Which Medical Ethics for the 21st Century? Cont'd

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B. The Moral Law

By contrast, the Church bases its ethical decisions on the moral law - and the moral law itself is composed of two basic laws - the natural law, or what we can know is right or wrong through the aid of reason alone, and Divine Law as interpreted (not made up) by the Magisterium.19

The natural law does not mean the "laws of Nature" or the "laws of the Cosmos" - as many New Age gnostic versions of natural law advance, nor does it refer to the "laws of society", but is grounded instead on the objective and objectively knowable nature of human beings. It is not something made up. Because it is based on our common humanity, natural law transends different cultures, times, ethnic backgrounds, etc. - and is therefore truly applicable to all people at all times - including the 21st century.

Here the common good is not defined as "the greatest good for the greatest number of people", but rather as those goods which all human beings, simply as human beings, have in common - e.g., food, water, shelter, clothing, friendship, etc. Maritain captures the stark difference between these two concepts of "the common good":

The end of society is the good of the community, of the social body. But if the good of the social body is not understood to be a common good of human persons, just as the social body itself is a whole of human person, this conception also would lead to other errors of a totalitarian type. The common good of the city is neither the mere collection of private goods, nor the proper good of a whole which … relates the parts to itself alone and sacrifices them to itself. It is the good human life of the multitude, of a multitude of persons; it is their communion in good living. It is therefore common to both the whole and the parts into which it flows back and which, in turn, must benefit from it. … It presupposes the persons and flows back upon them, and, in this sense, is achieved in them. … It is a fundamental thesis of Thomism that the person as such is a whole. The concept of part is opposed to that of person. To say, then, that society is a whole composed of persons is to say that society is a whole composed of wholes. …[I]f the person of itself requires "to be part of" society, or "to be a member of society", this in no wise means that it must be in society in the way in which a part is in a whole and treated in society as a part in a whole. On the contrary, the person, as person, requires to be treated as a whole in society.

As human beings we are always persons. "Personhood" is coextensive with human nature. By virtue of possessing intellect and will, we are "beings of a rational nature", or "rational animals" - and therefore by definition we are also persons simply by possessing this human naturenature20 - whether we happen to be exercising it or not. Nor is "person" the same as the common understanding of "personality".21

It is because we are persons who knowingly and willingly choose to perform certain actions that those actions are called "moral" or "immoral". Since our human natures always strive toward our human good or perfection - our "end" - we know empirically that those actions are morally right which lead us to our natural end, and those actions are morally wrong which lead us to harm instead, or go against the good of our human nature. For example, taking crack cocaine is wrong because it harms us, hurts us, prevents us from reaching our human ends or goods - not because God said so. A human act, then, derives its moral goodness from its conformity with human nature. And human nature cannot be changed (and still remain human).

The first ethical principle of the natural law, from which several other principles are drawn, is familiar to us all: "Do good and avoid evil".22 Natural law also includes three (not one) general norms against which we determine what is right or wrong: (1) the subjective norm - not just "conscience", but a well-formed conscience; (2) the objective proximate norm - right reason, a very rich understanding of reason which embraces the harmony, interrelationship and good within any single individual, as well as among individuals within a society. Here the "common goods" must flow back upon the backs of each and every member of that society, and the institutions are there to ensure that;23 and, (3) the ultimate norm - the Divine Nature itself, the ultimate measure of right and wrong, and of goodness. Of course, the Divine Nature is not the subject matter of natural law philosophical ethics, but of theology (which I will address in a moment).

In applying these general norms to concrete situations we decide what particular actions are right or wrong based on three (not one) conditions: the kind of action, the intention for doing the action; and the circumstances under which the action is done. All three conditions must be met for an action to be ethical; and although the intention and the circumstances are mostly determinative, there are some - not many, but some - kinds of actions that are absolutely morally right or wrong. For example, kinds of actions such as using human beings in research with the intention of helping to cure diseases is not inherently wrong, in fact it is laudable, as long as certain circumstances prevail, e.g., the person has given informed consent, and any harm sustained is proportionate to the medical good that can be derived. However, this does not mean that we can volunteer to mutilate or otherwise seriously harm ourselves. Nor does it mean that even early human embryos, who are scientifically human beings and therefore human persons, may be destroyed in order to help others in need.24 It is inherently wrong to intentionally kill an innocent human being - regardless of the intention, or the circumstances - or her size. Evil may not be done that good may come of it.25

Natural law theory may seem at first a bit complicated, but then life is complicated, isn't it? So shouldn't the theory reflect this reality? All in all, this is a very objective, realistic, interrelated, rich ethical theory - grounded on our very natures as human, and known deep in the heart of every human being.26 It is itself a part of the eternal law, which includes both the physical laws of nature and the moral law.

