensifying
deeper spiritual pleasures along with moderate bodily pleasures and by
realizing that one is able to develop as a person through suffering.
The Christian faith, then, looks upon suffering and death in
two different ways. On the one hand, death is evil because it is the
result of sin. On the other hand, it is a liberating and grace-filled
experience, if the proper motivation is present. These two views are
not contradictory; rather they are complementary. Suffering and death,
joined to the suffering and death of Jesus, the Lord of life, represent
not dissolution but growth, not punishment but fulfillment, not sadness
but joy. God allows suffering and death to enable us to live with Christ
now and forever. This principle, supremely exemplified in the Cross of
Christ, is rooted in the basic human need to preserve life, since people
suffer only in order to achieve a renewed, purified, and enriched life.
I will discuss this principle of growth through suffering and its
applications to health care in more detail in a future paper.
11. Principle of Personalized Sexuality
The gift of sexuality must be used in keeping with its intrinsic,
indivisible, specifically human teleology. It must be a loving,
bodily, pleasurable expression of the complementary, permanent
self-giving of a man and a woman to each other which is open to
fruition in the perpetuation and expansion of this personal communion
through the family they responsibly beget and educate.
This principle concerns personalized sexuality because it is
based on an understanding of sexuality as one of the basic aspects of a
person that must be developed (personalized) in ways consistent with an
enhancing of human dignity. Because human sexual life is not merely a
matter of animal instinct but requires free decisions, it sometimes
raises serious ethical dilemmas. These problems might well be
considered under norms of love, but more properly they belong to the
norms of hope because sexual love in a very special way looks toward the
future. The survival of the human community, as well as the maturation
and fulfillment of the individual, depends in a notable way on the right
use of the gift of sex.
Sexuality is a complex of many values that are generally
recognized in every ethical theory, but whose interrelation and priority
are the subject of much disagreement. These generally recognized values
can be summarized in four chief categories:
1. Sex is a search for sensual pleasure and satisfaction,
releasing physical and psychic tensions.
2. More profoundly and personally, sex is a search for the
completion of the human person through an intimate personal
union of love expressed by bodily union. Ordinarily, it is
also conceived as the complementation of the male and female
by one another so that each achieves a more complete
humanity.
3. More broadly, sex is a social necessity for the procreation
of children and their education in the family so as to
expand the human community and guarantee its future beyond
the death of individual members.
4. Ultimately, sex is a symbolic (sacramental) mystery, somehow
revealing the cosmic order.
These values are commonly recognized in all the great religions
and philosophies of life and are protected and developed in every viable
human culture.
In our modern culture, dominated by secular humanism, these
values are generally thought to be combined in sexuality by sheer
accident through the purposeless process of biological evolution.
Consequently, many today argue that we are free to combine or separate
these different values according to our own purposes and preferences.
Thus for secular humanists it seems entirely reasonable sometimes to use
sex purely for the sake of pleasure apart from any relation to love or
family; sometimes to use it to reproduce (making babies in a test-tube)
without any reference to pleasure or love; sometimes as an expression
of unselfish love, but without any relation to marriage or family.
For secular humanists, moreover, if sex is a symbolic mystery,
it is because love and sexual ecstasy are often considered the highest
happiness in life, without which no one can be complete as a person.
Consequently, for many secular humanists sexual morality can be reduced
to two fundamental norms: (1) laws or social attitudes that hinder human
freedom to achieve these sexual values in ways the individual desires
are unjust and oppressive, and (2) sexual behavior, at least among
consenting adults, is entirely a private matter to be determined by
personal choice, free from any moral guilt.
The Christian attitude to sex agrees with that of secular
humanism in recognizing these same four values of sexuality but differs
in its conviction that sexuality is a gift of the Creator, who in his
wisdom and love for humanity created in his image has so intertwined
these values that we cannot separate them without injury to that same
image. The Catholic Church has often been accused of a negative attitude
toward sexuality. It is true that in the course of her long history, the
expression of her teaching on sexuality has sometimes been colored by
the secular culture in which she has lived. Consequently, the pagan
philosophy of Plato, who taught that sex is a result of the fall of the
human soul into the tomb of the body, and of the Stoics, who rejected
physical pleasure and erotic love as unworthy of a philosopher and saw
no value in sex except procreation, as well as current secular
humanism, have sometimes distorted the ways Christians have thought and
spoken about sex.
