Theologians argue that "good of the whole" means not only the good of the physical organism, but also the good of the whole person.145 A. M. Hamelin observes that "it is not the principle of totality in itself that licenses these acts in which the individual exercise his rights over his body. It is only a criterion assuring man's prudent usage of the goods entrusted to him by the Creator. Human goods, let us not forget, are made for man's use; man himself is created for God."146 Here, the bodily organs (diseased or not) and the total good of the person in question are taken into consideration.147 We can find the relation between common good and the principle of totality. For instance, Thomas Aquinas mentions as "a particular good is ordered to the common good as to an end; indeed, the being of a part depends on the being of the whole. So, also, the good of a nation is more godlike than the good of one man."148 In this section, we present mainly the arguments of A. Vermeersch, Bert Cunningham, Gerald Kelly, and, briefly, the views of other scholars who have taken the integrated approach on the principle of totality to justify mutilation.
A. Vermeersch is the first moral theologian to justify mutilation in the case of skin-graft and blood transfusion on the basis of unity of human nature. He argues: "Must there not be admitted some ordination of our members to the body of the neighbor?"149 This points out an integrated concept of the principle of totality, which includes both the spiritual and the physical concept to justify mutilation. This type of argumentation can be seen in the writings of many moral theologians.
Again, Bert Cunningham rejects explicitly the physicalist approach in Catholic medical ethics in his dissertation on the Morality of Organic Transplantation.150 He has done this in presenting his judgement concerning the question of organ transplantation.151 Cunningham quotes a number of Fathers and theologians on the question of God's dominion over life. He analyses the view of Thomas Aquinas (Summa Theologica, Secunda Secundae, q. 65, a.1) on shaping of the principle of totality.152 With a physicalistically limited principle of totality, one would argue, "man does not have absolute dominion over his body."153 Here mutilation is permitted only for the physical good of the body. But Cunningham makes a change in these restrictions in the case of organ transplants. He observes that "direct mutilations are indeed licit according to the principle of totality, if this principle is extended to include not only the particular physical body from which the organ is removed, but the entire Mystical Body of Christ."154 Cunningham uses this type of concept of the principle of totality here.
Gerald Kelly holds that the principle of totality itself must be limited to the good of the individual physical organism.155 According to him, the principle of totality has a physicalist limitation. He strongly argues that the principle of totality can be used in the case of the subordination of part to the whole. Since each person is different and society is for the individual, there is no such type of subordination between human beings or between persons and society.156 Hence, for G. Kelly, "no mutilation for the good of the neighbour, even a minor mutilation, can be justified by the principle of totality."157 Though G. Kelly interprets the principle of totality in the strict sense, he allows mutilation especially in the case of organ donation and transplantation on the ground of charity.158 This may be considered as an integrated concept of the principle of totality.
We argue that principle of totality is relevant in many bioethical issues. However, there are theologians who criticises the relevance of the principle of totality in bioethical issues. They have seen it from the physicalist perspective. This happened because of the one-sided understanding of the principle. Principle of totality is an adequate principle in Catholic bioethics. For instance, Pius XII points out a harmonious relation between the physical element and the spiritual element in the principle of totality, which reveals the good of the whole person.159 He says that society cannot use individual for evil purposes. He also makes the difference between physical entity and the moral entity. In his opinion, principle of totality can be applied to the physical entity. This type of interpretation expresses the unjust discrimination.
Theologians have seen the principle of totality in relation with functional integrity. McFadden made a significant division between functional integrity and anatomical integrity.160 B. M. Ashley & K. D. O'Rourke present their own formulation of the principle of totality and call it the principle of 'Totality and Integrity.' It reads as follows: "Except to save life itself, the fundamental functional capacities which constitute the human person should not be destroyed, but preserved, developed, and used for the good of the whole person and of the community." On the one side this principle grants priority for some human values over others. On the other side, it breaks the "fundamental integrity" of human person for certain kind of worth, "except in the most extreme choice between life and death."161
Organ donation and transplantation is the best example of principle of totality which explains its use in bioethical issues. Principle of totality justifies living organ donation and transplantation. For Benedict M. Ashley and Kevin D. O'Rourke, organ transplants are justified when the functional integrity of the donor is maintained.162 They give a summary of moral teaching of the theologians on living organ donation and they present certain principles for living organ donation and transplantation:163 1) There should be a serious need faced by the patient, which can only be satisfied by organ donation. 2) Even if donation reduces "anatomical integrity, it should not diminish the "functional integrity" of the person. 3) The risk in donation as "an act of charity is [to be] proportionate to the good resulting for the recipient."164 4) There should be "free and informed consent" by the donor.165 All these norms can be seen in the principle of totality.