You might ask though, if the natural law is naturally known, why is it that so many people don't seem to know it, act against it, even deny it? This is a good question, and does indeed point to the limits of using just the natural law as a moral guide in the 21st century. Many people have lost their sense of the natural law within them by habitually acting against their true good, by seeking only things that feel good, or by succumbing to the myriad of temptations constantly surrounding us that seem good.

Can ethics, then, be built on man alone? If a human act derives its moral goodness from its conformity with human nature, from where does human nature get its goodness? To really answer these questions we need also look further at the other part of the moral law - the Divine Law, as interpreted by the Magisterium.

The Divine Law is essentially what we learn through Divine Revelation, as interpreted by the Magisterium - the Bible, the Word of God (not, by the way, to be equated with theological theories). We accept it on faith, and faith of course is a gift. It is roughly summarized for us in the 10 commandments - commandments which are definitely not emblematic of some dictatorship, but rather are there to help us, to guide our human actions toward an even higher good than natural ones - eternal life with God - our ultimate end or GOOD. It is from the Divine Goodness of the Nature of God Himself that the natural goodness of our own human nature is derived. And so it is this whole moral law, taken in its entirety, which grounds the Church's positions on the list of medical ethics issues I compared earlier.

C. The Choice

Now which of these ethical systems would you choose to guide you in considering the complicated ethical issues in the 21st century - many of which are already here? The choice is yours. Should we enter the 21st century embracing the relativistic and utilitarian bioethics of the National Commission - an ethics which in no way really reflects the consensus of the majority of human beings, an ethics which is artificial, not neutral, is theoretically indefensible and practically unworkable, and therefore already defunct? An ethics which absolutizes autonomy in the extreme, but where eventually even autonomy is rendered useless and absorbed into an absolute utilitarian ethics which abandons the good of the individual human being and eliminates any good of any minority?27 A theory where many human beings have less worth than a chicken or even a prawn - and so therefore they can be killed by "choice" or used as "biological materials" in research to further "the greater good" of perfect people?

Or will you choose an ethics which is objectively grounded on our very human natures, on what we know empirically is either harmful or good for us as human beings? One which defines the "common good" as those goods which we hold in common simply as human beings? A rich consistent ethics that is cognizant of and matches the complexities of daily living in the real world? One grounded on the immutable laws of man's nature but which is capable of being drawn to immeasurable heights by its perfection in the Divine Law, the Word of God?

D. The Individual Members of the John Carroll Society

It is indeed this moral law, I would suggest, which is embodied in the many good works of the John Carroll Society. How? Well, according to the moral law, among all other creatures, rational creatures (that's us!) are subject to and participate in Divine Providence in a more excellent way (if they so choose) insofar as they are provident- by trying to take care of, do good for, themselves and others:

… Now among all others, the rational creature is subject to divine providence in a more excellent way, in so far as it itself partakes of a share of providence, by being provident both for itself and for others.28 (emphasis mine)

And in a very special way you, the members of this Society, do precisely that. Through the kinds of actions such as sharing your gifts, your talents, your time and efforts, through your gifts of knowledge of medicine and law and all the other important professions, you have already produced enormous concrete good for our suffering and vulnerable brothers and sisters here in Washington. You have knowingly and willingly chosen to care for the sick, the troubled, the lonely, the forgotten, the abandoned, the disabled, the vulnerable. (We are all vulnerable, aren't we?).

By thus being provident for others you in fact do participate in the Divine Providence of God. Like Mother Teresa, your actions also help to fortify us all against our own deep dark unspoken fears of our earthly mortality, of the incontinence and dependency of aging, of the inevitable weakening of our bodies and our minds. In our vulnerable sisters and brothers we see ourselves, and we know that for the grace of God there go I! You have heard, "seen" through the light of understanding elevated by faith, and heeded the Word of God, instructing us that "As you did it to one of the least of these my brethren, you did it to Me."29 Somehow you understand that the reason why you do this is, your intentions, are ultimately because you love God - the ultimate reason for all of our actions. You know that there is more to life than this life!