Nevertheless, genuine Christian teaching on sexuality is clear
enough in the Scriptures and was given a rich and accurate expression by
Vatican II and Paul VI's encyclicals, Humanae Vitae, and John Paul II's
Familaris Consortio based on the Council. Genesis 1-3 teaches that God
created persons as male and female and blessed their sexuality as a
great and good gift. Jesus confirmed this teaching, and perfected it by
affirming that men must be as faithful in marriage as women (Mk 10:2-21;
1 Co 7:10). Nevertheless, Jesus also taught that although sexuality is a
great gift, its use in marriage is only a relative value, which can be
freely sacrificed for the sake of higher values. Thus, for the
Christian, the celibate or single life with its freedom from domestic
cares to be of service to others, can be even more personally maturing
and fulfilling than married life. St. Paul (1 Co 7:25-35) also
emphasizes the value of the single life, but teaches that marriage is
a sacrament in that the love of husband and wife is a symbol that shows
us the love of Christ for his people (Ep 5:22-23).
From this Biblical teaching it is clear why Vatican II and the
papal encyclicals teach that sexuality was given to us to help us love
one another whether we freely choose to marry or to live the single life
of service to society. Any use of sex outside marriage is ethically
wrong, because (1) it is a selfish pursuit of pleasure apart from love,
as in masturbation, prostitution, or casual or promiscuous relations;
or (2) it expresses love, but not a committed love involving true
self-giving, as in adultery or premarital sex; and (3) it is committed,
but practiced in a way contradictory to its natural fulfillment in the
family, as in contraception or the relations of committed homosexuals.
The reason such actions are ethically wrong is not some repressive rule
of the Church, but because they are contradictory to the intrinsic value
and meaning of sexuality as designed by the Creator and blessed by him.
Human culture and customs have undergone many revolutions, but such
changes cannot alter the basic structure of human nature without
destroying humanity itself. The medical-ethical problems that the
application of this principle raises will also be discussed in greater
detail in a future paper.
12. Principle of Stewardship and Creativity
The gifts of multidimensional human nature and its natural
environment should be used with profound respect for their intrinsic
teleology, and especially the gift of human creativity should be used
to cultivate nature and environment with a care set by the limits of
actual knowledge and the risk of destroying these gifts.
The hope that leads human beings to endure the inevitable pain
of human existence and to overcome human mortality by the perpetuation
of the human community also leads us to struggle with the environment.
The author of Genesis 3 profoundly symbolizes the evil of sin by the
expulsion from the Garden, the burden of sexism for Eve, and the burden
of struggle with the environment for Adam, These are the fundamental
realities of the human situation, yet Scripture says they are not what
God wanted for humanity. God has given persons the power of
intelligence, restored by grace in Christ, the new Adam, by which they
can deal with these problems. Yet, although they may deal with these
evils well or badly, they cannot escape the struggle and still remain
human.
This principle requires us to appreciate the two great gifts
that a wise and loving God has given us: the earth, with all its natural
resources, and our own human nature ("embodied intelligent freedom"),
with its biological, psychological, ethical, and spiritual capacities.
Recently, we have come to recognize that our earthly environment is a
marvelously balanced ecological system without which human life could
never have evolved. Although we certainly have a need and a right to
cultivate and perfect our earthly home, to till and irrigate its soil,
to build cities, and to use its raw materials for the wonderful
devices of modern technology, we should not do this ruthlessly but must
take the utmost care to conserve our ecological system unpolluted and
unravished, and to cycle its raw materials and its energy supplies. We
have already discovered how much damage the thoughtless exploitation of
natural resources can do to our own lives.