The 1975 Ethical and Religious Directives for Catholic Health Care Facilities states that "[t]he transplantation of organs from living donors is morally permissible when the anticipated benefit to the recipient is proportionate to the harm done to the donor." The Directives also mention that the donations of organ do not reduce the "functional integrity" of one's body.166 Moreover, the 1994 Directives, section no. 30 directly deals with living organ donation and transplantation. It reads as follows:
The transplantation of organs from living donors is morally permissible when such a donation will not sacrifice or seriously impair any essential bodily function and the anticipated benefit to the recipient is proportionate to the harm done to the donor. Furthermore, the freedom of prospective donor must be respected, and economic advantage should not accrue to the donor.167
Principle of totality defends basic human values. Our assessment in this article shows that the historical root of the principle of totality is based on the sanctity of life concept. It always protects human life from the beginning to the end. It is against, murder, killing, harm to the people. This is very clear from the application of the principle of totality which depends on the whole and its parts. Many moral theologians argue for the justification of mutilation by the principle of totality on the basis of the well-being of the body. Parts are destined for the whole means; the diseased part can be removed for the well-being of the body.
Moreover, principle of totality promotes the virtue of charity. This is also obvious from the case of organ donation and transplantation. According to Torraco Stephen, whenever the Magisterium speaks of organ donation it simply speaks about charity as the motivating force behind it. Until Veritatis Splendour, the Magisterium has not dealt with the specific act of mutilation involved in organ donation apart from its intention and circumstances. And even in VS, there are only passing remarks.168 The morality of major mutilation is justified in terms of charity, and the supernatural virtue of charity transcends the natural principle of totality.169 The point of Torraco Stephen is that "there is an aspect of organ donation that can be extremely helpful in gaining a deeper appreciation of the meaning of the intrinsically evil."170 John Paul II justifies organ donation and transplantation based on charity in general. In the address on blood and organ donations of August 1984, John Paul II commended the National Association of Italian volunteer blood and organ donors for their spirit and initiative. He urged them "to promote and encourage such a noble and meritorious act as donating your own blood or an organ to those of your brothers and sisters who have need of it."171 The donation of blood and organs is a sign of generous inspiration of the heart. It is, at the same time, human and Christian solidarity. This means the love of neighbour, which is rooted in the Gospel message of the new commandment, namely, love one another (John 13: 34).172 In addition, in an address to a Congress on Renal Illness and Transplants (April 30, 1990), he speaks about the Church's main concern for renal illness and donations. The Pope asks the directors of Catholic institutions to encourage this generous act of organ donations: "Those who believe in our Lord Jesus Christ, who gave his life for the salvation of all, should recognize in the urgent need for a ready availability of organs for renal transplants a challenge to their generosity and fraternal love."173 Further, in his address to the participants of the first International Congress of the Society Organ Sharing (June 20, 1992), the Pope considered organ transplantation as a new way of serving the human family.174 In organ transplantation man/woman has found a way to give himself/herself, in blood and body. This gesture allows others to continue to live.175 This gift is actually an authentic form of human and Christian solidarity.176 Similarly, John Paul II writes in Evangelium Vitae no. 86 that organ donation is an act of love when it is done in an ethical manner.177
The principle totality is against intrinsically evil act. This is very understandable from paid organ donation. Donation for the sake of money is an intrinsically evil act. The Boston-based Council for Responsible Genetics declared that "[t]he commercialization and expropriation of these life materials is a violation of the sanctity of human, animal, and plant life."178 It amounts to a decreased respect for life and the sanctity of the human body. R. C. Fox observes that commodification of the human body is the most serious argument against commerce.179 Organ donation becomes an intrinsically evil act when it leads to the reduction of a human person to a form of marketplace parts.180 In reference to blood donation, John Keown also notes that paid donation makes the human body a property.181 It regards the human body as property in which one does not find the subjective dimension of human person. Again, he argues that "the morally undesirable form of exploitation is the use of people for our own ends in ways that are detrimental to those people and/or that fail to respect their own autonomy."182 U. Fasting, J. Christian & S. Glending observe that there is a highly profitable black market trade in human organs. Even children have been kidnapped. Sometimes they will reappear later lacking one kidney. Other times they are killed to have all their transplantable organs removed for profit.183 Thus Church teaches that the principle of totality cannot be applied to paid organ donation.184
In this article we discussed the concept of the principle of totality from the philosophical and theological foundations, different views, and its relevance in bioethics. The roots of the principle of totality are extended through the writings of Aristotle and Aquinas. They explained the terms of the principle of totality such as part, whole, and their relationship. Thomas Aquinas justified mutilation by the principle of totality for the well-being of the whole body (Summa Theologiae IIa-IIae q.65, a 1). Moral theologians of the 17th, 18th, 19th and the first 40 years of the 20th century continued the same reasoning of Aquinas. Coming to the official teaching of the Church on the principle of totality, we can find application of the principle very briefly in Casti Connubii (no. 23) by Pius XI and in a wider perspective in the writings of Pius XII. Although moralists had incorporated the teachings of Aquinas on the subordination of the part to the whole, Pius XII made many official statements regarding the medico-moral application of the principle of totality.
Another discussion on the principle of totality that we focused on took into consideration its various interpretation by philosophers and theologians, and the teachings of the Church. There is the physicalist concept and the integrated understanding of the principle of the totality. In the physicalist understanding, direct mutilation is not justified outside the well-being of a patient's body. We noticed that this happens because of the one sided approach to the principle. Our analysis expresses that principle of totality can also be seen from the medical, physical, social, psychological, spiritual perspective. It prohibits any harm to the person, and at the same time protects human life. This points out its relevance in bioethical issues today.
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