Principle of Totality and its Relevance in Bioethics


1.1.3.2 The Moral Society and the Principle of Totality

We can see in the teachings of Pius XII the second dimension of the principle of totality as its moral whole (society). He speaks of the essential difference between the individual (physical organism) and the society (moral organism) and also the "essential qualitative difference" that exists between the relationship of parts to the individual and relationship of members to the society.87 So the moral totality is mainly analysed by Pius XII through 1) the physical being and parts of society, 2) the well-being of the whole, 3) rights of the society and the principle of the totality.

1) The Physical Being and Parts of Society: Pius XII does not clarify the substantial nature of being in the society. However, he says that a physical being could not be "claimed for society."88 He describes at the International Congress on the Histopathology of the Nervous System (September 13, 1952): "The community, considered as a whole, is not a physical unity which subsists in itself. Its individual members are not integrating parts of it." But the physical organism of living beings has a unity in itself.89 Likewise, he says in the Sixteenth Session of the International Office for the Documentation of Military Medicine on October 19, 1953: "The political community is not a physical being as is an organic body, but a whole which possesses only a unity of purpose and action. Man does not exist for the State but the State for man."90 He repeats these ideas in the Eighth Assembly of the World Health Association, September 30, 1954, to the Promoting Committee of the Italian Association of Corneal Donors, May 14, 1956, and in the radio message to the Seventh International Congress of Catholic Doctors, September 11, 1956.91

Another argument is that "the moral whole does not embrace the physical being of the persons who compose it." This indicates that individual parts in a community have their own "individual existence," which is different from the "whole of the society."92 Pius XII argues that a society has no physical nature. But, he favours its moral nature as a totality such as "its unity of finality and action, and its functional nature."93 So society can make a request to human beings for its finality. However, it may not hinder the existence of the individuals.

2) The Well-being of the Whole: Speaking about the good of the whole with regard to the community, Pius XII states: "The community is the great medium ordained by nature and by God to regulate the exchanges by which mutual needs are met, to help each one to develop his personality according to his individual social capacity."94 The aim of community is for individuals to help each other so that each one in society may achieve the integral development of his/her personality. For instance, in the Christmas Message on December 24, 1942 he stated: In the social organization, "particular societies" and persons occupy an exalted position. And the ultimate end of all the activities of the state is the fulfilment of the "common good."95 The common good includes the development of the human person.96 As a whole, the common good is always achieved by serving the personal good of the members of society.97 This does not allow the misuse of persons for the common good of the society.

3) Rights of the Society and the Principle of Totality: There is a difference between the rights of the society and of the individual. Regarding this difference, Pius XII writes: "Quite different is the case with society, which is not a physical being, but a simple community of purpose and action. In virtue of this it can demand of those who make it up and who are called its members, all those services essential for the true common good."98 It is also said that Pius XII was interested in protecting the individual against the actual and potential abuses of State totalitarianism. For instance, in the Roman Guild of St. Luke, he explains the distinction between the physical entity and the moral entity.99 The principle of totality applies to the physical entity and not to the moral entity. For him, the moral whole (society) is the second object in the principle of totality. No type of substantial or physical being may be claimed for the society.100 It is also interesting to note the historical context in which Pius XII wrote about the principle of totality. For instance, the Nazi regime in Germany abused the rights of the individuals. Here, human beings were used by the State in their very being.101 By the power of the police and other physical force, many were forcefully sterilized against their will. Pius XII was deeply aware of these problems. Hence, he excludes all legal basis of a State to dispose directly of human beings.102

Pius XII does not favour the application of the principle of totality to society.103 However, he is clearly convinced about some positive aspects in the use of the principle of totality for the betterment of society. In his address to the Promoting Committee of the Italian Association of Corneal Donors, May 14, 1956 he says: "[Society] constitutes a whole only in regard to act and finality; individuals, insofar as they are members of this organism, are only functional parts. The "whole" can make demands on them only in what pertains to the order of action."104 There is a difference between the right of the society and the right of human persons. According to Pius XII, each person is "both anterior to society in his origin and superior to it in his destiny."105 A human person has the right to protect his/her life from serious danger. This right is from the Creator. The totality of the society cannot destroy or even stop the rights of the human person.106 As a whole, the State can resort to the principle of totality when it is needed for the common good. It cannot make beyond this limit. The society has no direct right to take away human person for the common good.107

The teaching of Pius XII on the principle of totality, according to Martin Nolan, is primarily centred around the physical whole. However the physical whole has two dimensions, viz., its relation to "social totality" and as an "ordered totality" itself. All his teachings on the principle of totality given to doctors and their professional associates mainly focused on society and medicine, and the individual and medicine.108 Finally, we can say that Pius XII draws his conclusion for the principle from a philosophical and theological point of view "on the essence of notions and things."109 Thus, G. Kelly concludes that the teaching on the principle of totality, by Pius XII, should be seen in the light of the philosophical trends he was attacking. It may be unscholarly and even opposite to the Pope's own intentions if someone makes generalisations about the Pope's particular statements without considering the historical context which prompted him to make such statements.110

1.2 Different Views of the Principle of Totality

Theologians interpret principle of totality from different perspective. The main types of the interpretations include physicalist and integrated concept of the principle of totality.

