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A Course in Moral Theology

BIO-ETHICS
Fr. Dr. Selvaraj ANTONISAMY SAC

Chapter One
INTRODUCTION

1.1 Terminology and Definition

Ethics
The systematic study of human conduct
The standards of right and wrong by which human conduct may be directed
The goals and the goods to which human conduct is directed

It is concerned with choices, actions, attitudes and character

It involves an examination of the nature of the person as a moral being

Historically, it is a ‘Branch of Philosophy’

Different ‘Ethical Theories’ have explored the world of ethics in different ways
Some have tried to identify and define the ‘Ideal Human Character’
Others have sought to arrive at ‘Eternal Ideals’
Still others have sought to define the ‘Moral Laws of the Universe’ and have tried to conform
human conduct to these laws

Christian Ethics
It involves discerning the moral demands and obligations of the ‘Christian Faith’
It is an ethical reflection by Christian in the light of ‘Biblical Faith’
It is both Descriptive and Normative

Bioethics
The term was originally coined in the USA
Van Rensselaer Potter, claims to have invented the word in a book entitled ‘Bioethics: Bridge
to the Future’
‘Bioethics’ is derived from Bios meaning ‘Life’ and Ethics
Literally it means ‘Life Ethics’

It would include not only ethical issues involved in biological sciences and researches but also
all ethical issues that touch all life
Obviously, it is necessarily ‘Interdisciplinary’

Some Disputed Issues in Bioethics

There is some disagreement as to whether bioethics is an independent discipline, or simply a
branch of ethics like economic, sexual or political morality
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There are some who insist that it is a new discipline, and not a sub-division or sub-discipline of
ethics
They do so despite claims that bioethics is not yet fully established

Others believe that bioethics is a component of ethics, although they fully acknowledge the new
context and elements that have been added on to old-style medical ethics

There is also disagreement as to where it should be taught, and who should be responsible for
teaching it
The venues suggested include medical schools, law schools, public administration courses and
philosophy courses

Some aspects of bioethics are of more interest to some doctors than to others
But in certain aspects it is of interest to all because it affects humanity at the most profound
levels

Health professionals are also somewhat suspicious of moralists and ethical philosophers, on the
grounds that the latter pay too much attention to principles and shy away from practice

Others, by contrast, distrust doctors and health workers for their excessive preoccupation with
concrete matters

Francisco Javier Elizari BASTERRA

Bioethics attempts to deal with such exclusiveness and distrust by integrating all the various
approaches, thereby avoiding one-sided versions of what is richly a varied subject

Bioethics began to be discussed in the 1960’s at a time when such phrases as ‘Medical Ethics’
and ‘Biomedical Ethics’ were in fashion

The change in terminology may have been partly a question of arbitrary convention, but it was
the opinion of many that the new term underlined major differences between Bioethics and the
earlier Medical ethics
Others felt that the old term ‘Medical Ethics’ was sufficient to incorporate the new areas of
debate

The term ‘Medical Ethics’ was used to include the following concerns:
1. It meant a professional code of conduct for medical practitioners
2. Moral decisions faced by doctors and scientists in the area of caring for those ill and
dying This can be called ‘Clinical Medical Ethics’
3. A course of study for those training to be doctors, nurses, priests, etc.
4. In more recent times we have other related issues described under the title
‘Institutional Medical Ethics’ which examines the structural, or institutional context
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within which medicine is practised, such as issues in health care policy or the distribution
of resources within a hospital

There is also ‘Health Care Ethics’, which focuses primarily on policy analysis or issues related to
‘Insurance’

Now Bioethics is the term used to include all these concerns

The first half, that is the bio half, of the word takes us into the exciting, complex and often
troublesome world of medicine, life sciences, psychology, biotechnology, genetics and
demography

Sometimes, it even goes beyond human life and health, and involves itself in animal and plant
life
The ethical half of bioethics deals with providing ethical guidelines both for researches in these
sciences and the application of the benefits of these sciences

Towards a Definition of Bioethics

There is still much confusion over what bioethics actually means
Some people merely identify it with advances such as new techniques of ‘Assisted
Reproduction’ and ‘Genetic Engineering’

W.T. REICH
A systematic study of human behaviour in the fields of Life Sciences and Healthcare
Which behaviour is systematically studied from a very specific angle - that of moral values and
principles

This description tells us that bioethics deals with human behaviour in 2 specific areas:
Life Sciences (Biology) and Health Care
In Bioethics, this behaviour is studied from the specific angle of Moral Values and Principles

But the definition is limited because if we confine ourselves to this definition strictly it would
mean that Bioethics has to do one way or another with everything that touches human nature
We would then run the risk of turning Bioethics into a vast subject lacking consistency and
comprehension

Van Rensselaer POTTER

A new discipline which combines biological knowledge with a knowledge of human value
systems, which would build a bridge between the sciences and the humanities, help humanity to
survive, and sustain and improve the civilised world

POTTER envisioned a very wide scope for Bioethics as a bridge between value systems of
humanity and humanity’s advances in the life sciences
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He of course envisioned that the value systems of humanity would guide the direction in which
life sciences should grow so that in the end all sciences would serve the true good of humanity

Samuel GOROVITZ
The Critical examination of the moral dimensions of decision-making in health-related contexts
and in contexts involving the biological sciences
This definition is a good one as it highlights the interdisciplinary and social dimensions of
Bioethics

1.2 Methodology
Leaving to one side these disagreements about what Bioethics means, what we really need to do
is to turn the spotlight on numerous options for arriving at moral conclusions
These various options are certainly closely linked

The issues of fundamental principles and methodology bring us back to basic questions of the
study of moral issues, an examination of which will take us beyond our scope
Yet in passing we may mention a few methods of ethical decision making which are used in
Bioethics

Deontological Theory
The first goes by the name ‘Deontological Ethics’
The Greek word ‘Deon’ means ‘Duty, Obligation, or Principle

Deontological ethics is a method of asking ‘What are my obligations’ in a moral situation?

The correct ethical course is to follow one’s principles - regardless of where they lead
Once duties or obligations are established, the appropriate actions are clear

A very commonplace example of deontological or principle-based ethics is the ‘Ten

Commandments’
The Ten Commandments are basically a set of moral duties that tell what to do and what not to
do
They are presented as clear and certain moral guides that mean what they say and say what they
mean

The advantage of this method is that it keeps morality on an ‘Objective Plane’

Its disadvantage is that it fails to take into account the circumstances in which actions take place
and the consequences they always generate

Consequentialism
Moral obligations are established not by an evaluation of obligations, but by an examination of
consequences - thus the name ‘Consequentialism’
This method attempts to predict what will happen if one acts in various ways and to compare the
outcomes against each other
What is moral or the right act is determined through the evaluative process
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‘Situation Ethics’ is probably the best known of the many variants of consequentialism
Popularised in the mid 1960’s by Joseph FLETCHER, Situation Ethics requires that we attend
seriously to the implications of actualising our ethical beliefs
Thus, consequentialism would argue that it is not enough to do good; one must also know which
of the many possible goods is best

This theory tells us that we must choose that action which brings the best or better consequence
but it does not have any built-in standard by which to judge or discriminate between
consequences

Perhaps a viable ethical strategy would be to use the 2 theories in creative tension with one
another as a dialectical way of evaluating both the principles and outcomes
In this way the theories can be ‘Mutually Corrective’ rather than ‘Mutually Exclusive’ by being
attentive to both our obligations and various outcomes

Rights Ethics
This theory resolves ethical dilemmas by taking into account all the rights of all the concerned
persons and then give priority to those rights which are of greater value

The advantage of this position is that it places the human person and his rights at the centre of
ethical decision making
However, it does not tell us how to resolve conflicts of rights between individuals

Intuitionism
This theory resolves ethical dilemmas by appealing to one’s intuition, a moral faculty of the
person which directly apprehends what is right and wrong

Thus an intuitionist knows what is right in a concrete situation not by looking at his duties, the
circumstances or the consequences of the act but by appealing to his ‘Moral Sense’

Sometimes a person says, ‘I acted in this manner because I knew I was right’
Such a person is using intuitionist argument

Intuitions sometimes give a person great conviction and power to execute his conviction
But the difficulty with this approach is that if a person cannot articulate the reasons why he acted
in a way then he cannot be totally accountable to others nor can a person convince others that his
way of acting was the correct one

1.3 Why Study Bioethics

The study of Bioethics is even more compelling Today than ever before
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In olden times, medicine and religion were mingled

Not that this union of medicine and religion was healthy either to medicine or to religion
But it had the advantage of considering the spiritual and bodily aspects of man as one whole
inter-related reality

But, we live in a time of specialization

Specialization has mushroomed especially in life sciences
As each specialized branch of these sciences pursues its course and goals often independent of
each other, there is the danger of losing sight of the good of the whole man and society these
branches of science seek to serve

Moreover, as they break new grounds they also give rise to new ethical dilemmas which must be
resolved not in isolation but in reference to the genuine wellbeing of the whole human being as
well as the human society

Furthermore, the very nature of these sciences is such that they have a tremendous momentum
toward the future
Paul D. SIMMONS identifies 4 elements in this momentum:
i) Rapidity of growth: geometric rather than arithmetic
ii) Concern for human well-being
Generally speaking 2 concerns dominate life-sciences:
a) Well-being of the patient, i.e., curing illness, correcting deformities, etc.,
b) Social health i.e., general well-being of the society, e.g., genetics seeks to correct
genetic defects, improve the gene pool, etc.
iii) Curiosity of the human mind
iv) Avarice and ambition

These factors pull these sciences toward the future almost uncontrollably as they probe into
unknown possibilities
This momentum and the above elements of this momentum must be controlled and guided by
serious reflection on what is genuinely good for the human person and the human society at large
Lacking this reflection any of these sciences can take humanity into a blind alley from where
return may be costly if not impossible

1.4 Some General Principles Governing Bioethics

We often have to live in conflicting situations

We desire to do good but we often have to do evil
We constantly experience the inner tension between good and evil

This intertwining of good and evil in our choices brings ambiguity into the world
The limitations of the world return to us in the form of tragic conflict situations
Thus, the good we do is rarely untainted by hurt, deprivation and imperfection
Our ethical acts are at best feint approximation of the kingdom that is to come
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We must kill to preserve life and freedom

We protect one through the pain of another
Our education must at times be punitive
Our health is preserved by pain and disfiguring mutilation
We protect our secrets by misstatements
We protect our marriages and population by contraception and sterilization

If we keep this tension in mind, we will not ask of our principles more than they can yield
This realism will solve the problem of legalism (which expects principles to solve our problems
neatly)
It can also protect us from despair that abandons all principles and settles moral issues on the
basis of ‘Feelings and Private Choices’

Let us examine some of these principles:

Respect for Life

Human life is a basic value

All values are translated from abstraction to concreteness because living human being do values,
e.g., values like, love, fidelity, justice have meaning because living people love, and are faithful
and just
Without upholding the value of life, we cannot uphold any other value

However, human life is not an absolute good but a primary good

Sometimes it has to be sacrificed for the sake of greater good, e.g., service of one’s brethren
It is this distinction that has permitted ‘Capital Punishment’, ‘Just War Theory’ and Unintended
Death of the Aggressor’

This dimension of life is confirmed by Christ’s own example

He is the Good Shepherd who lays down his life for the sheep (Cf. Jn 10:11)
“We know love by this, that he laid down his life for us - and we ought to lay down our lives for
one another” (1 Jn 3:16)

The example of Christ must inspire similar attitudes in those who follow him:
“No one has greater love than this, to lay down one’s life for one’s friends” (Jn 15:12)

If the situation in which human kind must operate were pure then there will never arise a conflict
between human life and other values and in such a situation, the moral obligation is clear

But as it is, human life competes and sometimes conflicts with other values
It can come into conflict with moral and non-moral values - examples of the latter are: health,
pleasure, happiness, technical advances, art, knowledge and so on
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The possession of these values does not make men and women morally good; nor does their
absence make them immoral
Moral values are all to do with a correctly formed conscience
If life comes into conflict with a moral value, the latter takes ethical priority over the former

In the case of Christ, the realization of God’s design had precedence over the preservation of his
own life
When the conflict is between life and non-moral value, the correct decision will depend on a
comparison of all the values involved

The choice that is made will be morally good insofar as it protects the affirmation of the value or
values, which from a global standpoint and in a particular situation, are considered to be a
priority by the formed conscience

So the Christian is confronted by a double demand

On the one hand, there is the task of becoming ever more aware of the dignity of all
human life; this growing awareness must translate into a generous welcome for
everything that favours life, and a rejection of any more in the opposite direction
On the other hand, it is also a question of avoiding an idolatrous worship of life

Sovereignty of God

It is a basic belief shared by all Christians that all created beings live under God’s absolute
sovereignty
God, the absolute Lord of life, can authorize and order actions against life

So the Bible reports God asking Abraham to sacrifice his son (Cf. Gen 22:2ff)
It also reports case of suicide which appear to have been carried out with divine authorization,
e.g., Samson (Cf. Judg 16:27-30)
Eleazar, called Avaran (Cf. 1 Macc 6:43-46)
Razis (Cf. 2 Macc 14:37-46)
Deuteronomy 20 reports of God’s instruction to his people to indiscriminately kill the
people of the land he is giving Israel as its heritage

These Biblical reports are explained by seeing them as specific decrees of God given to
particular individuals and specific situations
They therefore do not apply to other individuals and situations as general principles do

In addition to these Biblical texts, there are other events attributed to the early Christians that
present similar problems
These concern women who took their own lives rather than surrender to assaults on their faith or
their chastity
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In St. Augustine’s view these events, far from attracting moral condemnation, are acts of
obedience to God.
St. Thomas AQUINAS agrees with St. Augustine on this, and also says that not even Samson is to
be excused that he crushed himself together with his enemies under the ruins of the house, except
the Holy Ghost, who had secretly commanded him to do this

The existence of such reports in the Bible is of no relevance to us as they are limited to specific
past events
They are not applicable to our world
Symbolically, however, their meaning is important insofar as it contains a particular
interpretation of God’s power and a special view of humankind

Culpable - Non-Culpable

When there are no direct injunctions from God authorizing or not authorizing a particular action
then we have to take other factors into consideration

One of such factors is the distinction between ‘Innocent People’ and ‘Wrong Doers’
If the victim is innocent, he evokes greater sympathy in us and the offender of the innocent
victim deserves greater punishment
If the victim is guilty then the offender is excused to some extent
This distinction is applicable both in respect of an individual’s ‘Legitimate Defence’, and in the
context of war

Another field where it is particularly relevant is that of ‘Criminal Law’

The distinction between innocent and guilty parties is fundamental if a person is to avoid
punishment, which might include the ‘Death Penalty’

The advance of social sciences has highlighted the ambiguity in this distinction and the need to
clarify the concept of innocent and guilty parties, and of criminal and wrongdoer

Society cannot be denied the right to characterize certain modes of behaviour in this way, but a
few questions will serve to underline the value of the distinction:
 Who determines which particular form of behaviour is to be considered criminal and
which not?
 Which criteria and interests does the distinction really serve?
 What percentage of criminality is down to the perpetrator and how much to social
conditioning?

It has been said, for instance, that the penalty that criminals have to pay is a simple form of
exorcism, which lets society off the hook and allows people to evade their responsibility for the
cause of the crime
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Then, there are those who believe that harsh actions simply camouflage society’s cruelty,
vengeance, laziness and inability to cope
Finally, some continue to see those actions as a necessary part of social self-defence

Public Authority - Private Individual

Public authorities are recognized to have greater powers to act against people’s lives
These range from deciding who is innocent and who is guilty to the waging of wars

As far as warfare is concerned, prerogatives granted to public authorities have been excessively
generous
In practice, the people who wielded this power were those who decided whether a war was just
or not, and, despite claims to the contrary, there was very little legitimate space for either legal or
moral dissent

Nowadays, the right to dissent, once jealously guarded by public authorities, is being exercised
with increasing zeal, not only because, conscientious objection is now legally recognized in
many countries, but because it is acknowledged that there is also a moral dimension to be
considered in war

This situation has been partly brought about by research into the phenomenon of war
This has served to uncover the shameful interests and ambitions that so often lurk behind calls to
justice

This is not to mean to undermine the basis of ‘Criminal Law’

What is intended is to highlight the ambiguities and injustices that have crept into the law,
following pressure from interest groups that have little connection with justice

This demonstrates that defending justice by violent means still ends up with innocent people
being killed, even when it is done in the name of the public authorities
It is a very poor way of encouraging respect for the value of life

The Distinction between Direct - Indirect

According to this distinction, such things as indirect abortion, indirect suicide and indirect killing
of innocent people are legitimate, whereas direct suicide and direct killing (this would include
direct euthanasia and direct abortion) are unacceptable

To decide whether an effect is direct or indirect in the case of an action with more than one
effect, we make use of the ‘Principle of Double Effect’

In the principle of double effect, we insist that the good effect does not come from the evil effect,
but that the 2 of them proceed from an action at least with the same immediacy
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This insistence establishes an objective norm on the basis of which we may allow an evil effect
to occur
In this way, giving such decisive importance to the physical way in which effects are produced
prevents the introduction of subjective assessments which could give rise to arbitrary evaluation

The great positive contribution of this principle would lie in the intended objectivity for
important decisions that affect life and health

Moralists criticize this principle as being too rigid and not very helpful in tragic situations
It has also been accused of being minimalist and incapable of responding to change

We note 2 points regarding the Principle of Double Effect:

1. The concept of an action is quite complex
What do we call an action, and what do we consider effect of an action?
Any action, even the simplest, can be divided up into a number of actions, or alternatively
integrated into a broader, more global, action

Thus, what is effect for one person may be an integral part of the action for another
In this way, we can see the obscurity, even the ineffectiveness, of the principle when we attempt
a moral clarification of behaviour

2. The main accusation levelled at this approach is that of ‘Physicism’

It attaches too much importance to the physical nature of the action at the point at which a
decision is being taken on morality
Moreover, the way in which cause and effect are physically connected determines whether the
action is good or bad

Fundamentally, this principle reveals an attitude that is very common traditional morality -
respect for physical nature as a moral criterion
That respect for nature has a part to play, but it seems to be an exaggeration to make it into a
moral arbiter, because that leaves out the spiritual faculties with which men and women perceive
and give meaning to things

These days, some prefer an approach that takes the form of comparing the values that are
involved

This system of moral approximation incorporates a number of things

In the first place, very honest analysis is needed to detect the values, and it is not only immediate
values that have to be borne in mind but also a perspective of the future
It is self-evident that, generally speaking, the more immediate values will be perceived more
easily, but this does not make it legitimate for us to settle for short term solutions which make
nonsense of reality
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At the same time, there is no need to begin searching obsessively for the more remote, distant
and problematic values, as they will do nothing but paralyse action completely

When personal awareness has before it the full range of values involved in a given action, there
is then a second step to be taken
This is to compare them in the light of the hierarchy of values, in order to decide on which route
to follow, and to opt for those values which genuinely appear to be most imperative at a given
moment

The hierarchy of values is the fruit of many factors such as the training that one has received, the
community in which one lives, historical influences, faithfulness to one’s conscience, and
personal character

However, for a Christian’s conscience to be correctly directed, the hierarchy of values needs to
be open to the scrutiny and influence of the Christian community in the light of the Church’s
teaching

The Principle of Totality

The Principle of Totality in its most general form states that ‘the good of the part may be
sacrificed for the good of the whole’
Individual parts of the body exist for the well-being of the whole organism
So when necessary a diseased limb or part of the body may be removed to promote the general
health of the whole body

This principle is used to justify amputation, removal of diseased organs and more recently to
justify organ transplants, human experimentation, etc.

