This Crash Course in Catholic Medical Ethics was originally presented in lecture format April 29, 2008 in Worcester, MA (USA) as part of the 4th Annual Healthcare Professionals for Divine Mercy Conference: Medicine, Bioethics, and Spirituality. It is reproduced here kindly with permission of Fr. Kopaczynski.Fr. Germain Kopaczynski, OFM Conv., Ph.D., S.T.D.
1. The Prime Directive: Every Discipline Has One
a. “We shall not interfere with the development of any culture.” – Star Trek
b. “Do good and avoid evil.” – Catholic ethics
c. “Primum non nocere.” – Medical ethics
2. Good vs. Evil.
3. Our faith teaches us:
a. God is creator of all.
b. We are made in the image of God.
c. God is the Lord of life and death (Deut. 32:39)—not us.
d. You shall not kill.
4. The Christian view of the human being:
a. God created us with intelligence.
b. God created us free.
c. Human beings are creatures of God. We are not absolute masters but responsible stewards. The great temptation of our age is to think that we can be absolute masters. We think: “If we can do it, then it is morally right to do it.” In other words, Technology trumps morality.”
d. This is the temptation of the Technological Imperative.
5. Faith and Reason:
a. “Join faith and reason if you can.” –Boethius
b. “A truth of faith and a truth of reason can never contradict.” –Based on St. Thomas Aquinas.
6. Moral dilemmas:
“While the Church cannot furnish a ready answer to every moral dilemma, there are many questions about which she provides normative guidance and direction.” – Ethical and Religious Directives for Catholic Health Care Services, USCC, June 15, 2001. If we understand the underlying principles, we have a guide to resolving dilemmas.
7. Moral Principles of Secular Medical Ethics: 1
a. Respect for autonomy
b. Nonmaleficence (doing no harm)
c. Beneficence (doing good)
8. Moral Principles of Catholic Medical Ethics: 2
a. Sanctity of life (right to life)
b. Principle of double effect
c. Human dignity
d. Informed consent
e. Principle of integrity and totality
f. Material cooperation
h. Common good and subsidiarity
9. Sanctity of Life:
“Sanctity of life creates a presumption in favor of sustaining life and so places the burden of proof on those who would take life or fail to forestall death.” 3
We must have a ‘bias for bios’, a bias, a presumption for life. This principle is the basis of numerous directives of the Ethical and Religious Directives (ERD) including #3 and 36.
10. Principle of Double Effect:
It is allowable to perform an action that will produce a good effect and a bad effect provided:
a. The good effect and not the evil effect is directly intended.
b. The action itself is good, or at least indifferent.
c. The good effect is not produced by means of the evil effect.
d. There is a proportionate reason for permitting the foreseen evil effect to occur. 4
For example, it is allowable to perform a hysterectomy on a pregnant woman with life-threatening uterine cancer. The doctor’s intent is to save the woman’s life, not to abort the fetus. This principle can rightly be regarded as “The Troubleshooter” because it helps resolve many difficult issues. This principle is the basis of ERD directives #47 (indirect abortion), #53 (indirect
sterilization), and #61 (pain relief).
11. Human Dignity
12. Informed Consent:
Medical procedures require informed consent because human beings are made in God’s image, that is, with intelligence, hence, informed, and with freedom, hence, consent. Regarding informed consent, The patient is to
a. The nature of the procedure;
b. the risks;
c. the probable benefits;
d. the possible alternatives.
This principle is the basis of ERD directives #26, 27, 28, 31, 32, 50, 51, 59, and 65.
We often hear: “One must follow one’s conscience in making ethical decisions.” We should be more precise: “One has a duty to follow a well-formed conscience in making ethical decisions.” 5
14. The Culture of Life vs. the Culture of Death:
a. “I have set before you life and death, the blessing and the curse. Choose life, then, that you and your descendents may live.” – Deut 30:19.
b. “The way of Christ ‘leads to life’; a contrary way ‘leads to destruction.’ 20 The Gospel parable of the two ways remains ever present in the catechesis.
c. The Dependent Person: In a Culture of Life the dependent person (the unborn, the disabled, the elderly, the poor; in a word, the youngest, the oldest, the weakest, and the sickest) are included. In a Culture of Death the dependent person is excluded, an exclusion which usually begins with linguistic subterfuge. For example, in its attempt to ‘package’ abortion, a Culture of Death will refer to the occupant in the womb as a ‘product of conception’ or ‘a blob of protoplasm,’ never an ‘unborn child.’ At the end
of life, it will speak of Terri Schiavo as a ‘vegetable,’ not a profoundly disabled human being.
15. Who’s in Control Here?:
a. “Man the measure of all things.” –Protagoras of Abdera (c. 480-410 B.C.)
i. Gloria Steinem once wrote: “By the year 2000 we will, I hope, raise our children to believe in human potential, not God.”
ii. Robert Edwards, the inventor of in-vitro fertilization was interviewed by The Times of London in 2003 about his discovery. He said, “I wanted to find out exactly who was in charge, whether it was God Himself or whether it was scientists in the laboratory.” And what did he conclude? “It was us.”
b. God is the measure of all things. “I, the LORD, am your God, who brought you out of the land of Egypt, that place of slavery. You shall not have other gods besides me.” –Exodus 20:2-3
1 – Principles of Biomedical Ethics, 4th Edition. Beauchamp, T.L. and Childress, J.F., Oxford University Press, USA, 1994.
2 – Health Care Ethics: A Theological Analysis. K.D. O’Rourke and B.M. Ashley, Georgetown University Press, 1997.
3 – Euthanasia. R.M. Gula, Paulist Press, 1995.
4 – Based upon Medical Ethics. E.F. Healey, Loyola Press, 1956, p. 94.
5 – “A well-formed conscience is upright and truthful. It formulates its judgments according to reason, in conformity with the true good willed by the wisdom of the Creator. Everyone must avail himself of the means to form his conscience.” Catechism of the Catholic Church, #1798.of the Church; it shows the importance of moral decisions for our salvation: ‘There are two ways, the one of life, the other of death; but between the two, there is a great difference.’” – Catechism of the Catholic