1.2.1 The Physicalist Concept of the Principle of Totality

In the history of moral theology, one can see the concept of physicalism and ecclesiastical positivism. Physicalism means:

the modality of application of theological principles whereby the emphasis is placed on the physical finis operis, objectum, or actual physical properties, motions, and goals of the action under consideration. Within a static natural law understanding of human nature, the ethical judgements arrived at are considered to be universally applicable to all situations involving the same physical act.111

The history of Roman Catholic medical ethics discloses a gradual shift of emphasis from physicalism to ecclesiastical positivism (from about 1940 to 1960). One cannot find a definite dividing line between the time of the development of physicalism and its approval by ecclesiastical authorities in medical ethics.112 Ecclesiastical positivism is defined as a "specific kind of theological voluntarism or metaethical supernatural absolutism."113 The main point is that the divine will is presented by the revelation that is given through the interpretations and pronouncements of the Catholic Church. Hence, the rightness and the wrongness of the action is judged by the authority of the Church. As a whole, we can say that ecclesiastical positivism acted on the basis of an authoritative defence of physicalistic criteria and on the conclusions reached in accordance with it.114 Thus, the principle of totality is used only for the justification of the physical good of the person.

The physicalist concept of the principle of totality can be seen in the teachings of several moral theologians. For instance, Austin O'Malley observes that "a direct mutilation may be permitted when it is for the physical good of the patient's own body, but not for any other reason,"115 otherwise it is de-ordination. It is against the authority of God. Hence, for him, "direct mutilation is not permissible to effect immediately a spiritual good, or the good of the soul."116 Similarly, P. Finney,117 D. Prümmer,118 H. Merkelbach,119 H. Noldin,120 A. Tranquerey,121 H. Davis,122 S. A. La Rochelle and C. T. Fink,123 C. McFadden,124 J. Kenny,125 J. Paquin,126 E. Healy,127 N. Lohkamp,128 L. Bender,129 and P. Palazzini130 held more or less the same idea.

Furthermore, concept of the principle of totality can be seen in the teachings of Paul VI in Humanae Vitae (July 25, 1965). The main aim of the encyclical is the regulation of birth. Our purpose is only to show the understanding of the principle of totality in Humanae Vitae. We see that sections 3, 14, 15 (footnote 19) and 17 of Humanae Vitae deal with the principle of totality.131 Joseph Selling analyses the principle of totality as expressed in Humanae Vitae. The principle of totality can be seen from three perspectives, viz., arguments A, B, and C. Argument A refers to the traditional understanding of the principle of totality which is used by Pius XII: When one part of the organ is diseased, it can be removed for the good of the whole. This argument concerns only the sick organs and not the healthy organs. For instance, it cannot be applied to the cases of "direct sterilization" in which healthy sex organs are involved "or pregnancy (even if related complications may threaten the health of the mother)."132 Argument B is not based purely on the principle of totality. The reason is that "it deals neither with the health of the organism nor with the specific physical acts. Rather, this is the reasoning outlined above as found in the Commission's report that applied a principle (intrinsic orientation of sexuality to procreation) to the totality of marriage."133 Argument C states that the principle of totality should be understood on the basis of the spiritual, psychological, social, and physical perspectives of the human person.134

Another understanding of the principle of totality is that "which does not relate to any principle as such but seems to be a restatement of the 'indissoluble connection' idea."135 More clearly, applying this argument to the "act of coitus" we may say that, intercourse is an act of totality in itself. Any interference, like contraception, deprives this act of coitus of its totality and hinders it from realizing its ends, especially "the expression of love."136 Selling says that this is another argument for justifying the conclusions of Humanae Vitae.137 He evaluates arguments A, B and C in Humanae Vitae as follows:

the encyclical names [argument] B (Humanae Vitae, 3) and rejects it (Humanae Vitae, 14) while restating A to be the only valid use of the principle of totality (Humanae Vitae, 17; it is also invoked in n. 19 to para. 15 on therapeutic means). It is unfortunate that it did not deal directly with argument C, but it would seem safe to assume that this, too, would be rejected because "an evil cannot be used to bring about a good" (Humanae Vitae, 14), and because the appeal to artificially ordering conception for the sake of higher values is also precluded (Humanae Vitae, 16).138

Janet E. Smith also observes that the footnote reference of Humanae Vitae no. 17139 mentions the principle by which somebody can formulate an argument against the use of the principle of totality to justify contraception.140 He writes that "those who dissent from Humanae Vitae on the basis of the principle of totality have in fact no basis for dissent...The principle of totality cannot ground the claim that singular acts which, taken as such are offensive, cease to be so when considered in the light of the moral life taken as a whole. The moral imperative is not that we should act well more often than not. Rather it is: Do good and avoid evil."141 Paul VI uses Pius XII's interpretation of the principle of totality.142 It is interesting to note that Pius XII uses the principle of totality for removal of an organ that is harmful for the healthy organs. Many authors argue that Pius XII did not condemn living organ donation, though he could have done so on several occasions. Likewise, the traditional understanding of the composition of the principle of totality makes a good deal of progress. For instance, mutilation is prohibited except in case of genuine necessity.

Louis Janssens comments on the principle of totality as given in Humanae Vitae. According to him, "... if the principle of totality imposes some limits on our rights over our body, it does not define "insurmountable limits (Humanae Vitae 17)."143 For example, living organ donation is morally justified on the basis of charity if the organ donation does not prevent the organic function of the donor. The principle of totality became an absolute principle in Humanae Vitae. Louis Janssens notes that the relational reality will overcome the biological principle of totality.144

In short, we argue that Humanae Vitae does not mention living organ donation and transplantation, it gives stress to the concept of the principle of totality in the context of sterilization and contraception. From these perspectives, we will debate the integrated approach of the principle of totality in the next section.

1.2.2 An Integrated Concept of the Principle of Totality

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.

1.3 Relevance in Bioethics

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

Conclusion

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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