The official Church teaching tends to interpret totality with specific reference to the anatomical
integrity of the individual person as distinct from the functional integrity of the individual

So while the official teaching would allow, therapeutic mutilations and donation of paired organs
and parts of the body, which regenerate (e.g., blood, marrow, tissue, etc.), it would not allow
amputation of healthy organs or subjecting oneself to experiments which might benefit the
human community but which might endanger one’s personal totality

Of course when a healthy organ threatens the health of the whole body it may be removed (e.g.,
male and female sterilization in cases of rare medical condition where sperm or ovum is treated
as a foreign body)
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In recent times some theologians have sought to expand the principle of totality in such a way as
to allow subjecting oneself to experiments that might benefit humanity
Totality for them would mean not mere anatomical totality but it would include the totality of the
whole human person i.e., his social and spiritual aspects as well. Man is called to live with others
in a caring way

A man expresses himself as a spiritual being when he lays his life down for others
So in the service of this social and spiritual dimensions of his being a man can donate his healthy
organs out of love for another

But in the Catholic view the principle of totality reminds us chiefly of the dignity and integrity of
the human body
Our body is not something we own; but a gift given to us; a gift we receive

1.4.7 The Principle of Lesser Evil

Sometimes the human person faces perplexing moral situations

He must choose between 2 alternatives both of which would bring about evil consequences
The theory admits that one can choose the lesser of the evil

To put it positively: when faced with conflicting duties one can choose the more urgent and more
important duty to the detriment of the less important and less urgent duty

It differs from the Principle of Double Effect insofar as it allows directly willed evil effect
whereas the Principle of Double Effect will not
Catholic magisterial teaching would not employ the Principle of Lesser Evil in the area of
intrinsically evil acts

The Principle of Cooperation in Evil Acts

One of the enduring principles of Catholic morality is that a principal agent may never perform
an action which is intrinsically evil
That is to say for the one who freely intends and then carries out the act it is never morally
justifiable to perform an intrinsically evil act, e.g., euthanasia, direct abortion

When we say that it is never morally justifiable we mean that the action is judged to be evil
regardless of any extenuating circumstances surrounding the action
Put another way, in an intrinsically evil act there can be no exceptional circumstances that would
allow the act to become morally acceptable

In carrying out an intrinsically evil action, the principal agent may need a or involve the
assistance of another individual (the Co-operator)
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For example, when a physician acts as a Wrongdoer, he may involve the cooperation of many
other members of a hospital staff: a hospital administrator, a nurse, a pharmacist, and possibly
even an elderly if the elderly must retrieve the lethal dose from the pharmacy

These examples indicate a range of possible cooperation with the intrinsically evil act of suicide
Determining the exact type of degree of cooperation are the crucial elements in the assignment of
co-operator culpability

In determining co-operator’s culpability we must take into account 3 factors:

i) The individual’s intent
ii) The degree of cooperation
iii) The likelihood of scandal

The primary distinction within cooperation is between

Formal Cooperation
Material Cooperation

Formal Cooperation
It is willing participation on the part of the Co-operator in an intrinsically evil act carried out by
the Wrongdoer
In formal cooperation both the Wrongdoer and the Co-operator have the same intention: i.e.,
both will the evil act

Formal Cooperation can be either

Explicit Formal Cooperation
Implicit Formal Cooperation

Explicit Formal Cooperation occurs when the Co-operator enters into open agreement with the
Wrongdoer’s intention
For example, suppose a physician receives a request from a patient for assistance in suicide
Physician who agrees with the patient’s request to commit suicide and writes out the prescription
for the lethal dose engages in explicit formal cooperation

Implicit Formal Cooperation occurs when the co-operator denies intending the Wrongdoer’s
act, but no other explanation can distinguish the Co-operator’s act from that of the Wrongdoer
Implicit formal cooperation would occur in the case of physician-assisted suicide if a physician
should state, ‘I am personally opposed to Physician Assisted Suicide (PAS), but I believe in
individual choice
Therefore, despite my personal opposition, I will write out a prescription for a lethal dose of a
drug that my patient may take to commit suicide’

Both types of cooperation in PAS explicit and implicit are always immoral regardless of any
surrounding circumstances
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Material Cooperation
Material Cooperation is that the Co-operator does not intend the Wrongdoer’s act, but
nonetheless contributes in some manner to the circumstances of that act
The Co-operator’s lack of agreement with the intention of the Wrongdoer is what prevents his
contribution from being formal cooperation

Whether an agent acts freely or under compulsion is an important consideration for all types of
material cooperation
Suppose a physician who personally opposes PAS is told by an administrator of a hospital that in
order to remain in the job he must prescribe lethal drugs for requesting patients

This external pressure constitutes force or duress

If the external force sufficiently impairs freedom of the will, then the culpability of the Co-
operator may be diminished or even eliminated

It should be noted, however, that the diminishment or even complete elimination of moral
culpability on the part of the Co-operator does not change the fact that PAS, in the objective
moral order, is and remains intrinsically evil

We can distinguish various shades of Material Co-operation:

Immediate Material Co-operation
Mediate Material Co-operation

Immediate Material Co-operation

Historically, most theologians have maintained that immediate material cooperation in
intrinsic evil is equivalent to implicit formal cooperation and therefore always immoral

Immediate material cooperation arises when the Co-operator makes a contribution to

circumstances that are essential for the performance of the Wrongdoer’s act
For example, if a physician personally opposed to PAS were to prescribe a lethal dose for a
patient because his hospital administrator threatens him with the loss of his job then it would
seem that he would not be able to claim force (duress)

The loss of one’s livelihood could not possibly justify immediate material cooperation in the
intrinsically evil act of suicide
Nor are there any circumstances that would permit this type of act

To take another example, if a physician were to allow his name to appear in an advertisement for
a hospital that advertises PAS as one of its ‘services’, then even though he may refuse to
participate in PAS himself, the use of his name in the advertisement would be a case of
immediate material cooperation
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Mediate Material Cooperation
In Mediate Material Co-operation, the Co-operator does not contribute to circumstances essential
to the commission of the Wrongdoer’s act, but nonetheless make a contribution that somehow
promotes that act

Thus, suppose, there is a health care worker who is employed in a government hospital that
provides PAS, but that does not require conscientious objectors to participate
The worker who uses the conscientious objector clause may nonetheless unintentionally give
assistance to others who provide PAS

For example, by taking on the work of others while they assist in the suicide
Though the worker does not directly participate in PAS, he nonetheless contributes
circumstantially through work for the government hospital

Mediate Material Cooperation can be justified provided that 2 conditions are met:
i) A sufficient reason must exist for the Co-operator’s actions
For example, employment at this hospital may be the only employment
opportunity available
If so, then there would seem to be sufficient reason for cooperation
If, however, other work is readily available, then continued employment in this
government hospital that provided PAS would not be moral
ii) The cooperation must occasion no scandal
If others will conclude that the health care worker agrees with the hospital’s
policy to provide PAS, then working in such a setting may lead others to commit
immoral acts themselves
The resulting scandal would make the cooperation immoral

Mediate Material Cooperation can be divided into

Proximate Mediate Material Cooperation
Remote Mediate Material Cooperation

Proximate Mediate Material Co-operation would occur if a physician personally opposed to

PAS were to advise others to buy stock in a pharmaceutical firm because it soon will come out
with a lethal mixture of drugs to be used in PAS

Giving financial advice, of course, is not an intrinsically evil act, but this advice encourages
others to profit from immorality
Also, the physician would cause scandal to others who (quite rightly) cannot understand why he
would give this advice if he opposes PAS
There are other companies that could offer similar returns

Remote Mediate Material Cooperation would occur if a physician opposed to PAS were to
write prescriptions for the therapeutic use of drugs whose manufacturer is also the leading
producer of a lethal mixture marketed for PAS
This cooperation is sufficiently distant (or remote) from the practice of PAS and would be moral
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The presence of additional aspects further subdivides material cooperation into

The Necessary Material Cooperation
The Contingent Material Cooperation

Necessary Material Cooperation arises when the Wrongdoer’s act would not occur without the
contribution of the co-operator
The refusal to engage in necessary cooperation, in effect, prevents the act from occurring
Therefore, necessary cooperation is more serious than contingent cooperation

Thus, if a physician were the only one available to substitute for another physician while he
assisted in a suicide, then the cooperation would be necessary to the performance of the
Wrongdoer’s intrinsically immoral act
If, however, there were other physicians available who could equally attend to the physician’s
patient, then a refusal to do so would not prevent the carrying out of the act

Proper understanding of the principles of cooperation is crucial to assessing the culpability of the
physician who finds himself faced with a request to assist directly or indirectly in an act of
physician-assisted suicide

A determination must be made whether withholding cooperation would effectively prevent the
patient from committing suicide or prevent someone else from assisting in the patient’s suicide

If prevention is not possible then the physician should determine whether his cooperation is
formal by asking whether his intention in cooperation is the same as that of the patient
If he believes that it is not, then he should analyse any apparent or implicit agreements that may
exist between him and all others who are involved with a patient’s request

If the physician is certain that he does not intend the patient’s suicide, then he ought to inquire
whether his cooperation is so closely tied to that act of self-destruction that it is immediate
material cooperation

When assured that his contribution falls into the category of mediate material cooperation, he
should determine how closely associated his actions are to the circumstances surrounding the
immoral act

If his actions can be viewed as cooperation with PAS without sufficient reason for him to do so,
or if his actions might give scandal to others, then he is also to avoid carrying out those actions
 18

Various Forms of Cooperation

Contingent
Formal Material
Necessary

Explicit Implicit Immediate Mediate

Proximate Remote

The Distinction between Ordinary and Extraordinary

Some of the most agonizing questions crop up in the area of death and dying
This distinction comes into focus in resolving some of these questions
Another term for this is ‘Proportionate and Disproportionate’ means (i.e., surgeries, treatments,
etc.).

Ordinary means are those which

 Offer reasonable hope of recovery and benefit
 Do not cause undue pain or inconvenience
 Do not damage greater spiritual values, e.g., love, interpersonal relationship,
personal dignity freedom, etc.

Extraordinary means are medicines and treatments, which cannot be employed without undue
pain, expense, inconvenience or reasonable hope of benefit or recovery

One is not obliged to employ such means to prolong life

But one can do so if one wishes
The decision of the patient here is crucial
It is not for the experts to decide what is ordinary and what is extraordinary

The distinction highlights the following:

1. It is a moral and not a technical distinction
It is a moral decision made by the patient and not by the experts

2. This distinction is crucial to avoid Medical Pessimism and Vitalism

Medical Pessimism hold that life is one’s own possession and it can be terminated when one no
longer wishes to suffer no matter how reasonable the suffering might be
 19
Also, if one determines that life is not of sufficient quality or too much of a burden then life can
be terminated

Medical Vitalism holds physical, biological life is the highest good

Therefore, all possible means should be used to prolong life

This distinction between ordinary and extraordinary means rejects both of these extremes

3. This distinction avoids Subjectivism and Medicalism

It places the delicate decision of life and death on an objective plane

It takes away that decision from subjective whims of oneself or others

It also safeguards against too eager or too defensive physician who considers all medical
technology is ordinary or demanded by law in order not to be sued
This distinction seeks to protect the dignity of the patient and the freedom of his decision

4. The distinction between ordinary and extraordinary means of prolonging life and the moral
limits for such prolongation, remind us that bodily physical life is not an absolute, ultimate good
to be preserved at all costs

There are limits to our duty to cure

Our technology and medical know-how is finite
There comes a time when machines must step aside, for it is time to go with dignity into the
mysterious night
Our Christian faith tells us that mysterious night wakes up into the eternal dawn of God’s love

The temptation today is to stop caring when we cannot cure

But there are limits to our curing but not limits to our caring
The rules of loyalty we owe to sick and dying are especially strong at the times when they are
weakest and most vulnerable
 20
Chapter Two
A PERSON-CENTRED HEALTH CARE

2.1 Who Is a Person: A Christian Understanding

The issue here is…
When does human being become a person?
When does he cease to be a person?
Is human life and human person the same?

These questions keep recurring in the discussion of different issues in bioethics like:
In protecting unborn life
In prolonging life
In scientific possibilities like cloning, etc.

Being a human being is having one’s own personality

Personality is not the prerogative of mega-stars and world famous models
Every person has a personality
Yet it is difficult to define it
There is a mysterious element to the personhood of people

Modern psychology has thrown much light on the inner world of man’s mind in recent times
Nevertheless, it has not managed to propose a coherent and adequate theory of what essentially
constitutes personhood

Much of the studies in psychology have made attempts to group people into one type of
personality or another on the basis of character traits and studying the relationship of behaviour
patterns to character traits

But the sheer variety of psychological theories at least tells us that a human person cannot be
reduced to a bundle of traits which blindly produce behaviour

Philosophers of all time have tried to capture the essence of the human person
We can notice the following trends:

Classical Philosophers summarized a person as ‘A Rational Animal’

From Descartes onwards the thinking aspect of man was emphasized - man is a thinking being
He is self-conscious and that is his uniqueness

From the Second World War the freedom aspect of the human person was emphasized
In freedom, human beings create themselves and shape the world meaningfully
 21
Philosophers of human freedom with a religious bend of mind (e.g., Soren KIERKAGAARD,
Gabriel MARCEL, Emmanuel MOUNIER) understand human freedom as a ‘Gift of God’ to be used
in search of Him

This view has given birth to seeing a human person as an independent being with a spiritual
nature, which transcends the limits of purely biological and material reality

Each person freely creates his personality but can also discover and freely accept a relationship
with the supreme person
So, in the modern view human person is also essentially ‘Relational’
He is a free moral agent relating to other moral agents in the pursuit of a common good

In current attempts to identify who a person is we can note 3 schools of thought:

1. The Genetic School

It defines a human person as any being that has a Human Genetic Code
This orientation would argue that personhood comes at the beginning of life
Further growth and development are simply spelling out the implications of the genetic code for
this particular individual

2. The Developmental School

It holds that while the establishment of the genetic code establishes the basis for further
development, some degree of development and interaction with the environment is necessary
for a being to be considered as a full human person

This orientation suggests that one’s genetic potential is not fully actualised until there has been
interaction with the environment
This understanding of person includes more than the biological dimension

3. School of Social Consequences

It focuses on what society sees as valuable for personal existence
It first determines what kind of persons are wanted by society and then sets the definition in
accordance with that
The desires of society, expressed in public policy, take precedence over the biological or
developmental aspects

Difficulties in answering the question ‘who is a person?’ have led to other directions
Some say that simply the capacity to experience pain or have some feelings confers rights that
must be respected
Others argue that consciousness confers the entitlement of respect
Still others would require self-consciousness for such rights
 22
4. Christian Faith and Human Personhood
Our Christian Faith adds further dimensions to the Human Person
The opening pages of the Bible tells us: “Then God Said: ‘Let us make man in our image; after
our likeness...God created man in his image, in the divine image he created him; male and
female he created them” (Gen 1:26, 27).

“...The Lord God formed man out of clay of the ground and blew into his nostrils the breath of
life, and so man became a living being” (Gen 2:7).

The Bible talks of man essentially in reference to God

Man derives his form, his life and his image, his maleness and femaleness from God
Man’s essential and original dignity lies not in his achievements and accomplishments (not
because he does something or succeeds in life) but because he comes from God - he is a gift of
God

Life is sacred; the human person is sacred because they are God’s
So, man’s dignity is an ‘alien dignity’

We humans are the apple of God’s eyes

Those who touch us touch him

Our worth is based upon this imparted sharing of divine life

Our dignity and inviolability is that we come from the hands of God and those hands rest upon
our lives and direct them until we go back to him from whom we came
We cannot seize this gift to ourselves

We can only stand and wonder as the Psalmist:

What is man that you should be mindful of him, or the son of man that you should care
for him?
You have made him little less than a God
And crowned him with glory and honour.
You have given him rule over the works of your hands...
O, Lord, Our Lord, how gracious is your name over all the earth! (Ps 8:5-7, 10).

This special relationship of the human person and the consequent alien dignity is present from
the beginning even before birth
The Psalmist writes:
O Lord, you have searched me and you know me;
You know when I sit and when I stand...
Truly you have formed my inmost being;
You knit me in my mother’s womb...
My soul you knew full well;
Nor was my frame unknown to you when I was made in secret, when I was fashioned in
the depths of the earth.
Your eyes have seen my actions;
 23
In your book they are written;
My days were limited before one of them existed (Ps 139: 1-2, 13, 15-16).

Zechariah and Elizabeth will have a son who is to be named John (Lk 1:13).

Before I formed you in the womb I knew you, before you were born I dedicated you, a
prophet to the nations I appointed you (Jer 1:5).

We live in the thought of God even before we are

Our dignity and our special relationship with God are not merely prenatal or limited to
this life
Our name once uttered by God is immortal

St. Paul captures this so well in Romans 14:7-9:

“None of us lives as his own master and none of his dies as his own master. While
we live we are responsible to the Lord, and when we die, we die as his servants.
Both in life and in death we are the Lord’s. That is why Christ died and came to
life again that he might be Lord of both the dead and the living.”

Furthermore the incarnation of Christ adds further dimensions to the person of the Christian:
The Christian is called to be a disciple of Christ and discipleship involves among other things:
 A gift
 A relationship
 Membership in community
 A call to renounce everything
 A call profound conversion

2.2 Person Centred Health Care

The human person as we saw above is a ‘Complex Reality’

He has a body and therefore has physiological needs
He has a mind and therefore psychological needs
He has a spiritual dimension and therefore has spiritual needs

All these dimensions interact in one and the same person

So, an adequate health care must take account of all the 3 dimensions

Modern medicine has gathered enormous knowledge about the 9 Basic Systems of the body:
 Nervous system and the related Endocrine system
 Reproductive system
 Skeletal system
 Muscular system
 Integumentary (skin) system
 Alimentary system
 24
 Respiratory system
 Circulatory system
 Excretory system

But modern medicine has also slowly grown to recognize that one can give health care only to
‘Persons’ and not to ‘Bodies’

Since 1930s there has been increasing recognition of the deep interactions of mind and body
The success of psychosomatic medicine has proved this

Research has demonstrated the role of psychological stress in the origin of such physical
conditions like…
 Hypertension (high blood pressure)
 Peptic ulcers
 Bronchial asthma
 Coronary heart disease
 Migraine headaches
 Diabetes
 Diarrhoea
 Skin acne
 Constipation, etc.

Research further indicates that anxiety and its emotional derivatives play a key role in producing
such ailments
The anxiety may even remain unconscious for the most part, and still the physiological
repercussions occur

Bodily reactions that accompany emotional states indicate the close interplay of body and mind
Fear or anger, as emotions, stimulate, protective or defensive ‘reactions’ of the body
Physical ailments usually arise when emotions are not discharged properly, as when they are an
unconscious response to stressful situation

Among the more unusual examples of Psychosomatic Neurotic Reactions, are instances of
‘Conversion Hysteria’
In this situation tensions generated on the level of psychological experience produce
disturbances in a person’s sensory or muscular abilities so they cannot see or hear or walk

Yet the physical apparatus for these functions remain intact although if the condition persists
over long periods they tend to degenerate because of disuse (one can notice that such cases lend
themselves to rather miraculous healing)
 25
The muscle system of the human body can also respond to emotional anxiety with various kinds
of spasms
Continuous misuse of the muscles for expressing anxiety has a tiring effect, giving rise to certain
types of back aches, even rheumatic pains

Modern medicine treats these psychosomatic illnesses through psychiatry as well as through
tranquillisers and other mood altering drugs
These drugs can allay anxieties and even eliminate hallucinations

These and other narcotic drugs (opium, morphine, heroine, codeine, marijuana, and cocaine) and
their influence over mental and emotional states of persons again indicate to the interaction of
body and mind

They even affect and enslave human freedom

These reflections show the complexity of the human person
Modern medicine only proves this complexity when it tries to heal the body through the mind
and mind through the body

Only Man can be steward of his health

Cats and dogs cannot assume responsibility for their health
The health or disease of pets and other animals does not depend on their attitudes, values, or life
choices
But the attitudes, values and life choices of human being determine to a large extent their health

Human Health:
According to Word Health Organization’s definition of 1958, human health ‘is a state of
complete physical, mental and social well-being and not merely the absence of disease or
infirmity’

The definition is vague but it highlights 3 aspects of good health:

 Physical
 Mental
 Social

Fathers Benedict ASHLEY and Kevin O’ROURKE (in Health Care Ethics) describe health in terms
of 4 interrelated levels of human needs:
‘Human health is the optimal functioning of the human organism to meet, biological,
psychological, ethical and spiritual needs’

The definition indicates the following:

 Human health will be impaired when human needs are not fulfilled on any of the 4 levels
 Biological health cannot be maintained in the face of a person’s psychological, ethical or
spiritual sickness
 26

 The above discussion of psychosomatic illnesses supports this broader notion of health
The tension and anxiety which lead to biological illnesses originate when a person’s
psychological, ethical and spiritual needs are not met (e.g., Jogging is accepted as good for
health; jogging people take time off from work and pressures, etc.)