Similarly our own human nature, our bodies, and our minds are
wonderfully constructed. We have the need and right to improve our
bodies and to develop medical technologies that prevent and remedy the
defects to which they are liable. But we must do so with the greatest
respect for what we already are as human beings. Our bodily and mental
functions have natural teleologies, which cannot be eliminated or
misdirected without injury to our humanness,
Consequently, a technology based on the false principle that
"If it can be done, it should be done" is a misuse of our creative
intelligence. Rather we should ask ourselves, "Should it be done?", and
only if the answer is "yes" develop and use the technology to do it.
Thus the God-given gifts of our environment and our humanity are ours in
stewardship, but because the greatest of our natural gifts are our
intelligence and freedom, the stewardship should be creative. Our
creativity should be used as a co-creativity with the Creator, not a
reckless wasting of his gifts.
This principle is rooted in the basic human need for truth,
since it is God-given human intelligence, the capacity for truth, which
makes persons co-creators with God. Its specifically Christian character
derives from the fact that the risen Christ is the pledge that the
Kingdom of God will eventually be built, and the coming of his Holy
Spirit gives persons the power to share in this building of the Kingdom,
the house built not on the sand of pride but on the rock of faith (Mt
7:24-29). The Gospel does not encourage Christians simply to wait until
the Lord returns, indifferent to the world's fate as Marxists and
humanists charge. Rather, Christians are called to play a historical
role in the liberation of the human race from poverty, disease, and
oppression with the assistance of the power of God, with a special
"option for the poor:"
Coordination of the Principles
Why have I chosen to list 12 principles rather than a few
broad ones? The main reason is that in the actual process of bioethical
decision making, each of these 12 plays an important role. In fact,
these could be still further multiplied by additional corollaries. Our
list, however, can be coordinated and simplified by showing how it flows
from the four basic needs of human persons enumerated by Aquinas:
1. The need to preserve life: the principles of totality and
growth through suffering.
2. The need to procreate: the principle of personalized
sexuality and moral discrimination.
3. The need to know the truth: the principles of well-formed
conscience along with the rules for resolving conflict cases
(principles of double effect and legitimate cooperation),
and finally the principles of informed consent and
professional communication, which provide the conditions for
a prudent Conscience.
4. The need to live in society: the principles of human dignity
and of the common good and subsidiarity along with the
principle of stewardship, which relate human society to the
environment and to the use of all gifts for the common good.
Summary
To sum up this discussion of the principles that govern bioethical deci-
sions from a Christian point of view:
1. Faith requires persons to act with an informed conscience,
which requires the intellectual effort of moral
discrimination between right and wrong, even in complex
cases wherein moral actions involve evil side effects or
material cooperation. It also requires a relation of trust
between persons (especially between professional and
client) in which there is an honest exchange of the
information necessary for an informed conscience.
2. Hope requires persons to accept growth through suffering,
to continue the human community through the institution of
the family, and to fulfill in a creative manner their
stewardship of their own nature and the world God has given
them.
3. Love requires a profound respect for human dignity, no
matter what the condition of the person. It also requires a
proper love of one's self and a responsibility for one's
own health. Finally, it requires persons to work for and
share in the common good.
Sources:
I. John Connery, "The Theology of Proportionate Reason," Theological
Studies 44 n.3, (Sept. i983) p. 489-498; G, Grisez, The Way of the
Lord Jesus, (Chicago: Franciscan Press, 1984), Chapters 4, 8, 35, 36.
2. Karol Wojtylo (Pope John Paul II), "Human Sexuality," in Towards a
Theology of Praxis, Alfred Bloch and G.T. Czuckza, editors, (New
York: Crossroads, 1982), pp. 57-104.
3. Pope John Paul II, "The Christian Family in the Modern World," (Nov.
22, 1981), in Austin Flannery, Post Conciliar Documents (North Port,
NY: Costello Publishing, 1982), p. 815-898.
4. Bracken, Fr. Jerome, O.S.B. Class Notes from "Health Care Ethics",
Immaculate Conception Seminary, Seton Hall University, Fall 1992.
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