E. Conclusion:

So which ethics will you choose to guide us through the turbulent 21st century before us - secular bioethics, or the moral law? The choice is yours - though it might be prudent to remember that it is not just that we have a choice. Of course we each have a choice, or there would be no ethics at all! The real issue is whether or not that choice is good or bad. A small error in the choice of an ethics will lead to multiple - indeed - massive harm and destruction in the 21st century - for ourselves, as well as for our culture and society.30 Choose well, my friends.


1.   Dr. Irving is Professor of Philosophy and Medical Ethics at The Pontifical Faculty, The Dominican House of Studies, Washington, D.C. She has also taught at the De Sales School of Theology, The Catholic University of America and Georgetown University. She is a former career-appointed bench research biochemist at the National Institutes of Health, Bethesda, MD. Her doctoral dissertation at Georgetown University was, A Philosophical and Scientific Analysis of the Nature of the Early Human Embryo (1991). She has written and lectured extensively on the ethics of human embryo research, human cloning, research with the mentally ill, abortion, natural law and "personhood". The second edition (1997) of her book, The Human Development Hoax: Time To Tell The Truth!, co-authored with human embryologist Dr. C. Ward Kischer, is distributed by the American Life League, Stafford, VA.[Back]

2.   National Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services (Washington, D.C.: United States Catholic Conference, Inc., 1995); these directives are supposed to be made known by Catholic health care institutions and followed by "the sponsors, trustees, administrators, chaplains, physicians, health care personnel, and patients or residents of these institutions and services.", p.2. See also The Pontifical Council for Pastoral Assistance, Charter For Health Care Workers (Boston: St. Paul Books and Media,1995).[Back]

3.   The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, U.S. Department of Health, Education and Welfare, The Belmont Report: Ethical Principles and Guidelines For The Protection of Human Subjects of Research (1979).[Back]

4.   See generally, Tom Beauchamp and James Childress, Principles of Biomedical Ethics (New York: Oxford University Press, 1979); Tom Beauchamp and LeRoy Walters (eds.), Contemporary Issues in Bioethics (Belmont, CA: Wadsworth Publishing Company, Inc., 1982).[Back]

5.   See Beauchamp and Childress, pp. 7-9; and, Beauchamp and Walters, pp.1-3.[Back]

6.   Mary Meehan's interview with Daniel Callahan, in "Eugenics: Still alive and well", National Catholic Register, August 8, 1993.[Back]

7.   Daniel Callahan, "Bioethics: Private choice and common good", Hastings Center Report (May-June 1994), Vol. 24, No. 3, p. 31.[Back]

8.   Edwin DuBose, Ronald Hamel and Laurence O'Connell (eds.), A Matter of Principles?: Ferment in U.S. Bioethics (Valley Forge, PA: Trinity Press International, 1994), p.1.[Back]

9.   Gilbert c. Meilaender, Body Soul, and Bioethics, (Notre Dame, IN: University of Notre Dame Press, 1995), p.x.[Back]

10.   Raanan Gillon (ed.), Principles of Health Care Ethics (New York: John Wiley & Sons, 1994).[Back]

11.   See Dianne N. Irving, "Scientific and philosophical expertise: An evaluation of the arguments on 'personhood'", Linacre Quarterly (1993), Vol. 60, pp. 18-47.[Back]

12.   E.g., to name but a few: United States Code of Federal Regulations: Protection of Human Subjects 45 CFR 46 (1981, revised 1983, reprinted 1989 - now incorporated into the Common Rule (Washington, D.C., DHHS); The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, 1983; National Institutes of Health: Report of the Human Fetal Transplant Research Panel (Washington, D.C.: NIH, Dec. 1988); NIH Guide for Grants and Contracts (Washington, DC.: NIH, 1990); NIH Revitalization Act, Public Law 103-43 (June 1993); Office for the Protection From Research Risks (OPRR), Protecting Human Research Subjects: Institutional Review Board Guidebook (Washington, D.C., NIH, 1993); NIH Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research, Federal Reg. 59 FR 14508 (Washington, D.C.: NIH, March 1994); NIH Outreach Notebook On the Inclusion of Women and Minorities in Biomedical and Behavioral Research (Washington, D.C.: NIH, 1994); National Institutes of Health: Report of the Human Embryo Research Panel (Washington, D.C.: NIH, Sept. 1994); CIOMS/WHO International Ethical Guidelines for Biomedical Research Involving Human Subjects (Geneva: CIOMS/WHO, 1993).[Back]