 Since human health derives from optimal human functioning on all 4 levels of the human
person, a great variety of professional persons can contribute to human health
Physicians, psychologists specialize in biological and psychological aspects of health
But many other persons, including clergy and wise counsellors provide for their spiritual and
ethical needs of health

2.3 Rights and Duties of the Patient as a Person

Human right and responsibilities flow from each other

God calls us to be and act as a human person - as a subject

Responsibility springs from this call

Responsibility means ability to give a response
Our rights and responsibilities start from the moment we come to be human persons

1. The human person has a right to seek self-fulfilment

Intellectual freedom means taking charge of one’s own life i.e. internal self-possession
But in Christian understanding genuine self-fulfilment cannot be reduced to pure individualism
because self-fulfilment also includes building a life outside oneself

The only worthwhile project outside ourselves is building a community, a family

A community is a necessity for biological survival
But a community is not only useful tool

We become good, healthy selves worthy of our human personhood when we can enter into
communion and presence with others
We need to share our ideals and joys and our worries and sorrows with others
We need their esteem and they ours
This comes only through sometimes hard but deeply satisfying work we call love

2. Patients are persons

Like all others patients are called to be and to act like persons.
This means:
i) Self-possession: fundamental control over one’s own person
ii) Building genuine community of persons

Like anyone else, patients are called to respond to this call

This is their responsibility
 27
Correspondingly, they have a right to be treated as persons and not as things; a right to expect
respect for themselves, their families and friends
This respect means that a patient will never be used as a means to get what someone else wants
This basically means reverence for the human person even if his intelligent freedom has not yet
developed or is lost to him

3. Health care personnel and facilities do not empower the patient to get well
They only assist his power to get well
The purpose of this assistance is to help the patient to grow toward that degree of self-possession
possible to him and to build up his place in the community of persons

This practically means that the real responsibility and right in this task belongs to the patient
Therefore, the right to make intelligent decisions cannot be taken away from the patient by the
health care professions or by the society at large

Even when a proxy must make the decision for the patient (i.e., in the case of a child or a
comatose) it must be with the aim of accurately presenting, what the patient would decide to do
under the circumstances
The patient himself cannot make unreasonable demands on the resources of the community
considering this responsibility towards the community

4. The Patient has a right to ‘Informed-Consent’

This means that he has a right to be informed and that he has the prerogative right and
responsibility to give consent to what regards his health
This involves competence, disclosure, comprehension and voluntariness

The right to be informed implies the followings 6 factors:

i. that the doctor must explain the nature, risks of the illness and of the treatment, the risks
involved, probable after-effects and hoped-for benefits

ii. that the doctor must not presume the patient’s consent to surgery more extensive than
which was agreed to, unless such a surgery is directly and causally related to the patient’s
immediate welfare (e.g., hysterectomy in the course of a caesarean section)

iii. that a doctor must not obtain a patient’s consent to any procedure which good medicine
would label as either unnecessary or purely experimental

iv. A doctor must not withhold from the mentally competent patient a frank and complete
disclosure of the pertinent facts in the case (e.g., the doctor should not withhold the
knowledge of near death)
 28
But this right to be informed is not unlimited
If the doctor knew that a particular patient will do unjustified harm to himself or others, he
should not inform him (e.g., if a nervous patient is told that he has cancer he might give up
all effort for a possible cure. If a pregnant woman wants an amniocentesis performed with
the declaration of abortion if she finds the foetus defective)

v. In emergency situations the consent for the needed medical procedures can be reasonably
presumed
When possible the permission of parents or guardians should be obtained

vi. Informed consent presupposes that the patient has a responsibility to develop good
standards of morality on the basis of which he can make a moral judgment regarding the
course of action to be taken when the physician provides him with adequate information

5. The patient has a responsibility to stay alive and therefore the right to receive whatever helps
necessary from health care professionals to do this

A Christian patient must love life and not death

He has no right to die
But he has a right not to have his dying dragged out for no good reason

6. Everyone has a responsibility not only to stay alive but to stay alive well
In other words we are called to a good quality of life i.e. to live a health life, to work toward
recovery of health when we become ill and to be rehabilitated when necessary

This call gives us the right to be helped to stay healthy

It is not the community that gives us this right e.g., it is not the community that bestows on a
child to be free from every defect which medicine can prevent or correct

God gives that right to every child

The community simply recognizes that right and actively supports it (e.g., polio)
Even more, the community has an obligation to protect the individual from any significant risk to
his life for the benefit of another, as in the case of experiments for which no valid consent has
been given

7. Persons have a right and duty toward a responsible life style

Medicine and good health care facilities are no substitute or a sober and moderate life style

8. Patients as persons have a right to privacy

Patients make themselves vulnerable by revealing themselves before health care personnel and
institutions
 29
Therefore doctors and hospitals must protect the secrets entrusted to them (e.g., Doctors must
obtain the consent of the patient before trainees are brought to examine them)

But this right to privacy is not an absolute one

It does not bind if the patient is going to harm himself or society (e.g., the patient threatens to
commit suicide when released from the hospital; he is the bearer of some contagious disease)

Secret must be revealed in order to protect an innocent party (e.g., aids patient wanting to marry;
the other party should be informed)
Secret may be revealed to protect the doctor or the hospital
If the patient sues the doctor or the hospital they may use the secret in their defence
By suing the patient the doctor loses his right to privacy

Secret must be revealed to proper authorities when patient’s condition is related to some
commission of crime (e.g., accident, a gun-shot wound)
The secret of patients, who come for medical examination as a prerequisite for jobs, insurance
policy, entry into armed forces, etc., must be revealed to the concerned authority

9. Patients have a responsibility for personal, spiritual and emotional maturity

They should be mature enough not to use other persons as instruments

Maturity implies not to use the health care services in a way that goes against the moral
commitments of those involved in health care (e.g., to expect Catholic doctors and hospitals to
take care of you when you have made a decision not to eat nor take medicine to speed up death)

Maturity means emotional maturity that one does not grow in self-pity demanding too much
attention
Persons who do not achieve self-possession through the drama of love play the drama of living
out their emptiness through sickness, complaining, obscure ailments, etc.

Maturity also means respecting the persons and feelings of doctors, nurses, cooperating with
them, being grateful to them, protecting their reputation, making prompt payments, etc.
Medical professions have an obligation to put a stop to the immaturity of an irresponsible patient
 30
Chapter Three
MORALITY OF THE RECONSTRUCTION OF THE HUMAN BODY

3.1 Organ Transplantation

Concept

A surgical procedure in which organs are removed from one person and placed in another, or an
organ is removed from one part of the body and placed in another part of the body of the same
person or organ taken from a cadaver or animal is placed in a recipient in the hope that these will
replace and serve the functions of the damaged or lost organs of the recipient

Implantation of artificial organs will also fall into this category

Advances in medical science have gone a long way in this direction

Now, with greater or lesser risk, it is possible to transplant

 Heart  Bone
 Kidney  Pancreas
 Cornea  Blood Vessels
 Lung  Ovaries
 Lever  Testicles
 Bone Marrow  Penis
 Skin  Finger
 Blood  Toe, etc.

With greater sophistication of technology almost any organ could be transplanted

After the initial fear that transplantation might change the nature of the person, some transplants
have become common place

The first ‘Skin Graft’ was done in 1923-24

The first ‘Kidney’ 1954
The first ‘Heart’ in 1967
In August 2, 1994, Dr. D. P. Venugopal performed the first heart transplant in India

Kinds of Organ Transplants

i) Autograft (Autoplastic transplant): Tissue is moved from one part to another of the same
person. From medical point transplant from identical twins can be considered as autograft
because these organs are not rejected
ii) Heterograft: Transplant from one species to another
iii) Homograft: Transplant from one member to another of the same species
iv) Temporary
v) Permanent
 31
Some General Aspects of Organ Transplants

1. The organ is a living system and when it is removed from the donor, it must be preserved in a
viable state before transplantation
Irreparable damage can be done to an organ and its cells by insufficient oxygen

It is possible to preserve simple cells for periods as long as 20 years through the ‘Rapid Freezing
Method’
When cells are preserved in deep-freeze temperatures their need for oxygen is minimal
But this method is not adequate for larger organs which consist a mass of cells

The process of freezing and thawing larger organs take time and this can result in the formation
of tiny ice-crystals in the cell which destroys irreparably the cell structure
So, the ‘Cryogenic’ (deep freezing) method is not suitable for larger adult organs

At present the method used for preserving organs is ‘Perfusing Method’ (circulating through the
blood vessels of the organ a fluid which is rich in electrolytes [intro cellular ions] and keeping
them in low temperatures but above freezing point)

Through this procedure human kidneys can be preserved for about 72 hours, hearts for about 6
hours and livers for 8 to 10 hours

Another problem with transplantation has to do with the ‘Rejection’ of the transplanted organ by
the recipients’ body which is combated by:
i) Choosing organs from persons genetically close to the recipient
ii) ‘Tissue Typing’ (matching certain specific characteristics of the recipient’s and
donor’s cells and choosing organs which very closely match the recipient’s cellular
needs)
iii) By administering ‘Immuno Suppression Drugs’ (But, these, while suppressing
rejection also attack the general immuno system and open the door for various infections)
The goal would be to control rejection of the transplanted organ without affecting body’s
capacity to deal with bacterial invasions
The invention of ‘Cyclosporin’ has helped in this regard

2. A second question organ transplantation raises is ‘How Much Money’ should be spent on
these procedures which benefit so few people
Should government spend so much money on one patient or on medical health to many more?

3. Should ‘Private Behaviour’ be modified in the interests of prevention of illness and injuries or
in the interests of the public good?
Smoking causes lung cancer, should the government spent public money on treating such
people?
Personal life styles cause diseases, should the government pay for it?
If people wore helmets injuries will be lessened and so should governments impose the wearing
of helmets, etc.?
 32
Moral Aspects

General
Catholic teaching on organ transplantation is based on some statements Pope Pius XII made in
1953 and 1956
We must keep in mind that the Pope was speaking in the context of revelations of Nazi medical
atrocities where human being was used for experiments

The Pope’s concern primarily was that no human being should be used as a tool for another or
the Society
So he interpreted the principle of totality exclusively in reference to the individual human being
and to his bodily integrity

According to the Pope the human being is part of the society not in the way a kidney is part of
the human body
So the God-given destiny of a human person, no matter how unimportant in the eyes of others
and the destiny of his bodily parts is not primarily disposable for the sake of others

So, according to Catholic teaching, every organ donation must bring some benefit to the donor
Most Catholic moral theologians today interpret this benefit to the donor in a broader sense to
include also spiritual benefit
So, for the sake of greater values like, love, freedom, etc. even life must be sacrificed

So, in the service of charity an organ may be donated

 The good and benefit brought to the recipient must be ‘Proportionate’ to the harm and
risk to the donor
 ‘Informed Consent’ of the donor must be obtained
 There should be no damage to the ‘Functional Integrity’ of the donor

In recent writings 2 sets of criteria are suggested to justify organ transplantation:

First Set of Criteria:
i. The duty of beneficence requires that we do good to others even if it involves some
reasonable risk to ourselves
ii. The recipient will receive reasonable benefit in terms of increased life span and improved
quality of life
iii. The risk on the part of the donor is modest

Second Set of Criteria: is more elaborate and is suggested by James NELSON:

i. The transplantation is the last resort (no other remedies are available)
ii. The primary intention is patient welfare (i.e. the primary intent is clinical and not
experimental)
iii. Consent to the procedure is free and informed (i.e. the patient must know the risks, the
benefits and other options and must give permission to the procedure)
iv. The protection of the innocent (i.e. all involved, the patient, the family, the donor must
have their rights respected, e.g., if the donor is a dead person he must really be dead
before the transplantation takes place)
 33
v. Proportionality (the benefits of the procedure must outweigh the risks or the costs. In
assessing the benefits the considerations of quality of life, medical feasibility, etc. should
be included)

Moral Aspects from Donor’s Viewpoint

a) The Donor May Be a Cadaver

In this case the death of the donor should be certain

‘Death’ now is recognized more as a ‘Process’ than as a single ‘Event’ taking place in a moment
There are 4 stages in this event:
i) Clinical death
ii) Brain death
iii) Biological death
iv) Cellular death

Increasingly ‘Brain Death’ is recognized as a ‘Certain Criteria’ of death of a person

Determining brain death itself is complex
Traditional method of determining brain death is cessation of heart beat and respiration

Heart can go on beating without any input from the circulatory system
But respiration is connected to activity on a part of the brain found in the ‘Brain Stem’
If that activity stops respiration will irreversibly stop

Clinically ‘Brain Death’ can be established by number of signs:

 Deep unresponsive coma
 Fixed, dilated pupils
 Loss of spontaneous breathing
 Absence of reflexes (touching the eye with cotton and eyelids do not close
 A flat EEG
 Cessation of brain blood flow for about 20 to 30 minutes

‘Deep Coma’ may not indicate brain death

Sometimes shock, low body temperature, presence of some central nervous system depressant
drugs in the body can mimic some of these above conditions

‘Irreversible Coma’ is not brain death or death

In such a condition the brain stem at least is functioning

Given these factors a person is considered to be alive until all brain functions including brain
stem function, irreversibly cease
Many countries have accepted brain death as the criterion of death
In India, in June 1994, the Indian parliament legalized brain death criterion
 34

The following points regarding special cases must also be kept in mind:
 If the donor is an ‘Anencephalic’ or ‘Foetus’ the death criteria should be further clarified
Taking of vital tissues will kill them and such an act would be equivalent to abortion

 It is not proper to take tissues from foetuses killed by abortion

Taking such tissues is exploiting deliberate killing of an innocent foetal child
It is further contempt heaped on the child and morally desensitises people who do this

 Some medical researchers believe that patients with Parkinson’s disease can be helped if
brain tissues from living foetus are transplanted
If it can be determined that if the foetal brain is totally functionally dead but without all of
individual brain cells being dead, then these procedures could be employed

 It is necessary to have obtained the prior permission of the donor that he is willing to donate
his organs
Donor card, license, signed document, etc. can reveal the mind of the donor
But if these are not available permission of the close relatives must be obtained

b) The Donor Could Be an Animal

 It is possible to transplant bone, cartilage, blood vessel etc. from animals to human beings
This is done hoping that the human tissue may build on it.
This graft does not grow by itself in the recipient but helps only as a supportive structure
Chimpanzee is most suited for transplant.
More recently Baboons are found to be good for transplants

 These procedures might mean ‘Medical Disaster’

Viruses or bacteria can jump from animal to man and cause contagious epidemics

c) The Donor May Be a Living Person

 The donor has a right and responsibility to integrity of his body.
So he can donate paired organs which would not impair his functional integrity.
But he cannot donate organs that are not paired (e.g., heart) or organs even if paired, the
donation of which will impair his functional integrity (man has only limited dominion over
his body)

 There must be informed and free consent by the donor

 When the potential donor is a ‘Brother or Sister’ subtle pressures can be brought into play and
if so the consent would be forced
 35

Similarly monitory and other inducements (threats) would not make a consent informed
consent

If the potential donor is incapable of informed consent (e.g., minor, mentally retarded) the
proxy consent cannot be given for the benefit of others if there is more a minimal risk or loss
to the donor
Proxy consent must see, ‘will that person give consent if he were able?’

People should be encouraged to give organs without violation to their dignity and without
they being made as means for others

Moral Issues Regarding the Recipient

There must be a ‘Moral Certainty’ that the transplantation will benefit the recipient
The benefits should be more than the risks
Informed consent of the recipient should be obtained

A problem arises in a hospital setting when for one available organ there are many recipients
 Who should receive it?
 One who is terminally ill or one who is ill but not terminally?
 Should an aged person receive the organ or a young person?
 A prominent citizen or a poor man?

Pragmatic reasons are often discriminative

Some suggest lottery method
Others, he who is in great need (but then who is in great need is difficult to decide)
Yet others suggest the one who can pay for it
Others however suggest one who has control over the disposal of the organ should decide

Issues Related to Some Specific Transplants

Heart: Before heart transplants ensure the death of the donor.
Brain death is the criterion

Kidney: has 9 times its capacity needed to maintain health

Therefore donation of a healthy kidney may be encouraged

Cornea: Transplantation of a cornea from a dead person poses no problem

But transplantation from a living person raises some difficulties
If the person is blind because of other reasons but cornea is good, it can be transplanted
 36
But from a normal person Catholic moralists with a traditional bend of mind hesitate to permit a
donation of a cornea since it will impair his functionality
However, more recently moralists would allow donation of a cornea by a healthy person on the
basis of Christian call to self-sacrificing love

Transplantation of Testicles or Ovaries for Procreation of Children

These procedures seem to go against the essence of marriage which is mutual, exclusive,
permanent union

There is a genetic link between the children and the parents

This link is passed on through organs of procreation
Another person’s procreative organs interfere with this link

It is like artificial fecundation

Recourse to gametes of a third person, in order to have sperm or ovum available, constitutes a
violation of the reciprocal commitment of the spouses and a grave lack in regard to that essential
property of marriage which is unity

Sexual Organs from Animals (Pope Pius XII, 1956)

The transfer of sex glands would have to be rejected as immoral because of the great disturbance
of freedom which would be likely to follow
The integrity of personal life and of a person’s identity prevail over prolonging life or any other
possible advantage accruing from a transplant

With regard to heart or lung transplants there is no reason to fear a dangerous modification of the
personality
A transplanted heart is less apt to injure the spiritual personality of the recipient than are
currently accepted psychiatric and neuro-surgical techniques

Some Social Aspects of Organ Transplantation

Today the human organ has become an object of commerce
Some term it as the
 Human Spare Parts Trade
 A Meat Bazaar
 Prostitution of the Human Body

Live donor kidney sells for Rs. 50,000/- and upwards

A live cornea Rs. 80,000/-
Skin Rs. 1000/- a patch

Madras has village with 100 families which have prospered because of kidney sales
 37
Children from Honduras and Brazil were being sold to traders of other countries who turned their
bodies into organ farms
WHO urged member countries to impose a ban on such ‘Dehumanising Practice’
Sale of organs has become a cottage industry

Some of the major ethical issues connected with organ sales are:
 Should a doctor perform an operation when he knows that the organ has been bought?
 Organ sale exploits the poor; it makes it to appear that some lives are more valuable than
others
 Should not a person make use of an available organ (voluntarily sold for a price) in order
to save his life?
Has a person the right to sell his organ (a parent child’s) in the face of poverty or other
evils?
 Should the doctor turn out a patient while he knows he can save his life because the
available organ is sold for a price?

As a general comment, we may say that the organ seller has his priorities wrong
He is making his integrity as a means for financial rewards
But how about a poor man out of love for his is starving children selling organs?
Is it a reprehensible act?
Is an act of self-sacrifice?

But if this is permitted, at a more fundamental level of morality we are making breaches that
could be detrimental to the very life we seek to protect
While the poor man’s action is laudable we should not forget the larger consideration - given the
basic premise of his action is children can be made use of for others

The buyer of the organ is unreasonably selfish

By using his economic power he uses the only thing the poor have their bodily integrity
‘Organ Transfer’ should be delinked from Commercial Transfer’ and put into the sphere of gift-
giving

3.2 Blood Transfusion

This Procedure is almost always an ordinary means and therefore morally obligatory in most
cases

Some people like ‘Jehovah’s Witnesses’ refuse to accept blood transfusion even when the refusal
may culminate in death
They oppose blood transfusions basing themselves on a statement from Leviticus 3:17:
“This shall be a perpetual ordinance for your descendants wherever they may dwell. You shall
not partake of any fat or any blood.”
 38

This religious attitude has led to many court cases in the USA
In general courts have respected the wish of a patient in refusing blood transfusion for himself

If the refusal of transfusion is for a minor child of a Jehovah witness parents the courts have
ordered transfusion against the wishes of the parents in the interest of the child

Ordinarily blood transfusion is morally obligatory means for us

We do not pass judgment on others

3.3 Morality of Surgery

General

Man as the steward has a duty to preserve the anatomical and functional integrity of his body
The morality of surgery is generally governed by the ‘Principles of Totality’ and the distinction
between ‘Ordinary and Extraordinary’ means

So, surgery is permitted and obligatory if it is an ordinary means required to preserve the life and
integrity of the person

Sometimes even healthy organs may have to be sacrificed for the good of the whole person
e.g., in case of breast cancer removal of ovaries; in case of prostate cancer male sterilization

Summing up we can note the following:

 There is no morality whatsoever involved in the lessening of mere anatomical
completeness of the body
 It is immoral to lessen the functional perfection and completeness of the body when such a
measure is not required for the preservation of the health and life of the individual
 Since the ‘Whole’ is greater and more important than any of its ‘Parts’, it is morally
permissible and often morally obligatory to lessen the functional completeness of the body
when this is the only effective means of safeguarding the health or life of the person.

Sex Change Surgery

Here we are not concerned with ‘Transvestitism’

Transvestite/Transvestist enjoys wearing the clothes of opposite sex
He usually does not seek to become physiologically a member of the opposite sex
He simply derives psychological or erotic pleasure from wearing the clothes of the opposite sex

We are also not talking here about ‘Hermaphroditism’ - a condition in which a person possesses,
in varying degrees, the sexual organs of both the male and the female
 39
In these tragic cases specialists in surgery, physiology, endocrinology and psychology must
combine their efforts to place the individual in what they believe to be his or her true,
predominant sex

The question here is about ‘Trans-Sexualism’ - i.e., a person who is physiologically of one sex
and for various reasons, wishes to undergo surgery to resemble a person of the opposite sex

The reasons could be numerous and unknown like:

 The abnormality may be caused by imbalance of hormonal system
 Being raised by parents as a member of the opposite sex
 Sexual adventurism and a love for the sensational
 To get a job or excel in sports, etc.

From the moral point of view, transsexual surgery is a grave mutilation of the human body
Surgery cannot change a person’s sex

Early attempts at such a surgery simply removed some genuine male sexual organs and created
some fake female organs
Penis and testes were removed
A slit was made in the groin and covered with sensitive skin from the penis and the incision was
made to resemble the Vagina

Today sexual reassignment surgery involves making an incision in the scrotum and pulling nerve
endings from the Penis inside the body to design a Vagina

‘Enlarged Breasts’ are created by injections of ‘Polyethylene Plastic’ or more recently by the use
of Breast Prosthetic (artificial) implants

Administration of female hormones removes

 Body hair
 Enlarges breasts
 Produces rounded hips

The whole process is like a masquerade, a biological dressing up

But putting on a skirt does not make a woman and so too this
Both the patient and the doctor are wasting their resources and expertise that can be used to save
life

Plastic Surgery

Bodily blemishes can impair peoples’ psychological and spiritual developments

A blemish when corrected early in life is more effective and causes minimum damage to the
child
 40
The physicians must advise the parents regarding this

There is nothing immoral about such enhancing procedures insofar as they involve no risks
But for the sake of promoting vanity, etc., when people expose themselves to risks, plastic
surgery cannot be morally commendable
e.g., Bobbing an elongated nose
Plastic foams used for breast enlargements
Silicone implants caused breast cancer and many cases were fought in the USA

Bad surgeons can cause damage to the body and future health
In brief we must consider the importance of expected benefit, the expertise of the surgeon and
the risk factor

Ghost Surgery

The surgery is performed by somebody other than the doctor who contracts to treat the patient
This is morally unacceptable because:
i) It violates the contract the doctor makes with the patient
ii) It violates the patient’s right to be treated by a doctor of his choice
iii) It puts the patient to risk because the one who operates has not studied the patient
previously nor does he offer postoperative care
iv) The patients are over-charged

3.4 Experimentation

The key issue here is ‘Consent’ of the patient

Obtaining consent protects the autonomy of the patient and acknowledges his control over his
life and integrity

It also increases trust between the researcher and the patient as well as trust among the people at
large towards scientific research

In any case since the patient is the centre of value and he cannot be used as a means for ends
however big they might be

Experimentation on the Healthy Person

We must distinguish here between

i) Experiments which most certainly or most likely injure the health and destroy life
ii) Experiments which involve some measure of risk to health and life
 41

It is immoral for a healthy person to consent to any experimentation which current incomplete
evidence indicates will most likely insure his health or hasten his death
The healthy person should not be ‘guinea pig’ for the unsubstantiated theories of some crazy
scientist

Experimentation is permitted when all available although incomplete evidence indicates that
though there may be some risk involved, the likelihood is that the procedure will not inflict any
grave injury upon the subject

Therefore:
 Immoral are any experiments based on inadequate knowledge that we have no solid
ground for believing that a person can undergo the experiment without suffering grave
injury

 Immoral are any experiments in which the intent is to continue it until the subject suffers
injury or death (e.g., Nazi Experimentations)

 Immoral are any experiment which was begun without the intent to injure the subject but
which is continued after it becomes clear that it is inflicting grave harm

Very often the poor, who have to receive government medical support, are subject to such
experimentation
They are often coerced to undergo these procedures in order to obtain treatment

 Permissible are experiments, which involve some risk to health or life but in which there is
neither the intent to inflict injury nor the probability that it will occur
The reason is that for sufficient reason we are entitled to run a risk for our own or someone
else’s benefit

This is different from engaging in an act which probably will result in injury or death
e.g., the air plane test pilot, the deep sea diver, the mountain climber, astronauts shot into
space risk their lives to some extent for the sake of sport, scientific advances, etc.

The first time man landed on the Moon the scientists involved were sure that they would
succeed because they had done their homework thoroughly although there was some
danger of failure

Many advances in medicine were made by those who ran risks by allowing themselves to
be infected in order to verify because they were sure of the cures they had discovered
But solid study preceded and they were sure that no serious harm would come
 42
Experimentation on the Sick

If standard, accepted, usually effective treatments are available the person is obliged to use them
A patient should not be induced to abandon these for the sake of testing some unproven
treatment, which might cause deterioration of his health

It is not only superstition and ignorance that drive people to try new fads from quacks
Sometimes ‘Ruthless Zeal’ of the scientists causes mad things to happen

The morality of experimentation on the sick can be summarized as follows:

 We are morally obliged to use accepted or standard proven available remedies for our
illnesses
If two or more such remedies exist, the doctor and patient should select the one that seems
best suited to the particular case

 When established remedies have failed to cure a minor illness or condition, the patient
may consent to experimental treatment only if it is evident that failure of the procedure
will not result in a condition worse than that with which he is currently afflicted

 When established remedies have failed to cure a serious condition, the patient may
consent to a medical experiment as a hope-for cure only if there is good reason to believe
that side effects of the treatment, or its failure, will not result in a condition more serious
than the one with which he is currently afflicted

 When established remedies have failed, the patient would only be allowed to submit to an
experiment that would seriously endanger his life if the actual saving of his life depends to
a great extent if not entirely on the success of this particular medical experiment

Experimentation on the Incurable

The question is often asked whether or not terminally ill patient out of charitable purposes
subject himself to experimentation that might hasten his death

Taking steps which will destroy life or hasten death is Euthanasia

The fact that this is done out of charity does not change its character
The ends do not justify the means

In fact all euthanasia is done out of good motive, i.e., alleviate pain
The crucial question here is ‘Is immediate loss of life or hastening of death the likely result of
the experimentation?’
If it is, we cannot condone it
 43
On the other hand, a person can run a risk to help someone else
In the case of the terminally ill since he has so little left in life he can run a more serious risk if
he can help others

Therefore:
 The patient may not submit to the experimentation if the available but limited knowledge
indicates that the procedure will probably result in death or hasten his death

 The patient may submit to the experiment if the available but limited knowledge indicates
that although the procedure entails grave risk, here is a sound probability that it will not
result in the immediate loss of life or hastening of his death
There should be the probability of obtaining new knowledge

Experimentation on Foetus

There are various forms of experimentation on the foetus some of which are permissible other
not
With abortion laws accepted in most states the ‘Non-Viable Foetus’ is considered as a thing, or
nothing, a zero
It has no right

States do not grant any rights to them

Some animals are more protected than a foetus

Foetal research has led to many advances:

 The ability to treat successfully RH-haemolytic disease of the unborn child, i.e.,
incompatibility between foetal and mother’s blood resulting in the death of the foetus or in
the child being born defective

 Development of vaccine against Rubella (German measles)

When a woman contracted this in early pregnancy, the chances of the child being born
mentally retarded or defective are great
The vaccine has solved this problem

 Many respiratory diseases in the new-born have been solved due to foetal research

 The development of ‘Amniocentesis’

Through this technique of sampling foetal cells taken from the amniotic fluid, great strides
have been made in diagnosing and remedying disorders in the foetus

 Development of new diagnostic procedures which can reveal the presence of inheritable
diseases
 44
Foetal research has also led to abuses like:
 Often foetuses are aborted for research
 They are often treated like things
 In our country foetal research has led to discriminate killing of female foetuses
 There is also the danger that the parents after having discovered some deformity, physical
or mental, may not wish to bring the pregnancy to full term

In this sphere, we must be guided by the following over all principle

Experiments that will injure or kill foetus cannot be permitted
If the experiment involves only a risk but will help the foetus and gain knowledge, it can be
permitted

From this general principle we may deduce the following principles:

 If research means observation and confirming hypotheses and experimentation means study
of the unknown effects of a treatment then research and experimentation are permissible
However, there should not be grave risk to the life of the foetus
If even observation involves risk to the life of the foetus, it cannot be morally permissible
Parental consent must always be obtained

 Experiment can be ‘Therapeutic and Non-therapeutic’

It can be on live or dead foetus

On non-therapeutic experimentation on live foetus the following must be noted

The human foetus is to be considered as a human person
So all the principles we stated about experimentation on human person must be applied
Therefore keeping alive a foetus for the sake of experimentation is immoral

The parents themselves have no right to give consent to any experimentation that will violate the
physical integrity of the foetus

Therapeutic experimentation that attempts to promote the integrity and life of the foetus is
permissible
In the situation of saving the life of a foetus untested embryo drugs and surgical procedures may
be used as a last resort when other options are not available

Dead embryos must be given the same respect given to dead persons
Therefore autopsy and mutilation for research should not be done before death has been verified
Parental consent must be obtained

Research and experimentation on foetuses produced in vitro:

In these cases only one fertilized ovum is transferred to the womb others treated as biological
material
 45

We note the following about these procedures:

 It is wrong to produce human life outside the context of the sexual act in marriage
 To dispose of the fertilized ova is killing (some call it murder of innocent life)
 The scientist is playing God
 The dignity of the human is violated

Cross-Fertilization and other Genetic and Chromosomic Manipulation, Gestation in

animal uterus, Gestation in artificial placenta, Cryo-preservation of the foetus:
In such procedures the right of a human being to be born in the context of marriage is
violated
Human dignity is jeopardized
There is separation of human birth from human sexuality
These procedures are not therapeutic

They are meant to produce human beings according to predetermined characteristics

They attempt to prove man’s superiority over and independence from God who is the
only author of life
 46
Chapter Four
ABORTION

4.1 General Concepts

Abortion is the process of ejecting out foetus from the womb of any woman or its destruction by
any external agency

The term comes from two Latin words ab and oriri

Ab means ‘off’ or ‘away’ and oriri means ‘to be born’

The foetus is referred to by different terms according to the stages of its development:
 The fertilized ovum is referred to as the Conceptus or Zygote till the first cell division
(36 hours after fertilization)
Zygote is the cell produced when the nuclei of the 2 gametes (ovum and sperm) have
fused

 It is called Morula till the 4th day

Morula is the ball of cells that results from the division of Zygote
Special techniques can tell the sex of the individual even at this early stage

 Then it grows into the Blastocyst status when Morula develops into a mass of cells with
2 distinctive parts-the inner cell mass and the outer cell mass
The inner cell mass consists of cells, derived from the innermost cells of the Morula
and they go to make up the Embryo

The outer cell mass will develop into the Placenta to which the foetus is attached by the
umbilical cord and through which it receives its nourishment

As cell division progresses the cells lose their pluri-potentiality, that is, their capacity to
contribute to the formation of any part of the human body
With the onset of this Blastocyst stage all is prepared for its implantation in the uterus

 Implantation takes place within about 14 days or so

From this point or shortly afterwards there is no possibility of ‘Twinning’
This stage of a child’s development is called Embryo

By 4 weeks, the heart as a simple tube starts to pulsate

By 5 weeks, parts of the brain are present and there is early differentiation of the
cerebral cortex (outer layer of the grey matter of the brain)
These processes are proper to the embryonic state
 47

 From 8th week or so the child is referred to as the Foetus

By this stage the human is distinctly seen

These various terms we use are simply technical terms to refer to the various stages of
development like we use the terms: infant, child, adolescent, etc.
Often the term ‘Foetus’ is used as a general term to cover all these stages

If a human foetus is expelled from the womb before 6 months of conception it is unable to
survive i.e., it is not viable even with the best of medical assistance
After 6 months it may survive through artificial incubation and therefore is considered viable

If the expulsion of the foetus from the womb occurs without external interference it is called
‘Spontaneous Abortion’- this is also called ‘Miscarriage’
If it is done deliberately it is called ‘Premature Induced Delivery’- sometimes used as another
respectable name for ‘Abortion’
Another respectable term used for abortion is ‘Medical Termination of Pregnancy’ (MTP)

Miscarriages are usually caused by some abnormality of the developing baby

It usually occurs in the first 3 months of pregnancy and it seems to be nature’s way of preventing
abnormal babies from being born

About one pregnancy in 7 ends prematurely in this way in a healthy woman

A miscarriage may also occur if the woman has an illness, such as
 High fever
 Insufficiency of hormones
 Incompetent cervix
 Infection
 Trauma, etc.

In Christian belief, there is surely a moment when the flesh formed in the womb of the mother,
receives the soul
This we call ‘Ensoulment’ or ‘Animation’ of the foetus

In the past theological discussion has tried to fix a timeframe to this event of ensoulment
Till the days of St. Albert the Great (13th century), the notion in vogue was that before
fertilization, the semen as the seed of life held only vegetative life, with conception came
animal life and as the foetus grew at some stage it received the human soul

St. Augustine said that the foetus is ensouled at 46 days

Albert insisted that the immortal soul was given at the very moment of conception
St. Thomas AQUINAS, although a disciple of St. Albert, stayed with the previous tradition of
delayed animation
He suggested that ensoulment took place at 40 days for male and 90 days for female
 48
Of course St. Thomas regarded abortion as a very serious crime although he would consider it a
homicide only after ensoulment

Some have suggested that because twinning may take place up into the 2nd week of pregnancy,
the event of ensoulment, which distinguishes the singularity of every individual, has to be placed
after that period
However this is not question that may ever be solved to the satisfaction of all

4.2 Some Methods of Abortion

1. D and E Method
This is called Dilation and Evacuation method or Dilation and Curette (D and C) method
This is employed for abortion during the first trimester (a period of 3 months, especially as a
division of the duration of pregnancy)

In this method, the uterus is accessed through vagina

The cervix is dilated, the curette which has a sharp blade is inserted and the surgeon cuts the tiny
body to pieces and cuts and scrapes the placenta from the inside wall of the uterus
The baby is thus dislodged from the womb

2. Suction Evacuation Method

In this method, the inner lining of the womb along with the embryo is sucked out with a vacuum
aspirator
This process is adopted in pregnancies that are less than 3 months old
It takes only 5 minutes to do this
Within 10 minutes the patient is removed from the operation theatre
In this method only the local anaesthesia is given and the patient may be discharged within a few
hours

3. Salt Solution Method

This method is employed in pregnancies advanced beyond 4 months
A large needle is inserted through the abdomen into the uterus and amniotic sac, and a strong
solution of salt is injected
The baby breathes in and swallows the salt and is poisoned by it
The outer layer of skin is burned off by its corrosive effect
The baby makes a few convulsive movements and dies
In about 24 hours labour starts and a dead baby is delivered

4. Hysterectomy
When pregnancy is advanced beyond 4 months this method is used
It is actually the surgical operation known as the ‘Caesarean Section’
A general anaesthetic is given, the abdomen and uterus opened, and the baby is removed, and
dropped in a bucket and left to die
Some babies may make weak movements of their arms or legs and try to breathe
Sometimes a pathetic cry is emitted, and the child dies of suffocation
 49
5. RU-486
This is a combination of 2 drugs administered in such a way as to bring about a ‘Miscarriage’
 Methotrexate (used to treat cancer)
 Prostaglandin Misoprostol (used as an ulcer drug, also known as Cytotec)

Such a method is known as ‘Contra-Gestative’ because it seeks to eliminate an already

fertilized and even implanted ovum
RU-486 causes deficiency in ‘Progesterone’, a hormone required to sustain early pregnancy and
preparation of the uterus for implantation

When pregnancy begins progesterone performs 3 essential functions:

i) It supports the lining of the womb and nourishes the foetus
ii) It stops the muscle of the womb from contracting
iii) It prevents the cervix from dilating

Obviously without progesterone, the pregnancy cannot be sustained

In other words RU-486 induces the woman to ‘Menstruate’, ridding herself of the pregnancy
Some contraceptive pills too operate in similar ways and therefore they are not merely
contraceptive but abortifacient

6. Intra Utrinal Devices (IUDs)

The loop, the ring, the spiral, the bow are all varieties of a simple kind of equipment technically
known as intrauterine devices-devices inserted into the uterus to prevent conception or Nidation
(Implantation)

These are also called ‘Interceptive’ because they seek to prevent an already fertilized ovum
from implanting in the womb
These devices come in many sizes and shapes and are made of many different kinds of materials-
stainless steel, plastic, surgical silk

Although it is not clear exactly how they function in each case, generally they cause the fallopian
tubes to contract more than normally and this exercises pressure on the fertilized egg to speed up
and reach the womb before it is ready to be implanted there
So it is ejected

Another theory is that the presence of these devices produces ‘Antibodies’ which kill the sperms
or the fertilized egg

Most of these methods have also severe ‘Side Effects’ on the mother’s life and health
In recent times there has been also the discovery that abortions themselves and the means used to
obtain them increase the risk of cancer especially of the breast
 50
4.3 Catholic Arguments against Abortion (SCDF)

The Context
All over the world there is a tendency to liberalize restrictions on legal procuring of abortion
This tendency is ‘Paradoxical’ because…
On the one hand there is an increase in unqualified protest against ‘Capital Punishment’ and all
forms of war
On the other hand there is this demand to remove restrictions against abortion

Opposition to Legal Restrictions on Abortion

Many oppose legal restrictions on abortion on the ground that such restrictions impinge on the
conscience of at least some of the citizens

Having no laws on abortion would violate no one’s conscience and each individual is left to
follow his own opinion while being prevented from imposing it on others

But such opinion is the result of the misunderstanding that ‘Ethical Pluralism’ is the normal
consequence of ‘Ideological Pluralism’

There is however a great difference between the 2 because ethical positions are more
immediately connected to actions which affect the interests of others more quickly than
ideological opinions

Moreover, apparent claims for freedom of opinion are actually a pretext for attacking the rights
of others especially the right to life

Church’s Competence to Teach

Charged with the office to teach on faith and morals the teaching Magisterium of the Church
hopes that its teaching will not be considered as one among several opinions, but will be received
as the constant teaching of the Supreme Magisterium which teaches moral principles in the light
of faith
Therefore the magisterial teaching places serious obligation for Christian consciences

Arguments against Abortion

1. Arguments from Faith

God wills life and not death
Death was not God’s doing (Cf. Wis 1:13)
It is true God has created beings who have only one life time and therefore physical death cannot
be absent from the world of those with bodily existence

But what is immediately willed is life and not death

On the human level it was the devil’s envy that brought death into the world (Cf. Wis 2:24)
Introduced by sin, death remains bound up with sin
 51
Death is the sign and fruit of sin

But the final victory does not belong to death because it has been defeated by the resurrection of
Christ
God is God, “not of the dead but of the living” (Mt 22:32)
And death like sin will be definitively defeated by the resurrection of Christ (Cf. 1 Cor 15:20-27)

Thus human life even on this earth is precious

Infused by the creator, life is taken back by him (Cf. Gen 2:7; Wis 15:11)
It remains under his protection
Man’s blood cries out to him (Cf. Gen 4:10) and he will demand an account of it

The commandment of God is formal:

“You shall not kill” (Ex 20:13)

Life is at the same time a gift and a responsibility

It is received as a “talent” (Mt 25:14-30)
It must be put to proper use

In order that life may bring forth fruit many tasks are offered to man in this world and he must
not shirk them
More important still, the Christian knows that eternal life depends on what, with the grace of
God, he does with his life on earth

2. Arguments from Tradition

The tradition of the Church has always held that human life must be protected and cherished
from the beginning
Opposing the morals of the Greco-Roman World, the Church of the first centuries insisted on the
difference that exists on this point between those morals and Christian morals

Didache: “You shall not kill by abortion the fruit of the womb and you shall not murder the
infant already born.”

Athenagoras:
He emphasized that Christians consider as murderers those women who take medicine to procure
an abortion
He condemns the killers of children, including those still living in their mother’s womb, where
they are already the object of the care of divine providence

Tertullian:
“To prevent birth is anticipated murder; it makes little difference whether one destroys a life
already born or does away with it in its nascent stage; The one who will be a man is already
one.”
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3. Arguments from History

In the course of history, the Fathers of the Church, the Pastors and Doctors have taught the same
doctrine - the various opinions on the infusion of the spiritual soul did not cast doubt on the
illicitness of abortion

It is true that in the Middle Ages, when the opinion was generally held that the spiritual soul was
not present until after few weeks, a distinction was made in the evaluation of the sin and the
gravity of penal sanctions

In resolving cases, approved authors were more lenient with regard to the early stages than with
regard to later stages
But it was never denied at that time that procured abortion, even during the first days, was
objectively a grave sin

This condemnation was in fact unanimous as illustrated below:

i) The First Council of Mainz (847) reconsidered the penalties against abortion which had
been established by preceding Councils
It decided that the most rigorous penance would be imposed ‘on women who procure the
elimination of the fruit conceived in their womb’

ii) The Decree of Gratian reports the following words of Pope Stephen V: “That person is a
murderer who causes to perish by abortion what has been conceived.”

iii) St. Thomas, the common doctor of the Church teaches that abortion is a grave sin against
natural law

iv) Pope Innocent XI (1676) rejected the propositions of certain lax canonists who sought to
excuse an abortion procured before the moment accepted by some as the moment of
spiritual animation of the new being

v) Pope Pius XI in Casti Connubii explicitly condemned abortion

vi) Pope Pius XII clearly excluded all direct abortion both as an end as well as a means

vii) Pope John XXIII affirmed the sacred character of life which from its beginning demands
the action of God the creator

viii) The Second Vatican Council condemned abortion in Gaudium et Spes (51): “Life must
be safe guarded with extreme care from conception; abortion and infanticide are
abominable crimes.”
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ix) Pope Paul VI declared that the teaching of the Church has remained unchanged and
unchangeable

4. Arguments from Reason

i) Respect for life is not only a Christian obligation but also a human one
As a person man is capable of self-reflection and freedom
He can choose his acts and thus determine his destiny
He is master of himself

Since self-mastery takes time, we can say he has the capacity to master himself and that is
precisely his task
Human self-mastery and human destiny are bound up with God who alone fulfils him
adequately

Man spends his life in the company of other men

He is nourished by interpersonal relationships in Society which is indispensable in his life
While society and other people must be taken into account, each human person possesses
himself
He possesses life and goods
He has these as a right in justice and this right is inviolable

ii) While bodily life is important it is not the ultimate destiny of man-although it is a
fundamental good, which is the condition for all other goods
However there are higher values for the sake of which one must be prepared to risk the loss
of bodily life

In a society of persons, the common good is an end for each one which must be served at
the expense of the interests of individual persons
But the common good is not the last end of the person

God is his last end

Society must serve each man to attain this goal
Therefore, he cannot be sacrificed as a means for a higher end

iii) What we call ‘Human Rights’ today precede society and therefore the society does not
grant them nor can it take them away
It is the society’s function to enforce and safeguard them

By its laws society does not determine these rights but merely organizes external behaviour
Life is the first right of a person
He has other rights that are more precious, but it is the most fundamental because it is the
condition for all others
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No society and no authority has the right to recognize this basic right to some and deny it to
others
All discrimination is evil whether it be on the basis of race, colour, sex or religion

In the case of life it is not any recognition by another that constitutes this right
It precedes all recognition and demands recognition
Any refusal of recognition is strictly unjust

iv) Any discrimination based on the various stages of life is as unjust as any other
discrimination
The right to life remains complete in an old person and in one weakened by illness or
incurably sick

The right to life is equally complete in a new born infant as in a mature person
Respect for human life is therefore called for from the moment of fertilization

When a life has begun, it is not the life of the mother or of the father but the life of a new
human being with its own growth
It would never be made human if it were not human already

v) Modern genetic science gives clear confirmation of the above.