13.   See especially the first draft, Office of the Maryland Attorney General, J. Joseph Curran, Jr., Attorney General, and Jack Schwartz, Assistant Attorney General, Initial Report of the Attorney General's Research Working Group (October 1996), revised May 1997, June 1998.[Back]

14.   Peter Singer, "Taking life: Abortion," in Practical Ethics (London: Cambridge University Press, 1985), p. 118; see also, Helga Kuhse and Peter Singer, "For sometimes letting - and helping - die," Law, Medicine and Health Care, 1986, Vol. 3, No. 4, 149-153; Kuhse and Singer, Should the Baby Live? The Problem of Handicapped Infants (Oxford: Oxford University Press, 1985). p. 138.[Back]

15.   Ibid., Singer, Practical Ethics, p. 123.[Back]

16.   R.G. Frey, "The ethics of the search for benefits: Animal experimentation in medicine", in Raanan Gillon (ed.), Principles of Health Care Ethics (New York: John Wiley & Sons, 1994), pp. 1067-1075.[Back]

17.   David S. Oderberg, "A messenger of death at Princeton", Washington Times, July 30, 1998, A17.[Back]

18.   H.R. Hare, "When does potentiality count? A comment on Lockwood", Bioethics (1988), Vol. 2, No. 3, p. 214.[Back]

19.   See generally, Humanae Vitae (Boston: Pauline Books & Media, 1968): "It is, in fact, indisputable, as our predecessors have many times declared, that Jesus Christ, when communicating to Peter and to the apostles His divine authority and sending them to teach all nations His commandments, constituted them as guardians and authentic interpreters of all the moral law, not only, that is, of the law of the Gospel, but also of the natural law, which is also an expression of the will of God, the faithful fulfillment of which is equally necessary for salvation." (emphasis mine) (p. 2); the NCCB's, Ethical and Religious Directives for Catholic Health Care Services: "The moral teachings that we profess here flow principally from the natural law, understood in the light of the revelation Christ has entrusted to his Church." (emphasis mine) (p. 2); Thomas Aquinas, Summa Theologica, IaIIae,q.94, Fathers of the English Dominican Province (trans.) (Westminster, MD: Christian Classics, 1981); Austin Fagothey, Right and Reason (3rd ed. only)(St. Louis, MO: The C.V. Mosby Company, 1963); Vernon Bourke, Ethics (New York: The Macmillan Company, 1953); Ralph McInerny, Ethica Thomistica (Washington, D.C.: The Catholic University of America Press, 1982).[Back]

20.   Thomas Aquinas, ST, Ia.q.29,a.1, ans., ad.2,3,5, p. 156; ibid, a.2, ans.; also ST, IIIa.q.19, a.1, ad.4.2127.[Back]

21.   See Kevin Doran, "Person - a key concept for ethics", Linacre Quarterly (1989), Vol. 56, No. 4,p. 39.[Back]

22.   See Vernon Bourke, Ethics (New York: The Macmillan Company, 1953), pp, 172-179.[Back]

23.   See Jacques Maritain, The Person and the Common Good (Notre Dame, IN: University of Notre Dame Press, 1972), pp. 50-58[Back]

24.   Donum Vitae (Boston: Pauline Books & Media, 1987). See also, Dianne N. Irving, Philosophical and Scientific Analysis of the Nature of the Early Human Embryo (Doctoral dissertation)(Washington, D.C.: Georgetown University, 1991); Irving, testimony as member of the Science Panel, "Cloning: Legal, Medical, Ethical, and Social Issues", Hearing before the Subcommittee on Health and Environment of the Committee on Commerce, U.S. House of Representatives, Washington, D.C., Feb. 12, 1998; Ward C. Kischer and Dianne N. Irving, The Human Development Hoax: Time To Tell The Truth! (1997)(2nd ed.) (distributed by the American Life League, Stafford, VA).[Back]

25.   See Declaration on Euthanasia (Boston: St. Paul Books & Media, 1980); Declaration on Procured Abortion (Boston: Daughters of St. Paul, 1974).[Back]

26.   Romans 2:14-15.[Back]

27.   But see Veritatis Splendor (Boston: St. Paul Books & Media, 1993).[Back]

28.   ST, I-II, q.91, a.2.[Back]

29.   Matthew 25:40.[Back]

30.  See Evangelium Vitae (Boston: St. Paul Books & Media, 1995).[Back]

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