It has established that from the first instant there is established the programme of what this
living being will be

It is surprising that science in its most evolved state does not offer support to those who
defend abortion
Moreover it is not for biological sciences to determine when exactly the humanness of a
human life is constituted - a question strictly moral and philosophical

From the moral point of view it is certain that humanness is constituted from the first
instance
But even if this were doubted it is objectively a grave sin to risk murder

The Church does not want to decide on the question when exactly the soul is infused
It also denies competence to Science to determine this issue because the issue is beyond the
scope of science
It is a philosophical question

The moral assertion of the Church is independent of this philosophical question for 2
reasons:

i. Supposing, a later animation, there is still human life preparing for and calling
for a soul in which the nature received from the parents is completed
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ii. It suffices that this presence of the soul is probable (and one can never prove
the contrary) in order that the taking of life involves accepting the risk of
killing a man, not only waiting for, but already in possession of his soul

Some Objections Considered

1. Reasons given to defend abortion are not always malicious

Denial of abortion often means ‘Endangering Important Values’ such us:
 Serious threat to health and sometimes even to life or death of the mother
 Burden of an additional child especially when there are good chances of the child
being abnormal or retarded
 Pregnancy being a matter of honour or dishonour, it being the cause of loss of
social standing, etc.

The Church proclaims that no reason is objectively good enough to directly attack the life of the
child even when that life is just beginning

With regard to the future unhappiness of the child no one (not even the father or mother) can
stand in the child’s name in order to choose life or death for it
Even the child when it reaches the age of decision cannot choose suicide
No more may his parents choose death for the child when it is not of an age to decide for itself

2. ‘Emancipation of Women’ is laudable since attempts at emancipation seek to free women

from all discrimination

But one cannot change nature

Women cannot be exempted (just as men cannot be exempted) from the obligations of nature
Therefore women cannot argue that abortion is a matter of their right over their own bodies

Furthermore, all publicly recognized freedom is always limited by the certain rights of others
Therefore the child’s rights limit the rights of the mother

3. ‘Sexual Freedom’ is another argument used in favour of abortion

If by this term is meant the mastery of sexual impulse by reason and authentic love, without in
any way diminishing pleasure, then there is nothing objectionable
This kind of freedom will always respect justice

But if by sexual freedom is meant that men and women are free to seek sexual pleasure to the
point of satiety without regard for any law or for the essential orientation of sexuality to fertility,
then there is nothing Christian about it
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In any case it does not invest anyone with the authority to dispose of human life or to suppress it
under the pretext of it being burdensome

4. The ‘Advancing Technology’ increasingly makes delicate interventions possible

The consequences of technology is the expression of human spirit and therefore admirable

Nevertheless, progress of technology cannot be morally evaluated independent of man,

Because it exists for man and therefore must respect his finality

Just as there is no right to put nuclear energy to every possible use so also there is no right to
manipulate human life in every possible direction
Technology must be at the service of man, to enable him function his normal abilities, to cure his
illness and to contribute to his human development

It is true that the evolution of technology makes early abortion easier but this does not modify its
moral evaluation

5. Often ‘Birth Control’ efforts justify abortion

But the Church restates the teaching of Humanae Vitae and Gaudium et Spes that under any
pretext, a family or a state may never use abortion as a means of controlling birth

Considerations of Morality and Law

1. The moral discussion on abortion is accompanied by a juridical debate

All countries punish murder and many countries did include abortion in the category of murder
But presently the tendency is to make the law as less restrictive as possible especially in matters
of private life

The argument of ‘Pluralism’ is used

The argument goes as follows:
In a country where many believe abortion is wrong and a majority accept it as licit why impose
laws which force the major section of the people to follow an opinion which is not theirs

Moreover, it is pointed out abortion laws are ‘Not Enforceable’

The crime has become too common to be punished every time
And so the public authority closes its eyes to the crime

But it must be pointed out that preservation of a law which is not applied is detrimental to the
authority and to all the other laws
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So the Church urges those countries where abortions are still prohibited by law to enforce those
laws
It must be also noted that ‘Clandestine Abortions’ endanger the fertility and even life of women
who resort to it
So if the legislator continues to regard abortion as an evil may he not propose to restrict its
damage?

2. ‘Civil Law Cannot’ be expected to cover the entire sphere of morality

It ‘Must Tolerate’ sometimes what is in fact a lesser evil in order to avoid a greater one

But it must be noted that ‘Legalizing Abortion’ simply means that the state ‘Refuses to Punish’
those who procure abortion

But many will take this to mean that it is an authorization to abort and that the legislator no more
considers abortion as a crime against human life

It is true that civil law should not take sides on opinions

But the life of the child takes precedence over all opinions

3. ‘The Role of Law’ is not to approve what is done but to improve society
For this it will have to right many wrongs
Civil law cannot be expected to punish every wrong but it cannot also go contrary to a higher
law - the Natural Law

It may refrain from punishing

But it cannot declare to be good what is evil according to a higher law
For, then it would cease to be a law

4. In any case a Christian can never conform to a law which is immoral in itself - abortion law
is immoral
Nor can a Christian take part in a propaganda campaign in favour of it, or vote for it
Moreover, he may not collaborate in its application

5. Civil law must strive to reform society, to create a milieu of life so that always and
everywhere it may be possible to give every child coming into this world a welcome worthy of a
human person

4.4 Current Trends

Throughout Christian history abortion has been ‘Condemned’ although, as we saw above, there
have been differences of opinion about when the crime became more serious
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Much of the discussion took place without correct understanding of the origins of human life
Today we have more improved knowledge of the origins of human life and of the development
of a foetus in a mother’s womb

But clearer knowledge has only polarized the debate on abortion more sharply
For example, Women’s Liberation Movement argues that abortion is the ultimate exercise of
freedom for a woman

Abortion provides her with the freedom from her own body and its sexual processes thereby also
freedom from male domination

On the other hand, another school of thought points out that abortion shows the kind of respect a
particular society will show to the most defenceless beings in our midst

If the life of a defenceless foetus is not respected, then there are good reasons to believe that the
most fundamental of all rights - right to life, will be undermined
The test of humaneness of a society is not the respect it shows to its powerful members but the
respect it show to the weakest

At the centre of such differences is the type of recognition given by different schools of thought
to the ‘Status of the Foetus’

We may classify these different Schools of Thought into 3 (Kenneth KEARON):

1. Continuity Argument

The personal identity of a person is a continuum which includes his past, present and future
Just as a person moves through various stages of life after his birth (infancy, childhood,
adolescence, adulthood, etc.), so also the person’s history goes back before his birth to the very
moment of fertilization of an ovum by a sperm

It is the same person who has grown from the one cell stage to the stage of mature-adulthood and
after, despite numerous changes that has occurred in his life-story
There is continuity between the fertilised ovum and the person we see today

There is no one remarkable or exceptional moment or event this continuum goes through in order
to acquire the status of personhood
Therefore, the status of personhood must have been there from the very beginning

Even if we have doubts about the status of personhood of this continuum in its early stages of
life, there is no doubt at all about it being a human being
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The Catholic position on abortion would fall into this school of thought
This school would use the ‘Principle of Double Effect’ in order to resolve conflicting situations
like ‘Ectopic Pregnancy’ and ‘Cancerous Uterus’ and permit the loss of the foetus in these
cases as not being directly caused but indirectly permitted

2. Process Argument

This view holds a person to be someone who thinks, talks, reflects, has memories, feels
sensations, eats, walks, relates, etc

Being a person does not imply the ability to do all these, but the absence of the capacity to
perform any of these or other similar functions would cause most people to question whether in
fact we are dealing with a person at all

In order to be a subject of consciousness, to perform any of these functions we associate with

persons, we need a ‘Functioning Brain’
Today it is widely accepted that a person is recognized to be dead when his brain activity
completely ceases

In similar lines it can be argued that a person comes into be only with the development of brain
at least in its early stages
Up to the 14th and 15th day after fertilization ‘Individuation’ (twinning) can take place
After this stage the individuality of the foetus is never in doubt

This is also the time when the first recognisable features of the embryo proper appear
Throughout all this implantation is taking place

There is a very high wastage rate of embryos as a result of failure to implant before this period
By the 17th day [after fertilization] the neural groove appears
By the 22nd to 23rd day this has developed to become the neural folds, which in turn start to fuse
and form the recognisable antecedent of the spinal cord
This marks the earliest stage of the appearance of something which will become the future brain

On the basis of these findings, the Church of England stated that the establishment of a
functioning nerve-net at around 40 days after conception can be regarded as a necessary criterion
for the beginning of personal life, paralleling the common acceptance of brain-death (as distinct
from, say, heart-failure) as the mark of the end of physical life

Some of those who accept this line of thinking may wish to pin point the exact stage of
development when personal life appears
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But the general argument of this school is that becoming a person is a process that begins with
conception
Although the embryo demands our respect at every stage yet our respect for it must grow with
the growth of the embryo

Therefore, there should be very grave reasons ever to violate the embryo at any stage of its
development
But there comes a stage where violation of the life of the embryo is unacceptable for whatsoever
reason

Many in this school of thought suggest that we should look to brain-based criteria
The basic structure of human cerebral cortex takes shape between the 15th and 25th day
There is a functioning nerve-net around 40 days
By 8th week there is detectable electrical brain activity
By 12th weeks the brain structure is complete

Those who look for brain-based criteria usually cite one of these stages (often the 12-week stage)
as the point beyond which termination is not morally acceptable

3. Right to Choose Argument

This school suggests that the decision whether to continue with a pregnancy or terminate it is a
decision that rests solely on the woman concerned
This argument presupposes 2 things:
i) Abortion is an expression of total control on the part of the woman over the process
of reproduction and therefore it is like contraception
ii) The foetus, especially in its early stages, has no separate status; it is simply part of the
woman’s body

These assumptions are questionable

First of all, in abortion there is a destruction of human life which is not there in contraception
While both are morally questionable; they are certainly not the same
Secondly, the foetus is not part of a woman’s body just as a kidney or a lever is part of her body

The foetus has a separate genetic constitution, and grows and develops independently of the
woman though dependent on her
These facts certainly falsify the claim that a foetus is part of a woman’s body
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Chapter Five
EUTHANASIA

5.1 Terminology

The term ‘Euthanasia’ comes from Greek Eu, a prefix indicating ‘Good’
Thannatos meaning ‘Death’
The term thus refers to the practice or the institution of ‘Good Death’

Until not long ago it was used to express the kind of assistance of the physician in alleviating the
suffering of the dying patient

From the ancient times death itself was considered to be an enemy to be dreaded and avoided
Bible itself considered death as a ‘Penalty for Sin’ (Cf. Rom 6:23) and described it as the ‘Last
Enemy’ (Cf. 1 Cor 15:26)

In Greek mythology when Odysseus met Achilles in Hades and congratulated him on his
eminent position in the Hades, the hero replied, ‘it is better to be the servant of a mean man in
life than the Lord among all those dead and gone’

While death itself was considered as something never good, the ancients emphasized the value of
dying honourably and courageously

The case of Jacob’s death was typical of a desirable ending to human life (Cf. Gen 49)
Jacob blessed each of his sons speaking with unimpaired insight into the character of each son
He also gave detailed instructions for his burial, clarifying the title of his family burial plot

His death came gently:

“When Jacob finished charging his sons, he drew up his feet into the bed and breathed his last
and was gathered to his people” (Gen 49:33)

In the Bible no tragedy was attached to death as long as there had been a normal life span, one
had children for posterity and no scandal would forbid burial with honour
This issue of honour was a point of distress for Jesus and his interpreters in coming to grips with
the scandal of the cross (Cf. Mt 26:36-46 - Gethsemane; 1 Cor 1:23)

However, Christ transformed even the meaning of the cross

It became a sign of assurance and hope as Christians confronted death

Paul’s reflection on the matter summarized this insight:

“Whether we live or whether we die, we are the Lord’s” (Rom 14:8)
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The concern had been shifted from the ‘Manner’ in which one died to the ‘Purpose’ for which
one lived
Death regardless of how it came to one, who lived righteously before God, was a good death

To die well one must live well

Preparation for the encounter with death was necessary if one was not to be unduly anxious
about or be destroyed by fear
This was the concern of the spiritual exercise of ‘The Art of Dying’ (Ars Moriendi) that
developed in the Middle Ages

Knowing well that death was inevitable and anticipating one’s own experience required
cultivating the art of dying well

5.2 A Brief Historical Survey

The ‘Moral Acceptability’ of suicide has been debated among philosophers from Pythagoras to
Albert Camus

Many argued that suicide was immoral

Pythagoras’ objection to suicide was religious - Life was God’s property
Without God’s command, one had no right to kill God’s property

Plato: It was a person’s duty to stay alive for service

Aristotle: Objected to suicide on the ground of civil obligation

Stoics: Generally accepted death as an evil but acknowledged that suicide as a cure for life’s
burdens
Some stoics even argued that suicide was even a ‘Duty’ if one concluded that death was
advisable

Epicureans: Regarded death as an evil but acknowledged that suicide was acceptable when life
became an even greater burden

Jerome: Approved of suicide in defence of virginity, though most argued that suicide hindered
the soul’s passage into eternity

The Council of Arles (314): Condemned suicide as inspired by Satan

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St. Thomas AQUINAS: Formulated the teaching still held by Roman Catholics
He accepted the arguments against suicide proposed by Plato and Aristotle
In addition, he added the notion that suicide violated the 5th Commandment
He added special gravity to suicide by saying that it precluded forgiveness and thus incurred
‘Eternal Punishment’

St. Thomas MORE: Advocated voluntary euthanasia for those suffering from incurable and
painful diseases

Francis BACON: Doctors should assist those who wish to die

The physicians duty was ‘to mitigate pains and dolours, and not only when such mitigation may
conduce to recovery, but when it may serve to make a fair and easy passage’

John DONNE: Suicide was not inherently evil

He defended it under certain circumstances on the grounds of Christian Theology. Published
posthumously, the work was entitled Biathanatos

David HUME: In his essay ‘On Suicide’ argued that a person had a ‘Native Liberty’ to determine
his death under certain circumstances such as pain and disease
He skilfully refuted the main religious objections, saying it was not necessarily sin

Immanuel KANT: Argued that suicide contradicted the categorical imperative, but his
philosophical argument on the whole could be used to support its acceptability

William Frederick NIETZSCHE: Rejected suicide, saying that one ought to assert one’s will
against all pain and suffering
Even so, because of his bad health, he often took overdoses of chloral, hoping to die
He also admitted that contemplating suicide helped him get through many a bad night

Jeremy BENTHAM: Accepted the notion of suicide on utilitarian grounds or the pleasure-pain
principle and demanded assistance in his dying moments

William JAMES: Rejected suicide at the theoretical level on pragmatic grounds, but suffered
bouts of suicidal depression and admitted that probably every educated person had considered
suicide

Sigmund FREUD: Explained suicide as the death wish in immature people but died at his request
for a lethal injection to end his pain from cancer of the jaw
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Albert CAMUS: Held the basic conviction that life was absurd and therefore according to him
the only serious philosophical problem was the problem of suicide
He held that suicide acknowledges that life is not worth the trouble
Even so, he did not recommend suicide but that people discover meaning by becoming involved
with suffering humanity

5.3 Some Conclusions from the Historical Survey

1. The brief historical survey makes obvious that there has been ‘Strong Differences of
Opinion’ among people of good will, profound religious faith, and unquestioned intelligence
regarding the question of suicide

2. The different moral judgments are based on ‘Varying Assumptions about Death’, the nature
of God, salvation and the afterlife, the role of reason and the meaning of life

3. Those who oppose suicide do so arguing on the basis of some principles

 AQUINAS stated suicide was against the ‘Fifth Commandment’
 Plato argued that the ‘Principle of Duty’ disallowed suicide
 KANT used the ‘Formal Rule’ of the categorical imperative to oppose suicide
 Those who permit suicide do it on considerations of finding meaning in life
 HUME for example argued for suicide on the basis of ‘Human Rights’ and
‘Anthropology’ CAMUS on the basis of the meaning of life itself

4. Even those who give any approval to suicide do not do so for any reason at all
The permit suicide only under some specific and constraining conditions, usually the
‘Immanence of Death’

5.4 Towards a Definition of Euthanasia

The issue of Euthanasia is no more limited to the question of putting an end to a painful life
Advances in medicine and the available technologies of prolonging life have broadened the
scope of the question of Euthanasia

For example, a case like that of Karen Ann QUINLAN raises question like:
 To what extend are we obliged to use life prolonging procedures?
 When can we stop these procedures?
 When can we, if at all, put an end to life?
 Can we choose the circumstances of our death?
 There is still a third question involved in the contemporary debates about euthanasia
which is posed by cases such as those of infants or the terminally ill who are dying.
The issue concerns the morality of mercy in aiding the dying patient. The question
goes beyond simply withdrawing treatments. The Issue is whether, in the name of
mercy, one might morally aid someone’s dying.
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In the light of these questions we may define euthanasia as “an action or an omission which of
itself or by intention causes death, in order that all pain and suffering may in this way be
eliminated” (SCDF).

5.5 Types of Euthanasia

From the point of view of ‘Who’ does the action, Euthanasia may be Active or Passive
i.e., when one does an action or omission upon oneself in order to cause or welcome death it is
active when someone else does an action or omission on oneself it is passive

From the point of view of the ‘Consent’ or request of the patient Euthanasia may be Voluntary
or Involuntary
i.e., if the patient consents or requests death then Euthanasia is voluntary otherwise it is
involuntary

From the point of view of the ‘Means’ employed Euthanasia may be Direct or Indirect
i.e., if direct means are employed to procure death of a patient then it is direct euthanasia
otherwise it is indirect

On the basis of these considerations we can distinguish 6 Types of Euthanasia:

1. Active, Voluntary and Direct

The patient makes the death decision and carries it out using direct means
This also called ‘Euthanatic Suicide’
Here the patient is not mentally ill or incompetent

The person acts on the basis of personal freedom and in the light of attitudes towards what it
means to live and when it is desirable to die

Groups such as ‘Society for the Right to Die’ and ‘Exit’, in Britain are founded on the
philosophy that each person has a basic, human right to make such a decision and take such
action freely

2. Active, Voluntary and Indirect

In the face of terminal illness the patient himself makes a decision not to accept medical
treatment thereby hoping to hasten death without however doing anything direct to cause death
The means whereby he actively and voluntarily seeks to hasten death are indirect
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3. Passive, Voluntary and Direct

The patient exacts a pledge from someone (friend, relative or physician) to hasten his dying or to
intervene to bring death more quickly if he is unable to do it himself
The agreement may be made well in advance of the problem or once the patient is already in
form

Such pledges place great moral responsibility, mental burden and legal vulnerability upon those
who enter such a covenant

The act, however, is the carrying out of a promise made to the patient and under circumstances
set by the patient himself
The moral rightness of such an agreement is seen to be justifying the tragedy involved in
terminating life

4. Passive, Voluntary and Indirect

This differs from the 3rd type only in the means chosen to carry out the promise
The means are indirect only
The practice of drawing a ‘Living Will’ falls into this category

Living Wills:
Nowadays many people believe they have the right freely to take decisions that are most directly
related to the process of dying
When somebody on the point of dying is still conscious, and is capable of saying that he does not
want his life prolonged by extraordinary means, that in itself should be a sufficient indication for
the family members and doctors as to what course of action to take

The most difficult situations arise when the person is unconscious and incapable of expressing
his wishes
There are 2 solutions to this type of problems:
i) The person can make a ‘Living Will’, whereby the patient himself gives instructions
about the decisions to be taken if he is close to death and can no longer express his
wishes
ii) The person designates a representative as the person authorized to take decision on behalf
of the patient at such a time

The ‘Living Will’ itself is a document in which someone in complete control of his faculties
requests that certain wishes relating to his health care should be carried out
The wish most frequently expressed in these documents concerns not prolonging life by
disproportionate means
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In the Catholic context we cannot permit living wills that ask for euthanasia on the basis of the
right to die
A Catholic living will may contain the following points:
 The appropriate treatment to be used to relieve pain
 Rejection of disproportionate or extraordinary treatment
 Rejection of active euthanasia
 No painful or unreasonable prolongation of the process of dying
 A request for help in dying in a humane and Christian manner

5. Passive, Involuntary and Direct

This is simply ‘Mercy Killing’ without the request of the patient and using direct means
Examples of these would be
 Shooting a person trapped on a fire
 Smothering or tranquillising a new born rather than force it to starve to death
 Terminating a patient in the agonizing stages of a terminal illness such as
leukaemia, aids, etc.

Actions of this type are considered ‘Homicide’ by laws of most countries

Morally such actions are extremely problematic
Anyone who promises to make a ‘Death Decision’ for another is accepting grave responsibility

There are also grave chances of misusing occasions of this type if such actions are permitted
For example, the delicate balance between a judgment to preserve the severely handicapped and
the decision to terminate since the prospects for a meaningful life are slim may be tipped by an
awareness of bothersome and prolonged therapeutic care, the appeal of estate settlements, or the
prospects of more attractive sexual opportunities

Proponents of euthanasia point out that such actions done out of mercy should not be identified
with murder which is killing with ‘Premeditated Malice’

6. Passive, Involuntary and Indirect:

This is also called ‘Negative Euthanasia’
There are procedures that ‘Let the Patient Go’ by withdrawing or withholding life-preserving
treatments

The attending medical personnel may

 Turn off a Respirator
 Stop giving intravenous injections
 Withdraw drugs
 Cancel an operation
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Another means used by physicians to permit death to come more quickly for the patient is that of
not treating a ‘Secondary Illness’ contracted in the terminal stage of an illness
Thus, should an elderly patient suffering from ‘Cancer’ contract ‘Pneumonia’
The physician may leave the pneumonia untreated and thus shorten the patient’s life

The decision to withhold treatment is based upon mercy for the patient
The conclusion has been reached that it is better for the patient to die of pneumonia than to suffer
the final agonizing stages of cancer
The secondary illness intervenes to shorten the period of suffering

5.6 Teaching of the Magisterium on Euthanasia (SCDF)

Inviolability of Human Life

i) Human life is a basic good

It is the basis of all goods, and is the necessary source and condition of every human
activity and of all society

Most people would regard human life as something sacred and that it may not be disposed
of at will
But Christian faith would also see human life as a gift of God’s love

ii) No one can make an attempt on the life of an innocent person without:
 Offending God’s love for that person
 Violating the fundamental right of that person
 Committing a crime of utmost gravity
Therefore no one can permit the killing of embryo, foetus, infant, adult or old person, one
in an incurable disease or dying

One cannot ask for death for oneself or for another, not consent to it
It may happen that because of severe and prolonged pain people may be led to believe that
they can legitimately ask for death or obtain it for others
In these cases the guilt of the individual may be reduced or completely absent

Nevertheless the error of judgment into which the conscience falls, perhaps in good faith,
does not change the nature of this act of killing, which will always be in itself something to
be rejected

The pleas of gravely ill people who sometimes ask for death are not to be understood as
implying a true desire for euthanasia
In fact it is almost always a case of an anguished plea for help and love
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What a sick person needs, besides medical care, is love, the human and supernatural
warmth with which the sick person can and ought to be surrounded by all those close to
him or her, parents and children, doctors and nurses

No authority can permit such an action because it is a question of

 Violation of the divine law
 An offence against the dignity of the human person
 A crime against life
 An attack on humanity

iii) Everyone has a duty to lead his life in accordance with God’s plan.
The gift of life is given to each individual as a good that must bear fruit here on earth and
reach fullness in the hereafter

So suicide (intentional causing of one’s own death) is wrong as murder because:

 It is a rejection of God’s sovereignty and his loving plan
 The denial of the natural desire to live
 A flight from the duties of justice and charity we owe to our neighbour and society
at large
However, psychological factors present can diminish or completely remove responsibility
(culpability)

iv) A distinction is to be made between ‘Suicide’ and ‘Sacrifice of Life’

For a higher cause, like God’s glory, the salvation of souls, or the service of one’s brethren,
a person may offer his life or place it in danger

Christian Understanding of Suffering and Norms Regarding the Use of Painkillers

i. For most people death does not come in a dramatic and quick way
For many it comes after long periods of painful ordeal

So prolonged illness, advanced old age, or a state of loneliness or neglect can bring about
psychological conditions that facilitate the acceptance of death

Elizabeth KÜBLER-ROSS:
The dying person normally passes through 5 stages:
i) Denial
ii) Anger
iii) Bargaining
iv) Depression
v) Acceptance
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The patient is able to work through the earlier stages but arrives at the last only when he meets
with love and understanding - just the opposite of loneliness or neglect

ii. Physical pain is unavoidable in this world

On the biological level it is a ‘Useful Warning’
But pain affects the psychological makeup sometimes so severely that its biological
usefulness is overridden by resistance to pain

This causes in people the desire to remove pain at all costs

In the Christian view, suffering especially during the last moments of life has a special
place in God’s saving plan

It is in fact a sharing in Christ’s passion and a union with the redeeming sacrifice which
he offered in obedience to the Father’s will

iii. Therefore:
 There should be no surprise if Christian prefer to moderate their use of pain killers, in
order to accept voluntarily at least a part of their suffering in order to identify them
with those of Christ crucified (Cf. Mt 27:34)

 Nevertheless, it would be ‘Imprudent’ to impose a heroic way of acting as a general

rule
Human and Christian prudence suggest for majority of sick people the use of
medicines capable of alleviating or suppressing pain, even though these may cause a
secondary effect semi-consciousness and reduced lucidity

 As for those who are not in a state to express themselves, one can reasonably presume
that they wish to take these painkillers, and have them administered according to
doctor’s advice

 The intensive use of painkillers brings about the problem of habituation and
consequently increased doses
Administration of increased doses of painkillers may cause unconsciousness and may
even shorten life

In such cases, if no other means exist, and if, in the given circumstances, this does not
prevent the carrying out of other religious and moral duties increased doses of pain
killers may be administered
Here death is in no way intended or sought, the risk of it is reasonably taken
The intention is simply to relieve pain
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 Painkillers that cause unconsciousness need special consideration

For a person not only has to be able to satisfy his moral duties and family obligations
He also has to prepare himself with full consciousness for meeting Christ
Thus, Pope Pius XII warns:
“It is not right to deprive the dying person of consciousness without a serious reason.”

Care for the Dying

i) Technological advances can prolong life, but they can also be used abusively to deprive the
dying person of his dignity
This has led some to speak of a ‘Right to Die’

In the Catholic understanding ‘Right to Die’ cannot mean that one may actively procure
one’s death by one’s own hand or through someone else
But one has the right to depart with human and Christian dignity

ii) With the advances in medical technology, the use of therapeutic means in terminal illness
often poses ethical problems
A decision regarding the use or non-use of these means must be arrived at by the
conscience of the sick person, or of those qualified to speak in the sick person’s name, or of
the doctors
Such decisions must be made in the light of moral obligation and of the various aspects of
the case

iii) The distinction between ‘Ordinary and Extraordinary’ means comes handy in making
decisions in the above situations
Because of the imprecision of these terms, it is now more fashionable to speak of
‘Proportionate and Disproportionate’ means

The distinction is made by studying the type of treatment to be used, its degree of
complexity and risk, its cost and the possibilities of using it, and comparing these elements
with the result that can be expected, taking into account the state of the sick person and his
physical and moral resources

iv) The following rules make the application of the above distinction clearer:
 If there are no other sufficient remedies, it is permitted, with the patient’s consent,
to have recourse to the means provided by the most advanced medical techniques,
even if these means are still at the experimental stage and are not without a certain
risk
By accepting them, the patient can even show generosity in the service of humanity
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 It is also permitted, with the patient’s consent, to interrupt these means, where the
results fall short of expectations
But for such a decision to be made, account will have to be taken of the reasonable
wishes of the patient and the patient’s family, as also of the advice of the doctors
who are especially competent in the matter

The latter may in particular judge that the investment in instruments and personnel
is disproportionate to the results foreseen
They may also judge that the techniques applied impose on the patient strain or
suffering out of proportion with the benefits which he may gain from such
techniques

 It is also permissible to make do with the normal means that medicine can offer
Therefore, one cannot impose on anyone the obligation to have recourse to a
technique which is already in use but which carries a risk or is burdensome

Such a refusal is not the equivalent of suicide

On the contrary, it should be considered as an acceptance of the human condition,
or a wish to avoid the application of a medical procedure disproportionate to the
results that can be expected, or a desire not to impose excessive expense on the
family or the community

 When inevitable death is imminent in spite of the means used, it is permitted in

conscience to take the decision to refuse forms of treatment that would only secure
a precarious and burdensome prolongation of life, so long as the normal care due to
the sick person in similar cases is not interrupted
In such circumstances, the doctor has no reason to reproach himself with failing to
help the person in danger

5.7 Some Points of the Theological Debate

1. Points of Agreements
Proponents and opponents of Euthanasia agree on the following:
i) It is permissible to refuse treatment in case of incurable illness
ii) It is permissible with the consent of the patient to withdraw treatments that uses
disproportionate means
iii) It is morally justifiable to let the patient go and not strive to maintain vital signs after
a patient is recognizably dead or dying
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2. Points of Disagreements
The debate is sharp in the following areas:
i) Justifiability of euthanatic suicide and aiding the patient to commit suicide
ii) Killing the patient upon request
iii) Killing the patient without his request

One’s position on these decisions would depend upon one’s

 Definition of personhood and life
 Attitude towards death and divine providence
 Distinction between killing and allowing to die

From the Catholic point of view euthanasia is not morally acceptable

This is true even if it is considered objectively, either from Christian standpoint or from more
specifically humane points of view

There are, however, some who believe that outright condemnation of euthanasia is not
completely correct from a humane point of view

A document produced by Spanish Bishops (1986) on euthanasia provides a detailed position on

the Christian basis for condemning euthanasia:
Neither the New Testament nor the Old Testament tackled euthanasia directly and
explicitly. The Bible, however, contains a fundamental affirmation: God is the Lord of
life and death. It is God who has called men and women into existence and given them
life as a gift, and as a blessing, which they must look after and cherish, and never
dispense with. Within the biblical tradition, there is a line of progress, which increasingly
underlines the value, and sacrosanct nature of all human life. “Thou shalt not kill”
thereby acquires much more relevance, to the extent that the principle of the inviolability
of human life is now extended to everyone. Jesus gives special impetus to the demand for
respect for all human life. As the Church examines the principle further, it teaches
explicitly that the inviolability of all human life extends to any phase of human life.

Non-voluntary euthanasia is a grave moral wrong in that it takes away from another a quality as
basis as life itself without any regard for the wishes of the person concerned
When such an act is committed for eugenic or racist reasons, or is encouraged by public
authorities or other influential bodies, the wrong is colossal

We should not try and place the morality of euthanasia within a narrow, individual, moral
framework
As St. Pope John Paul II has pointed out, the issue contains a genuine cultural option:
The task which is imposed on the Christian community in a similar socio-cultural context
is more than mere condemnation of euthanasia or a simple attempt to prevent its
dissemination and subsequent legalization. The fundamental problem above all is this:
How can we help men of our time to become aware of the inhuman character of some
aspects of the dominant culture and to rediscover the most precious values guaranteed by
it?
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The Pope understands well that socio-cultural conditioning can so shape people’s value systems
that sometimes they can consider bringing one’s own or somebody else life gently to a close as a
humane solution

We can none-the-less pick out a number of factors that favour a growing trend in support of
euthanasia
To quote again from the Spanish Bishops’ Statement on euthanasia, these factors include
“The process of secularisation, the crisis of religious values in the west, and the prioritising
of the freedom of the individual which ultimately affirms that a terminal patient has the
right to dispose of his/her life as she/he wishes. It is equally undeniable that the
legalization of abortion has an impact in the area of euthanasia. When the law allows a life
in gestation to be disposed of, it is on its way of accepting that other human lives can also
be disposed of.”

5.8 Two Difficult Questions Connected with Euthanasia

1. Artificial Feeding

Of all the treatments used to maintain life, one that has aroused most debate in recent times is
that of ‘Artificial Nutrition and Hydration’
The questions that arise in this area are 2:
i) Whether it must be used at all in the first place
ii) Whether it is legitimate to withdraw it after having started it

These questions arise in situations of people

 Close to death
 Permanently comatose patients
 Patients whose health is in serious decline but who lives are not in danger

For many decades now, Catholic scholars have said that it is legitimate to withhold intravenous
feeding in particular circumstances, on the assumption that it was not a case of ordinary means

Within the Church we find 2 points of view

G. DURAND and J. SAINT-ARNAUD put them forward as follows:
“There are those who believe that respect for human life demands that we continue
feeding seriously ill people, even artificially, and that includes people in irreversible
comas, because feeding and hydration are part of the minimum care that compassion
demands. On the other hand, there are theologians and philosophers who maintain that
recourse to artificial nutrition and hydration does not involve the same moral obligation
as the natural process of ingesting solids and liquids. This medical technique is more akin
to treatment than to everyday care.”
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By contrast, the Pontifical Academy of Sciences places feeding under the heading of ‘Health
Care’ rather than ‘Treatment’

D. CALLAHAN describes the struggle between heart and mind on this issue
Although he admits the legitimacy of not using artificial nutrition in some circumstances, he is
fully aware of the profound significance of feeding
As it is ‘the most fundamental of all human relationship’, it would be most dangerous, he says to
play with such a basic moral emotion

Therefore, continuing with the feeding is a tolerable price to pay to preserve one of the few
moral emotions that could be called a necessary social instinct
The same idea is used when arguing with those who defend Euthanasia, and who would not
consider artificial nutrition to be obligatory

St. Pope John Paul II in an Address given on March 20, 2004, at an international congress on
“Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas”
stated the following:
 The human person, even if seriously ill or disabled in the exercise of his highest functions,
is and always will be a human person and he will never become a ‘vegetable’ or an
‘animal’
 Even the most sophisticated diagnosis about a person reaching the PVS is not an
absolutely certain one. If there are even slight chances of a person becoming well, denying
him food and water would be a very serious error
 Administration of water and food, even when provided by artificial means, always
represents a ‘Natural Means’ of preserving life and not a ‘Medical Treatment
 Families having such PVS patients should not be left alone. They must be helped by
society in concrete terms

Some of those who consider artificial feeding as a treatment would argue that there is no real
difference between switching off a respirator and withdrawing tubal or intravenous feeding
Both of these are means to support failed systems of the body one the respiratory system and the
second alimentary system

When such measures yield absolutely no hope by way of recovery of the patient or qualitative
improvement in his condition they can be withdrawn
The removal of the respirator may cause death in a few minutes
The withdrawal of artificial feeding brings about death within two weeks or three
But there is no real difference

Despite all the arguments for and against artificial feeding, we must maintain that giving food
and water to our beloved ones even to the very end is part of the basic care we are obliged to
offer to those whom we love
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All the same when these measures involve sophisticated techniques and involvement of expertise
which are too complex and expensive but which do not yield any hope of recovery can be
considered extraordinary means and therefore not morally obligatory

Resuscitation

This term refers to procedures that have been developed in the last few decades in the field of
‘Restoring Heartbeat after Cardiac Arrest’

If the heart does not resume beating after a few minutes, the brain suffers total and irreversible
damage
Cardiac arrest occurs at some moment in anybody’s dying process whatever may be the cause of
death
Therefore, any decision to resuscitate is a very important one

The decision to resuscitate a dying patient is made more complex by 2 factors:

i) The decision has to be taken very quickly as any delay in resuscitation limits the chances
of success. If the heart does not start beating again within a few minutes, the brain suffers
irreversible damage
ii) The decision has also to take into account of the chances of success resuscitation may
have (if the resuscitation procedure does not fully succeed it may just help prolong the
person’s life in the form of burdensome existence)

The decision is rendered more complex by the fact that neither the consent of the patient nor of
his family is available in the here and now, when decision must be taken

The decision itself may involve profound and long term obligations on the part of the patient’s
family
For example, if resuscitation revives the patient but leaves him in a near PSV state

These factors can make the decision whether or not to resuscitate a very difficult one
The path we must walk here is indeed very narrow - between doing the best we can to help
preserve the life and promote the health of another and doing too much so that another’s life is
reduced to an intolerable burden

The right moral response in this area lies precisely in walking that narrow path
Finally there are other situations that throw up questions of similar nature
Questions like artificial feeding and resuscitation

These situations include whether or not to continue with mechanical ventilation, dialysis after
chronic renal failure, and antibiotic treatment when it only serves to maintain the patient
artificially in a vegetative state
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Chapter Six
MORALITY OF BIO-TECHNICAL PARENTING METHODS

6.1 Infertility: Notion and Causes

Infertility is the inability to produce living offspring

Infertility in men is the inability to fertilise the ovum
Infertility in women it is the absence of conception after a year or so of marriage without the use
of contraceptives

The partners of a marriage may be considered infertile when pregnancy has not occurred within a
year of regular coitus without contraception
Here the word ‘Infertility’ is being used in the comprehensive sense of being ‘Unable to have
Children’

‘Sterility’ implies an absolute bar to conception

‘Infertility’ signifies an impairment of normal reproductive capacity

In the case of sterility marital act is normal but due to some inherent defect in the organs of
generation the natural act does not effect generation

In infertility the organs of regeneration may be in order but because of deficiency in their
functioning fertilisation does not take place
To put it in another way all those who are sterile are infertile but all those who are infertile need
not necessarily be sterile

Some of the factors that cause infertility in women are:

 Failure of ovulation due to hormonal imbalance
 Endometriosis (i.e., portions of the inner lining of the uterus growing outside the uterus)
 Blocked fallopian tubes
 Congenital malformations such as absence of vagina, uterus or ovaries, sperm allergy,
cervical factors such as poor production of cervical mucus or infection, etc.

Factors that render a male infertile are:

 Low sperm count
 Impotence
 Ductal obstruction caused by injury
 Infection or sterilizing operations
 Failure of the semen to liquidify
 Hypospadias (an irregularity of the male penis in which the urethra opens not at the
end of the penis but on its underside close to the body
Epispadias - a similar defect on the upper-side close to the body), etc
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In addition to these, there are other factors that can cause infertility which go under the general
heading of ‘Sexual Dysfunction’

Both men and women can be affected by inhibited sexual desire resulting from boredom in the
relationship, depression or use of drugs

Men suffer from

 Inhibited Sexual Excitement (i.e., inability to attain or to maintain an erection satisfactory
for normal intercourse)
 Premature Ejaculation
 Absence of pleasure experience in Erection and Ejaculation

Women suffer from

 Frigidity
 Inhibited orgasm
 Painful intercourse for various reasons, etc.
Often these sexual dysfunctions are of psychic origin and ‘Psychotherapy’ can help those who
suffer from these

Infertility is quite widespread

Rough statistics show that 1 in every 10 marriages in the world will not be blessed by children

In the past people accepted ‘Childlessness’ in marriage with a sense of fatalism and passivity
Now with many a technology available to remedy this situation people are resorting more and
more to ‘Bio-Technical Parenting Methods’ which they hope will alleviate the pain of infertility
in a marriage

6.2 Various Techniques of Artificial Reproduction

Artificial Insemination

Artificial insemination is ‘the artificial placing of human semen into the interior of the female
genital organ, other than by sexual intercourse’

This procedure may be Homologous - the semen involved in this procedure is of the husband in a
marriage - this is more commonly called Artificial Insemination by Husband (AIH)
It may be used when the husband is unable to deliver the sperm into the genitals of the woman,
because of e.g., Hypospadias or Epispadias or impotence etc.
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This procedure may be Heterologous - the semen used is of a donor - this is more commonly
called Artificial Insemination by Donor (AID)
This procedure may be used when the husband is sterile or his sperm is defective so that
fertilization by him is either impossible or considered undesirable

The standard procedure is for the husband or the donor to produce the semen by self-induction
and the ejaculate is then transferred by syringe into the vagina, cervical canal or uterus of the
wife in order to induce pregnancy

Sometimes the semen is frozen and the insemination is done some time in the future as required
and convenient
Before the semen is placed in the woman’s body, it has to be carefully prepared in the laboratory,
and this process makes different demands on the people involved, according to the circumstances

One condition that is vital for the success of the operation is knowing the precise moment when
‘Ovulation’ is about to take place
Once these preparatory phases have been completed, the semen is placed in the vigina, cervix, or
uterus according to medical indications

For artificial insemination to take place, fresh or stored human semen must be available
We must not forget that this semen is provided through ‘Masturbation’, and this in itself raises
moral problems

The questions raised by masturbation are sidestepped by the use of perforated condom
The husband and wife have sexual intercourse while the husband wears the perforated condom
Since some of the semen goes into the woman the integrity of the sexual act is preserved while
the rest of the semen gathered in the condom is later used for insemination

We must also note that certain procedures of AI can be acts that replace the sexual act between
the spouses
These render the sexual act needless for conception
Whereas some procedures of AI may only be assisting the sexual intercourse that has already
taken place between the spouses

In Vitro Fertilisation and Embryo Transplant

In Vitro is a Latin phrase which means ‘In Glass’

In Embryology it is used in contrast with In Utero or ‘In the Uterus’

In normal circumstances, human fertilization takes place In Utero (strictly speaking, in the
Fallopian Tubes) when a sperm cell unites with an ovum
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Therefore, In Vitro Fertilization (IVF) is fertilization that is artificially performed outside the
woman’s body ‘In a Test-Tube’
In Vitro fertilization is a process that helps a woman overcome her infertility in cases where the
woman’s fallopian tubes may be absent, abnormal, or damaged

There are 4 basic steps involved in the process of In Vitro Fertilization (IVF)

1. The woman concerned is given a reproductive hormone in order to cause ova to ripen
A few hours before ovulation can be expected to occur a small incision is made in the abdomen
just below the navel
A laparoscope (an instrument with a built-in lens and light source) is inserted through the
incision, the ovaries are examined directly
When mature eggs are found that are about to break free from the thin walls of the ovarian
follicle, the walls are punctured and the contents are removed by a vacuum aspirator
Several eggs may be removed

2. The eggs are transferred to a nutrient solution bio-chemically similar to that found in the
fallopian tubes
Sperm is then added to the solution
As soon as a single sperm cell penetrates the ovum, the ovum is fertilized

3. The fertilized egg is transferred to a nutrient solution where, after about a day, it begins to
undergo ‘Cell Division’
When the ovum reaches the eight-cell stage, it is ready to be returned to the uterus
The woman concerned is then given injections of hormones so as to prepare her uterus to receive
the fertilized egg

4. The small ball of cells is placed in the uterus through the cervix (the opening that leads to the
vagina) by means of a hollow plastic tube called a ‘Cannula’
Although there are differences of opinion about when the fertilized ovum should be transferred
to the uterus, the weight of expert opinion leans towards the time between 24 and 48 hours after
fertilization

Early contact of the fertilized ovum with the cervical mucus increases the likelihood of success
It is also considered advisable to use 3 embryos, as the chances of succeeding seem to be better
than with 2 or 1

The fertilized egg continues to divide, and somewhere between the 32 and 64 cell stage, it
attaches itself it the uterine wall
If the attachment is successful, then from that time onwards, development takes place as though
fertilization had occurred in the normal fashion
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Like artificial insemination, IVF/ET can be performed using the gametes of the couple or of
donors
It is very difficult to evaluate the success of this technique as consistent data are not available
Some evaluate the success rate on the basis of successful pregnancies and others evaluate its
success on the basis of birth

Effectiveness is heavily dependent on the skills of the medical team, the number of transferred
embryos and so on
This is truer of IVF/ET than artificial insemination

IVF/ET began to be developed in 1950, and was first used on human being in 1969
The first completely successful operation took place on 1978 when Louis BROWN was born in
Britain on 25 July

Among the recent techniques of artificial fertilization which have gradually assumed a particular
importance is ‘Intracytoplasmic Sperm Injection’
This technique is used with increasing frequency given its effectiveness in overcoming various
forms of male infertility

Intracytoplasmic sperm injection is similar in almost every respect to other forms of in vitro
fertilization with the difference that in this procedure fertilization in the test tube does not take
place on its own, but rather by means of the injection into the oocyte of a single sperm, selected
earlier, or by the injection of immature germ cells taken from the man

There is ongoing discussion among specialists regarding the health risks which this method may
pose for children conceived in this way

GIFT, TOT & SIFT

The technique of ‘Gamete Inter-Fallopian Transfer’ (GIFT) is a more recent procedure

It is indicated to overcome infertility due to
 Pelvic infections
 Endometriosis
 Blocked or damaged fallopian tube
 Male infertility factors

It involves putting the ova and spermatozoa in contact with each other inside the fallopian tubes
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The ovaries are hyper-stimulated and ova are obtained as in IVF

The oocytes are then kept in the incubator until the times comes to place them in the fallopian
tube
Semen is collected from the husband about 2½ hours prior to the procedure through masturbation

In its modified form husband and wife engage in the marital act, using perforated condom
The sperm is ‘Washed’ and further ‘Processed’ by ‘Centrifugation’
The eggs and processed sperm are placed in a very small-bore catheter separated by an air
bubble
The tip of the catheter is inserted about 1.5 cm. into the fallopian tube and its contents are gently
pushed out, so that insemination can occur in vivo

Similar GIFT procedure is another called

‘Tubal Ovum Transfer’ (TOT) or
‘Low Tubal Ovum Transfer’ (LTOT)

Here too ova are obtained through laparoscopy and the husband’s sperm is obtained either
through masturbation or through the use of perforated condom
Separated by an air bubble they are then introduced into the fallopian tube, where it is hoped that
they will unite and conception will occur

Formerly this procedure was known as ‘Low Tubal Ovum Transfer’ (LTOT)
Now the ‘L’ could be dropped because the target area now is not the lower tube or the uterus, but
rather a site as high as possible in the fallopian tube

‘Sperm Intra-Fallopian Transfer’ (SIFT) is a procedure which involves only the transfer of
the husband’s sperm
Hostile cervical mucus can make sperm immobile
This can be due to increased viscosity of the cervical mucus which forms an impenetrable
barrier, infection, acid mucus, presence of sperm antibodies, etc.

Although these conditions can be remedied through hormonal treatments there could be a
situation where the only reasonable and available treatment would be to use a catheter to by-pass
the inhospitable atmosphere of the cervical canal, so that sperm can be deposited closer to the
fallopian tubes

The husband’s sperm is obtained by morally acceptable means

It could be washed, centrifuged and treated as required before delivery by catheter through the
vagina and uterus
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It is presumed that this procedure is restricted to husband and wife

Before appearing at the hospital for the procedure the conjugal act takes place, hence this
procedure takes place within the context of conjugal union

From the Catholic point of view these procedures could not be found to be too objectionable
provided the gametes involved are of a husband and wife, and provided these procedures do not
replace the conjugal act and provided the sperm is not obtained through objectionable means

Egg Transfer, Artificial Embryonation and Embryo Adoption

‘Egg Transfer’ involves the transfer of an egg of another woman into the uterus of one’s wife
where it may be fertilized by the sperm of the husband through regular intercourse

Artificial Embryonation and Embryo Adoption involve the transfer of an already fertilized
egg from another woman (the egg of this woman has been fertilized with the sperm of the
husband through artificial insemination) and placing it in the uterus of one’s wife
If attachment to the uterine wall is successful, then development of the embryo would take place
in the normal fashion

These techniques are chosen if…

 One’s wife is not able to ovulate
 She has no fallopian tubes at all
 There is something abnormal causing blockage of the fallopian tubes
 Her tubes is damaged

Clearly, the 3 techniques can possibly assist an infertile woman to bear and give birth to a child
The problem is that in the case of egg transfer, the woman will bear a child with half of the
genetic identity of her husband and none of her own
While in the case of Artificial Embryonation or Embryo Adoption, the child would have the
genetic complements neither of her husband nor of herself

Surrogate Motherhood

‘Surrogate Motherhood’ involves a husband who is married to an infertile wife, and who finds
another woman willing to receive his spermatozoa (usually obtained through masturbation and
subsequent adulterous artificial insemination

The husband’s semen is injected into a fertile woman who is not his wife and this woman is
called ‘Surrogate Mother’
The surrogate mother carries the child to term on behalf of the natural father and his wife and
relinquishes the child to them upon birth
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In this case one of the child’s parents is related biologically and one is not
The surrogate mother can be pregnant in 2 ways:

i) Artificial Insemination (in this case the surrogate mother supplies the ovum and the
husband the semen; this could be called ‘Partial Surrogacy’)
ii) IVF and Embryo Transfer (in this case both egg and sperm come from the spouses
themselves and fertilization takes place in vitro and the embryo is transferred to the
prepared womb of the ‘Surrogate Mother’ and the pregnancy is brought to full term;
this could be called ‘Full Surrogacy’)

Surrogacy is often undertaken for ‘Financial Benefits’ and this could be called
‘Commercial Surrogacy’
In other cases surrogacy may be undertaken for altruistic reasons

Press Trust of India reported on 24 August 2016, that on this day the Indian Cabinet gave its
approval to a draft law, i.e., The Surrogacy Bill 2016
The bill aims at legalizing surrogacy in India but not as a commercial enterprise but to provide
relief to proven infertile Indian couples

According to the bill, only a close relative can be a surrogate mother and other than the medical
bill no payment can be made.
It would be illegal for foreigners to seek surrogate mothers in India, according to the bill
The bill is yet to be tabled in the Parliament

Asexual Reproduction - Cloning

The reproductive technology known as ‘Cloning’ represents the most intense intervention of all
The word ‘Clone’ comes from the Greek word Klon meaning ‘Twig’ or ‘Slip’

As houseplants, for example, can be reproduced asexually through ‘Cuttings’, ‘Cloning’ is a

word for a form of ‘Asexual Reproduction’

Clonal reproduction does not involve sexual intercourse or even the union of egg and sperm
Cloning would remove completely insemination and fertilization from the marriage relationship
It could also avoid one of the partners of marriage from the entire process of procreation

Its supposed benefits are eugenic such as removing unacceptable or inferior material from the
gene pool and maximising desirable traits
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The term ‘Eugenic’ applies to the knowledge of the genetics of man

This term was coined by Francis GALTON in 1904
It is a science which deals with all influences that improve the inborn qualities of a race, also
with those influences that develop them to the utmost advantage

The theory behind cloning is that each body cell contains in its nucleus all the genetic
information (i.e., in the form of chromosomes), necessary to create a whole new organism that is
genetically identical to the existing organism

It is only through the process of differentiation that a cell acquires its identity as a brain cell,
liver cell, or skin cell, etc.
Each sex cell (ovum and sperm) contains only half the genetic complement
In human beings this amounts to 23 Chromosomes
When egg and sperm cells unite, the resulting zygote has the necessary 46 Chromosomes to
develop as a human being
Cloning can occur in 2 ways:

i) Simple Cloning
This can be done in the course of IVF procedures
At the 2 cell stage, both cells are separated and each cell is placed in suitable conditions for
growth
It is, therefore, possible that both could grow to childhood and would be equivalent to identical
twins with common genetic constitution

ii) Carbon Copy Cloning

This essentially ‘Nucleus Transplantation or Substitution’
The nucleus of an unfertilised egg is removed and replaced by the nucleus from a somatic cell
(preferably an intestinal or skin cell)

For some strange reason, the egg with its transplanted nucleus appears to embark on a normal
development
The parent of the offspring would be the one from whom the nucleus was taken in the first place

If the nucleus was taken from a woman the offspring will be female and if it is taken from a
male, the offspring will be male
The parent and the offspring would be genetically identical
In this case the clone can be incubated in surrogate mother or indeed the mother parent of the
clone
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Storage Techniques

Perhaps the oldest, most well established, and accepted form of birth technology is the
‘Sperm Bank’
An individual’s sperm is frozen and reserved for later use at a convenient time

Commercial sperm banks have been in place for many years and are fairly well accepted means
of obtaining sperm for a couple who is having infertility problem
The semen donor and the semen are screened for bacterial or viral infection, but the danger of
infection can never be completely excluded

Due to inadequate screening and selecting semen donor, some women have ended up with
venereal disease, or with genetically defective child
There are cases of HIV infection from the infected semen
A survey of 1979 at the University of Wisconsin, USA, revealed that 70% of physicians had kept
no records of the identity of the sperm donor

Likewise, embryos and ova can be frozen and stored to be used at a convenient time in future
The first pregnancies using stored human ova occurred in Australia at the end of 1985
The first known pregnancy using a frozen embryo took place in Australia on 2 may 1983, but the
experiment was unsuccessful
The first human being conceived with a frozen embryo was born on March 28, 1984
It was a girl and she was called ‘Zoe’ - the Greek word for ‘Life’

6.3 The Teaching of the Church

The Church’s position on these above issues is put forward by the SCDF in its documents
“Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation, Donum
Vitae”, issued in 1987
“Instruction on Certain Bioethical Questions Dignitas Personae”, 8 September 2008

The following are some of the salient points (10) highlighted by the documents:

1. Technological advances are man’s exercise of dominion over nature

In themselves they are legitimate because they are fulfilment of God’s own commandment
So anything artificial is not bad because it is artificial
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2. But technological advances like man’s dominion over nature have their limits
In the area of procreation man has now not only the capacity to assist the process of procreation
but to dominate it and take his destiny in his own hand

However, technological possibilities should not be allowed to determine man’s destiny

But rather man’s destiny - i.e.
 His life being derived from God
 His dignity as a person
 His being endowed with a spirit soul, and with moral responsibility
 His being called to communion with God
should determine the limits of technology

In other words science and technology must be at the service of the human person, of his
inalienable rights and of his true and integral good according to the design and will of God
Science and technology without conscience can take humanity only to ruin

3. By virtue of man’s possession of a rational spiritual soul, his body cannot be considered as a
mere complex of tissues, organs and functions nor can human body be considered in the same
way as we do the body of animals

Human body is an integral part of the human person

To touch a human body is to touch the human person
This norm applies very specially in the area of human sexuality where a man and woman realize
the values of life and love

Human sexuality and its expressions in marriage are essentially different from animal sexuality
insofar as human sexuality shares in the nature of the human person
The transmission of human life is entrusted by nature to a personal and conscious human act
Therefore, what might be licit in the transmission of life of plants and animals may not be licit in
the transmission of human life

4. Human procreation requires on the part of the spouses responsible collaboration with the
fruitful love of God
The gift of human life must be actualised in marriage through the specific and exclusive acts of
husband and wife in accordance with the laws inscribed in their persons and in their union

God’s laws demand indissoluble unity of marriage, which is the natural setting for the
procreation of children
This indissoluble unity presupposes fidelity of the spouses
Moreover, fidelity demands reciprocal respect of their right to become a father and mother only
through each other
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The child too has the right to be conceived, carried in the womb, brought into the world and
brought up in marriage
It is through the secure and recognized relationship to his own parents that the child can discover
his own identity and achieve his own proper human development

5. From the above it is clear that these techniques of artificial parenting must respect 3
fundamental goods:
 The right to life and to physical integrity of every human being from conception to
natural death
 The unity of marriage, which means reciprocal respect for the right within marriage to
become a father or mother only together with the other spouse
 The specifically human values of sexuality which require that the procreation of a
human person be brought about as the fruit of the conjugal act specific to the love
between spouses

6. Heterologous Artificial Fertilization is immoral because:

i) It is contrary to the unity of marriage - unity and fidelity demands that they become
father or mother only through each other
The child must be the fruit of marriage
The child is the confirmation and completion of their self-giving
The child is the living image of their love, the permanent sign of their conjugal union,
the living and indissoluble concrete expression of their paternity and maternity
In heterologous procedures, there is the involvement of a third party gamete,
which contradicts all what is said above

ii) It violates the child’s right to be conceived, carried in the womb, brought into the world
and brought up within marriage
It is in the context of this secure set of relationships a child discovers and lives his
identity

iii) It violates the dignity of the spouses (the spouses seems to be saying to each other, ‘if
you cannot give me a baby, I will get it from someone else’)

iv) It demeans the vocation proper to parents.

They are called to fatherhood and motherhood in conjugal fruitfulness in a bond of unity
and integrity

v) It ruptures the fundamental link between genetic parenthood, gestational parenthood and
responsibility for upbringing
Such damage to the personal relationships within the family has repercussion on civil
society - i.e., what threatens the family will in the long run bring disorder and injustice in
the society
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7. Surrogate Motherhood is immoral for the following reasons:

i) It is contrary to the unity of marriage
ii) It is contrary to the dignity of the procreation of the human person
iii) It is an objective failure to meet the obligations of maternal love, of conjugal fidelity
and of responsible motherhood
iv) It violates the right of the child to be conceived, carried in the womb, brought into the
world and brought up by his own parents
v) It is detrimental to family because it brings about a division between the physical,
psychological and moral elements which constitute those families

8. Certain Homologous Artificial Fertilization procedures (e.g., homologous IVF and ET)
which seek to substitute the conjugal act are immoral because:
i) They violate the God-willed inseparable connection between the conjugal act and
procreation

ii) They also violate the intrinsic connection between the 2 meaning of the conjugal act viz.
unitive meaning and procreative meaning
While contraception separates the 2 meanings of the conjugal act by suppressing its
procreative meaning, artificial fertilization suppresses the unitive meaning of the conjugal
act in that it seeks to procreate life apart from the conjugal act

iii) By attacking the unity of the 2 meanings of the conjugal act, homologous artificial
fertilization undermines the very unity of the human person
Human person is both body and soul, corporal and spiritual
The spiritual finds expression through the bodily

In marriage the conjugal act is the bodily expression of the spiritual act of total self-gift of
the spouses
Human procreation is to take place in the spiritual and bodily union of the spouses
It is to be linked to the union-not only biological but also spiritual-of the spouses
Artificial fertilization by attempting to realize fertilization outside the body of the woman
tries to achieve the biological union without the personal spiritual union of the spouses

iv) God has designed that a human being be born in the noble context of a man and woman
giving each other without restraint and this giving expressed through the conjugal act
This is the only fitting context in which a human person should be born

Anything other than this context for his birth is inadequate and offensive to his dignity
When a child is conceived by artificial fertilization, he becomes the object of scientific
technology
To be reduced to a product of a biological or medical technique is not in keeping with the
dignity of the child
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9. Certain Homologous Artificial Fertilization procedures which seek to assist the conjugal act
(and not replace it) may be morally acceptable
Here the technical means is not a substitute for the conjugal act but serves to facilitate and to
help so that the act attains its natural purpose

The Congregation did not discuss the moral permissibility of any particular technique of
fertilization
However, theological opinion today suggests that the following methods may be morally
acceptable provided they abide by the above stated principles
In all cases, it is understood that the procedure may licitly be used only by marital spouses:

i) Procedures involving the repositioning of sperm or ova before or after an act of sexual
intercourse:
 A surgical procedure moves sperm past a blockage in the epididymis, followed by a
normal act of sexual intercourse
 After an act of sexual intercourse, a syringe is used to siphon the semen from the vagina
and to propel it into the uterus and fallopian tubes
 Low Tubal Ovum Transfer (LTOT & TOT): This procedure begins with ovulatory drugs
being administered to the woman to stimulate the maturation of multiple ova
The couple engages in sexual intercourse just prior to the predicted time of ovulation
Immediately thereafter, a laparoscopy is performed to retrieve the woman’s ova
The ova are then repositioned in the mid or lower portion of the fallopian tube or in the
uterus, and the couple repeats sexual intercourse to enhance the chances of fertilization

ii) Procedures involving the temporary exteriorization and processing of sperm after an act
of sexual intercourse:
 Semen is removed from the vagina and centrifuged to bring about a greater concentration
of spermatozoa, and then reinjected into the vagina
 Semen is removed from the vagina and washed to eliminate sperm-agglutinating and
sperm-immobilizing antibodies, and then reinjected into the cervical canal
 Semen is collected from acts of intercourse, by morally acceptable means, and spun down
to leave a residue containing a heavy concentrate of viable spermatozoa.
This concentrated deposit of active sperm is reinjected into the woman’s generative tract
either immediately before or after an act of sexual intercourse in order to mix with and
fortify the husband’s ejaculate
The SIFT procedure is similar to this

iii) Procedures involving the temporary exteriorization of ova after an act of sexual
intercourse:
 Tubal Ovum Transfer (TOT)
 Gamete Intrafallopian Transfer (GIFT)
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10. Other Arguments the document Donum Vitae uses against unacceptable artificial
parenting methods:
i) The child is always a gift from God
Strictly speaking, parents have no right to a child
They have only the right to place procreative acts, which are generative of children.
So the infertile couple may not resort to any means whatsoever to obtain a child

ii) Many artificial parenting methods involve masturbation in order to obtain semen
Masturbation itself is an intrinsically disordered act and good motives can never justify
it

iii) Many artificial parenting methods fertilize many ova but only one or two are transferred
to the woman
The rest are treated like biological material and are either used for experiments or
destroyed
What we said of abortion at the earliest stage must be said of this kind of destruction of
embryos

6.4 Some Related Issues

Technology and medicine are meant to assist the human person and the human society
They must assist nature to overcome difficulties and remedy natural deficiencies
But when they attempt to modify nature itself, they become questionable

We can explain this by an analogy:

In sports, people all over the world use medical assistance and drugs in the case of injuries and
developing potential
But when drugs are used to improve performance, when they are used to produce superhuman
beings, then they become questionable

A similar line of reasoning needs to be done in this area of medical assistance in biotechnical
parenting methods
These methods may assist nature but not supplant it

1. Homosexual and Lesbian Parents

In recent times ‘Lesbian Couples’ have been seeking to have children of their own
The most common argument against this is that the child needs both the father and the mother
(male and female influences) in order to attain balanced maturity
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But against this it can be argued that many children grow up and grow up well in single parent
homes
What a child needs is an environment of love and security and this is not guaranteed by the
presence of a man in the family nor is it excluded by his absence

But the more fundamental argument against such requests is that they would involve
heterologous artificial insemination or heterologous IVFET

In any case, the Catholic Church believes that marriage is the only morally acceptable
framework for human reproduction
The tradition of the Church and anthropological reflection recognise in marriage and in its
indissoluble unity the only setting worthy of truly responsible procreation

2. Procreating after Death

There have been court cases where a widow attempts to establish ownership of her late
husband’s semen, which had been frozen and stored in a clinic before his death
The purpose of this is so that she can have a child by artificial insemination

At a civil law level the dispute is about to whom the semen belongs
At a moral level, we can say that with death a marriage ends and nature renders a person
incapable of procreation after death

It is therefore logical that a donor’s sperm be destroyed at his death

Impregnating a wife with a dead husband’s sperm separates procreation from the mutually self-
giving conjugal act of spouses

3. Post-Menopausal Mothers
It is not a defect in nature when a woman ceases to be able to have children after menopause
So, it would appear to be a misuse of medicine to use it to create a situation which could not
occur naturally
In this case, by the use of hormone or other therapies
One could not argue that since men could procreate well into old age women should be helped to
do the same

4. Donation of Sperm, Ova and Embryo

Donum Vitae states that there are several negative aspects about this type of donation:
i) These procedures are an attack on the institution of marriage
These procedures are opposed to the unity that is demanded of a married couple
They are a violation of both the bond of conjugal fidelity that unites them, and of the
reciprocal promise that they have made
They are unsupportive of the couple’s right and are opposed to the objective and
inalienable properties of marriage
They indicate to a break in the common calling of motherhood and fatherhood
They alter personal relations
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ii) They are contrary to the dignity of the married couple

iii) They harm the child’s rights

They run counter to a child’s right to be conceived and brought into the world within
marriage and by the married couple of that marriage, and they can lead to difficulties in
personal development

iv) They prejudice the true interest of society

They create discords, confusions and injustices in social life
Donum Vitae states that these social imbalances are nothing other than the amplified form
of disruptions caused at the family level

5. Freezing Embryos and Oocytes

Since taking oocytes from the woman’s body is a major procedure, often several oocytes are
taken together and fertilized and some are implanted and others are preserved for future use in
case the attempted pregnancy fails

Now there are thousands of such frozen embryos which have been orphaned in all those
countries which permit such procedures
The question is what can be done with them?

First of all ‘Cryopreservation’ is incompatible with the respect owed to human embryos
 It presupposes their production in vitro
 It exposes them to the serious risk of death or physical harm, since a high percentage
does not survive the process of freezing and thawing
 It deprives them at least temporarily of maternal reception and gestation
 It places them in a situation in which they are susceptible to further offence and
manipulation

The suggestion that these ‘Orphaned Embryos’ can be used for research or to heal illnesses is
unacceptable because that would be using human life merely as biological material which would
in the course of such procedures be destroyed

The suggestion to thaw them without reactivating them and then use them for research as
cadavers is also not acceptable since we are dealing with human life here

The suggestion that these embryos can be adopted by childless couples is unacceptable because
the processes of thawing, reactivating and implantation, etc. would involve moral issues like
those in invitro fertilization, surrogate motherhood, etc.
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So, according to Dignatas Personae the problem of ‘Frozen Embryos’ is an irresoluble one
What is needed is immediate cessation of such procedures
Likewise freezing of oocytes in order to avoid the above problem of preserving embryos cannot
also accepted because it would raise the same moral issues that in vitro fertilization and related
procedures raise

6. Reduction of Embryos
When artificial procreation is attempted, several fertilized ova are transferred to the mother’s
womb
This results in multiple pregnancies which may cause many complications for the life and health
of the mother
So, some of the ‘Implanted Embryos’ are eliminated

Such procedures are certainly immoral because they are equivalent to selective abortion which
systematically eliminates human life in its very beginning

Some would argue that during natural disasters we attempt to save some although we cannot
save all likewise some implanted embryos could be saved since all of them together would
endanger themselves and the mother

Such arguments or those based on principles of double effect or lesser evil would not permit
such direct intrinsically evil actions of destruction of embryos

7. Preimplantation Diagnosis
Preimplantation diagnosis is a form of ‘Prenatal Diagnosis’ connected with techniques of
‘Artificial Fertilization’ in which embryos formed in vitro undergo genetic diagnosis before
being transferred into a woman’s womb 

Such diagnosis is done in order to ensure that only embryos free from defects or having the
desired sex or other particular qualities are transferred
Those found to be defective or of undesired sex are immediately eliminated

In other type of ‘Prenatal Diagnosis’ there is a time gap between the diagnosis and the choice to
abort
But in preimplantation diagnosis there is no such time gap
This is selective abortion in its cruellest form
Besides such procedures are connected with in vitro fertilization and suffer from the same moral
defects that affect in vitro fertilization
 95
Chapter Seven
MORALITY OF STEM-CELL RESEARCH

7.1 What is a Stem Cell?

A stem cell, whether of the adult or embryonic type, is an ‘Undifferentiated Cell’ with 2 unique
capacities:
The first, for rapid and prolonged self-multiplication into daughter cells identical with itself
The second, the capability to produce non-permanent progenitor cells, with limited capacity for
proliferation, from which derive a variety of lineages of highly differentiated cells (neural cells,
muscle cells, blood cells, etc.)

‘Undifferentiated Cell’ is a cell that has not yet specialized into a particular cell type, like, liver
cell, pancreatic cell, or cardiac cell

For about 30 odd years stem cells have provided a vast field of research in adult tissue, in
embryonic tissue and in in vitro cultures of embryonic stem cells of experimental animals

7.2 What is a Stem Cell’s Potency?

A stem cell’s ‘Potency’ refers to its capacity for differentiation, that is, for developing into
particular kinds of human cells, e.g., liver, kidney, blood, etc.

Different types of stem cells have different scopes to their potency:

e.g., Totipotent, Pluripotent, Multipotent or Unipotent

A totipotent cell is capable of differentiating into every tissue in the human body, including
extra-embryonic support tissues necessary for human gestation
e.g., Placenta
Umbilical cord
Amniotic sac

A single-celled embryo, also called a zygote, possesses the capacity of totipotency

Also, the individual cells of an embryo’s body, called blastomeres, in the first few days of the
embryo’s life are totipotent
If a blastomere splits off from the embryo’s body, it has the capacity for complete human
development, which is how we get identical twins

A pluripotent cell is capable of differentiating into almost all the tissues of the human body, but
not the extra-embryonic support tissues
Embryonic stem cells are pluripotent
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Stem cells can also be multipotent capable of differentiating into the cells of a cell group type,
e.g., blood cells

Stem cells can also be unipotent unable to differentiate into any other cell type than itself

7.3 Differences between Embryonic and Adult Stem Cells

Embryonic Stem Cells (ESCs) are undifferentiated, self-renewing, pluripotent cells

They are harvested from the bodies of embryos at approximately day 5 of human development

At day 5 the embryo’s body takes the shape of a hollow sphere

The embryo at this time is called a ‘Blastocyst’

The blastocyst has an outer cell layer and an inner cell mass
(Picture a basketball with a small group of marbles clumped together on the inside)

The cells of the inner cell mass will eventually differentiate into the varied tissues of the person’s
body
The outer cell layer will develop into the placenta and other support tissues
But it is important to understand that at this point, both the outer cell layer and inner cell mass
constitute the embryo’s body

The inner cell mass can be understood to be the embryo’s internal organs
These cells are what we call embryonic stem cells and have the capacity of pluripotency
They are coveted by ESC researchers precisely because of their pluripotency
Just as harvesting all the internal organs of an adult would kill the adult, harvesting the stem cells
of an embryo kills the embryo

Today, the preparation of human embryonic stem cells implies the following:
1) The production of human embryos and/or the use of the surplus embryos resulting from
in vitro fertilization or of frozen embryos
2) The development of these embryos to the stage of initial blastocysts
3) The isolation of the embryoblast or inner cell mass (ICM) - which implies the
destruction of the embryo
4) Culturing these cells on a feeder layer of irradiated mouse embryonic fibroblasts in a
suitable medium, where they can multiply and coalesce to form colonies
5) Repeated sub-culturing of these colonies, which lead to the formation of cell lines
capable of multiplying indefinitely while preserving the characteristics of ES cells for
months and years
 97

These ES cells, however, are only the point of departure for the preparation of differentiated
cell lines, that is, of cells with the characteristics proper of the various tissues
 Muscle
 Neural
 Epithelial
 Haematic
 Germinal, etc.

Methods for obtaining them are still being studied

But the injection of human ES cells into experimental animals (mice) or their culture in vitro in
controlled environments to their confluence have shown that they are able to produce
differentiated cells which, in a normal development, would derive from the 3 different
embryonic tissue layers:
 Endoderm (intestinal epithelium)
 Mesoderm (cartilage, bone, smooth and striated muscle)
 Ectoderm (neural epithelium, squamous epithelium)

Adult Stem Cells (ASCs) also have the capacities of self-proliferation and differentiation,
But are not derived from the bodies of embryos
They are ‘adult’ not because they’re found only in adults, but because the tissue in which they’re
found is differentiated tissue (as opposed to the undifferentiated tissue of an embryo’s body)

From studies on Adult Stem Cells (ASC) in the last 30 years it had been clearly shown that many
adult tissues contain stem cells, but stem cells capable of producing only cells proper to a given
tissue
That is, it was not thought that these cells could be reprogrammed

In more recent years, however, Pluripotent Stem Cells were also discovered in various human
tissues –
 In bone marrow (HSCs)
 In the brain (NSCs)
 In the mesenchyme (MSCs) of various organs
 In umbilical cord blood (P/CB, placental/cord blood)

These are cells capable of producing different types of cells, mostly blood cells, muscle cells and
neural cells
It was learnt how to recognize them, select them, maintain them in development, and induce
them to form different types of mature cells by means of growth factors and other regulating
proteins

Indeed noteworthy progress has already been made in the experimental field, applying the most
advanced methods of Genetic Engineering and Molecular Biology in analyzing the genetic
program at work in stem cells, and in importing the desired genes into stem cells or progenitor
cells which, when implanted, are able to restore specific functions to damaged tissue
 98

It is sufficient to mention, on the basis of the reported references, that in human beings the stem
cells of bone marrow, from which the different lines of blood cells are formed, have as their
marker the molecule CD34; and that, when purified, these cells are able to restore entirely the
normal blood count in patients who receive ablative doses of radiation and chemotherapy, and
this with a speed which is in proportion to the quantity of cells used

Furthermore, there are already indications on how to guide the development of neural stem cells
(NSCs) through the use of various proteins - among them neuroregulin and bone morphogenetic
protein 2 (BMP2) - which can direct NSCs to become neurons or glia (myelin-producing neural
support cells) or even smooth muscle tissue

The progress and results obtained in the field of Adult Stem Cells (ASC) show not only their
great plasticity but also their many possible uses, in all likelihood no different from those of
embryonic stem cells, since plasticity depends in large part upon genetic information, which can
be reprogrammed

Obviously, it is not yet possible to compare the therapeutic results obtained and obtainable using
Embryonic Stem Cells and Adult Stem Cells
For the latter, various pharmaceutical firms are already conducting clinical experiments which
are showing success and raising genuine hopes for the not too distant future

With Embryonic Stem Cells, even if various experimental approaches prove positive, their
application in the clinical field - owing precisely to the serious ethical and legal problems which
arise - needs to be seriously reconsidered and requires a great sense of responsibility before the
dignity of every human being

7.4 Ethical Controversy Surrounding Stem Cell Research

Every reasonable person agrees that the clinical end being sought in stem cell research is
praiseworthy - namely, finding clinical solutions for remedying serious illnesses

Controversy surrounds the ‘Means’ by which that end is pursued

The familiar ethical question raised by ESC research is this:
Is it justifiable to kill human embryos in order to explore potentially healing remedies for other
persons?

Those who judge human embryos to be human beings, albeit at an early stage of development,
think it’s wrong
Those who believe embryos are ‘Pre-Human’ entities, developmental precursors to whole human
beings, think it sometimes can be justified
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ASC research avoids this ethical problem by avoiding research on embryos altogether
The ethical questions surrounding ASC research then are similar to those involved with all
research on human subjects:
 Do the benefits promised by the research outweigh the burdens imposed by it for the
human subjects of the research?
 Is fully informed consent being secured?
 Is truthfulness in reporting of data being maintained?
 Are unwarranted promises of benefit being eschewed?

If the answer to these is yes, then one may proceed with confidence that the research is
legitimate
In fact, the magisterial teachings have consistently supported research on stem cells that does not
exploit or destroy human embryos

This support is reaffirmed in the document of the Congregation for the Doctrine of the Faith On
Certain Bioethical Questions, Dignitas Personae, 8 September 2008
Basing itself on the principles of Donum Vitae, this document deals with some of the newer
issues that modern stem cell research throws up

We will look at some of them below:

1. The Therapeutic Use of Stem Cells

With regard to the ethical evaluation of the therapeutic use of stem cells, it is necessary to
consider the methods of obtaining stem cells as well as the risks connected with their clinical and
experimental use

In these methods, the origin of the stem cells must be taken into consideration 
Methods which do not cause serious harm to the subject from whom the stem cells are taken are
to be considered licit
This is generally the case when tissues are taken from:
 An adult organism
 The blood of the umbilical cord at the time of birth
 Foetuses who have died of natural causes

The obtaining of stem cells from a living human embryo, on the other hand, invariably causes
the death of the embryo and is consequently gravely illicit (Pope Benedict XVI):
Research, in such cases, irrespective of efficacious therapeutic results, is not truly at the
service of humanity. In fact, this research advances through the suppression of human
lives that are equal in dignity to the lives of other human individuals and to the lives of
the researchers themselves. History itself has condemned such a science in the past and
will condemn it in the future, not only because it lacks the light of God but also because it
lacks humanity
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The use of embryonic stem cells or differentiated cells derived from them - even when these are
provided by other researchers through the destruction of embryos or when such cells are
commercially available - presents serious problems from the standpoint of ‘Cooperation in evil
and scandal’

There are no moral objections to the clinical use of stem cells that have been obtained licitly
However, the common criteria of medical ethics need to be respected 
Such use should be characterized by scientific rigor and prudence, by reducing to the bare
minimum any risks to the patient and by facilitating the interchange of information among
clinicians and full disclosure to the public at large

Research initiatives involving the use of adult stem cells should be encouraged and supported,
since they do not present any ethical problems (Pope Benedict XVI)

The Use of Human ‘Biological Material’ of Illicit Origin

In the light of what has been said above it is absolutely immoral to produce cell lines for the sake
of research which involve risk or destruction to embryos
This is equivalent to abortion

Even if one has not participated in the production of such illicit cell lines, it would be immoral to
use these cell lines for research or production of vaccines, etc., because there would be
cooperation in the evil action of others besides the danger of causing scandal to others

Some justify use of illicit cell lines available freely in the market for the purpose of research by
using the ‘Criterion of Independence’
According to this criterion, the use of ‘Biological Material’ of illicit origin would be ethically
permissible provided there is a clear separation between those who, on the one hand, produce,
freeze and cause the death of embryos and, on the other, the researchers involved in scientific
experimentation 

The criterion of independence is not sufficient to avoid a contradiction in the attitude of the
person who says that he does not approve of the injustice perpetrated by others, but at the same
time accepts for his own work the ‘Biological Material’ which the others have obtained by
means of that injustice

When the illicit action is endorsed by the laws which regulate healthcare and scientific research,
it is necessary to distance oneself from the evil aspects of that system in order not to give the
impression of a certain toleration or tacit acceptance of actions which are gravely unjust
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Any appearance of acceptance would in fact contribute to the growing indifference to, if not the
approval of, such actions in certain medical and political circles
One has a duty to stand up against anything that violates human life and dignity

Nevertheless if a child were to be in serious danger of illness and the only remedy available is a
vaccine developed from an illicit cell line, there would be proportionate reason for the parents to
use that vaccine
But the parents also have a duty to demand that they be provided with vaccines which are from
licit sources

Attempts at Hybridization

Recently animal oocytes have been used for reprogramming the nuclei of human somatic cells -
this is generally called ‘Hybrid Cloning’ - in order to extract embryonic stem cells from the
resulting embryos without having to use human oocytes

From the ethical standpoint, such procedures represent an offence against the dignity of human
beings on account of the admixture of human and animal genetic elements capable of disrupting
the specific identity of man 

The possible use of the stem cells, taken from these embryos, may also involve additional health
risks, as yet unknown, due to the presence of animal genetic material in their cytoplasm
To consciously expose a human being to such risks is morally and ethically unacceptable
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Chapter Eight
MORALITY OF GENE THERAPY

8.1 What are Genes?

On the head of each spermatozoon, there is a one meter length of DNA (Deoxyribonucleic Acid),
cut in 23 pieces
Each segment is very precisely coiled to form a thread-like structure which are called
‘Chromosomes’

Likewise the ovum of a woman contains 23 chromosomes

As soon as a sperm penetrates an ovum in the process of fertilization the ‘Zona Pellucida’ - the
bio-bag which covers the ovum becomes impenetrable to another spermatozoon
The fertilized ovum now contains 23 paternal and 23 maternal chromosomes and has the total
information necessary and sufficient to dictate the genetic makeup of the new human being

Thus, all cells of the human body - except the spermatozoon and ovum - in their nucleus contain
23 pairs of chromosomes
One chromosome of each pair is from the father and the other from the mother
Of the 23 pairs, 22 pairs are known as ‘Autosomes’ or ‘Ordinary Chromosomes’ which are same
in males and females

The 23rd pair is a ‘Sex Chromosome’, known also as ‘Gonosome’, and it differs in male and
female
It is XY in the male XX in the female

The chromosomes consist of tightly coiled strands of DNA which when opened uncoil in the
form of a spiralled ladder
The ladder’s 2 beams are made up of strings of Phosphorous Acid (P) and Sugar Molecules (S)
which follow each other alternately

The rungs of the ladder are connected to the Sugar Molecules

The rungs or base pairs consist of molecules of 2 sets of organic substances
One set represented by A (for adenine) and T (for thymine) and the other set represented by G
(for guanine) and C (for Cytosine)

A and T always go together to form a rung or base pairs

Likewise G and C
A and G or C, or T and G or C never form a rung or base pairs of the genetic ladder
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3 rungs or base pairs can contain a gene that codes a protein (composed of amino acids)
An average gene consists of 3000 bases but some genes consist of over 2 million bases
There are about 3 billion base pairs in the DNA in all the 46 chromosomes in a human cell

The whole collection of base pairs in the entire stretch of DNA cut up into 46 chromosomes is
called the ‘Human Genome’
Base pairs in vast stretches of DNA do not code proteins and they are called ‘Junk DNA’ and
they form barrier between bases between genes, i.e., sequence of bases which code proteins

The base pairs in the human genome of 2 individuals are 99.9% identical
Nevertheless, there are about 3 million base-pair differences between 2 individuals

There are about 25000 genes distributed in the 46 chromosomes

Some chromosomes contain more genes others less
For example, the chromosome numbered 1 as scientists contains 2968 genes whereas the Y
chromosome contains only 231 genes

8.2 Morality of Gene Therapy

Gene therapy commonly refers to techniques of genetic engineering applied to human beings for
therapeutic purposes, that is to say, with the aim of curing genetically based diseases, although
recently gene therapy has been attempted for diseases which are not inherited, for cancer in
particular

In theory, it is possible to use gene therapy on 2 levels:

i) Somatic cell gene therapy
ii) Germ line cell therapy
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Somatic Cell Gene Therapy seeks to eliminate or reduce genetic defects on the level of somatic
cells, that is, cells other than the reproductive cells, but which make up the tissue and organs of
the body 
It involves procedures aimed at certain individual cells with effects that are limited to a single
person

Germ Line Cell Therapy aims at correcting genetic defects present in germ line cells with the
purpose of transmitting the therapeutic effects to the offspring of the individual 
Such methods of gene therapy, whether somatic or germ line cell therapy, can be undertaken on
a foetus before his or her birth as gene therapy in the uterus or after birth on a child or adult

For a moral evaluation the following distinctions need to be kept in mind:

Procedures used on somatic cells for strictly therapeutic purposes are in principle morally licit 
Such actions seek to restore the normal genetic configuration of the patient or to counter damage
caused by genetic anomalies or those related to other diseases 

Given that gene therapy can involve significant risks for the patient, the ethical principle must be
observed according to which, in order to proceed to a therapeutic intervention, it is necessary to
establish beforehand that the person being treated will not be exposed to risks to his health or
physical integrity which are excessive or disproportionate to the gravity of the disease for which
a cure is sought
The informed consent of the patient or his legitimate representative is also required

The moral evaluation of germ line cell therapy is different

Whatever genetic modifications are effected on the germ cells of a person will be transmitted to
any potential offspring
Because the risks connected to any genetic manipulation are considerable and as yet not fully
controllable, in the present state of research, it is not morally permissible to act in a way that may
cause possible harm to the resulting progeny 

In the case of gene therapy on the embryo, it needs to be added that this only takes place in the
context of in vitro fertilization and thus runs up against all the ethical objections to such
procedures 
For these reasons, therefore, it must be stated that, in its current state, germ line cell therapy in
all its forms is morally illicit

As far genetic engineering for eugenic reasons, i.e., not for medical treatment but for bettering
the gene pool, the following must be said:
Some of these proposals exhibit a certain dissatisfaction or even rejection of the value of the
human being as a finite creature and person
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Apart from technical difficulties and the real and potential risks involved, such manipulation
would promote a eugenic mentality and would lead to indirect social stigma with regard to
people who lack certain qualities, while privileging qualities that happen to be appreciated by a
certain culture or society

Such qualities do not constitute what is specifically human 

This would be in contrast with the fundamental truth of the equality of all human beings which is
expressed in the principle of justice, the violation of which, in the long run, would harm peaceful
coexistence among individuals
 

Furthermore, one wonders who would be able to establish which modifications were to be held
as positive and which not, or what limits should be placed on individual requests for
improvement since it would be materially impossible to fulfil the wishes of every single person 

Any conceivable response to these questions would, however, derive from arbitrary and
questionable criteria
All of this leads to the conclusion that the prospect of such an intervention would end sooner or
later by harming the common good, by favouring the will of some over the freedom of others

Finally it must also be noted that in the attempt to create a ‘New Type of Human Being’ one
can recognize an ideological element in which man tries to take the place of his Creator

In conclusion we observe that the Church sees her moral stance in this area as a stance of
defence for the defenceless

In the past when industrialization brought progress to humanity, Church stood for the rights of
the workers who were the weakest section of the then society
Now human society’s progress takes place through advances in information technology, research
in genetics, medicine and biotechnology

Here too some sections of humanity get adversely affected

The Church seeks to take up the cause of these weakest sections of humanity and stand for their
dignity and rights
Church’s moral stance in these areas of progress has to be seen in this light