Which Medical Ethics for the 21st Century?
Presented at the Eighth Annual Rose Mass Brunch, sponsored by the John Carroll Society,
The Grand Hyatt Hotel, Washington, D.C., March 14, 1999.
Reproduced with permission
Introduction
Everyday we read and hear about the constant onslaught of controversial medical issues, e.g., euthanasia, physician-assisted suicide, test-tube babies, cloning and stem cell research, creating monsters in the lab, etc. -- it is all coming down very fast! This is not just business as usual!Yes, we will all have to make decisions about these and many other issues not even imagined yet in the 21st Century. But what will be the basis of our decisions, of our choices? Perhaps it is time to stop and seriously reconsider which medical ethics should be used as the basis of these choices - while we still can!
This choice will be critical to the well-being of each of us individually, as well as to the well-being of our society at large. I cannot help but recall a favorite caution of St. Thomas (paraphrased): "A small error in the beginning leads to a multitude of errors at the end"! Indeed, the ethical theory we choose will be the starting point for these complicated decisions. As such it can cause us to reach conclusions and perform actions that are harmful and destructive - or those, which will enrich, fortify, and strengthen all of us. The choice, of course, is yours.
Abstracting from all the possible academic ethical theories which will be vying for your patronage, I will focus narrowly instead on two theories of medical ethics - secular bioethics and Roman Catholic medical ethics, pointing out briefly what they are, comparing their conclusions about what is right or wrong, and indicating where they have already lead us. Frankly, I am convinced that secular bioethics can only lead us - individually and collectively - to profound destruction, and should in no way be confused with Roman Catholic medical ethics. In fact, I would encourage Catholics to stop using the term "bioethics" with reference to the Church's moral positions. I want to end by touching briefly on how the John Carroll Society itself embodies the very heart and soul of Roman Catholic medical ethics - and as such serves as a working role model for the rest of us.
To begin with, consider that ideas do have consequences - especially ideas about ethics when they are applied. Fundamentally different ethics lead to fundamentally different conclusions about what is right or wrong. Nowhere is this more obvious than in medical ethics. A quick comparison of the different conclusions already reached by secular bioethics and Roman Catholic medical ethics should make this graphically clear. Consider for a moment the strikingly different conclusions they reach.
Secular bioethics considers the following as ethical: contraception; the use of abortifacients; prenatal diagnosis with the intent to abort defective babies; human embryo and human fetal research; abortion; human cloning; the formation of human chimeras (cross-breeding with other species); "brain birth"; "brain death"; purely experimental high risk research with the mentally ill; euthanasia; physician-assisted suicide; living wills documenting consent to just about anything; and, withholding and withdrawing food and hydration as extraordinary means.
In contrast, Roman Catholic medical ethics, as expressed in the National Conference of Catholic Bishops' Ethical and Religious Directives for Catholic Health Care Services[1] , considers all of these unethical - with the possible exception of the use of "brain death" criteria (and some Catholic theologians are now becoming concerned about that as well). Probably the only issues on which they both agree is that the use of extraordinary means, e.g., a ventilator, is not morally required if a treatment is medically futile, and that even high doses of pain medication may be given if medically appropriate. How is it that these two ethical systems lead to such opposite and contradictory conclusions? It is because their conclusions flow necessarily from very different ethical principles, or premises.
A. Secular Bioethics
Secular bioethics is an academic ethical theory that was made up in 1979 by a group called the National Commission, and documented in their Belmont Report.[2] They were attempting to identify "neutral" ethical principles that could be used in a pluralistic, multi-cultural society - where no one's ethics should be imposed on others. The Belmont Report identified three ethical principles - respect for persons (which rapidly evolved to mean pure autonomy), justice and beneficence - otherwise known as "the Georgetown Mantra".[3] These principles were supposedly drawn from the systems of various philosophers - e.g., Kant, John Stuart Mill, and John Rawls. In effect, they took bits and pieces from different ethical theories and rolled them up into one ball. Each of these principles they referred to as prima facie - i.e., no one principle could over-rule any of the others. The way we come to know these ethical principles is by taking courses, attending conferences, and listening to bioethicists lecture.However, eventually and inevitably cracks began to form in the very foundation of this brand new ethical theory. For example, because bioethics was derived from bits and pieces of fundamentally different and even contradictory theoretical systems, the result was theoretical chaos, rendering it academically indefensible. More problematic, when people tried to apply the theory it didn't work because practically speaking there was no way to resolve the inherent conflicts among these three principles.
While
the Commissioners of the Belmont Report gave a nod to the traditional Hippocratic
understanding of Beneficence as "doing good for the patient", their definition
is essentially and predominantly utilitarian, with particular emphasis placed in that
Report on the "good" for society at large - or roughly, "the greatest good
for the greatest number of people".
Utilitarianism has always had a serious problem with defining in practice what
"good" is, but it is generally reduced to some sort of lack of pain, or
pleasure. It is clear, however, that their formula leaves minorities and the
vulnerable out in the cold. There are no moral absolutes here - only "rules" or
risk/benefit ratios, which are by definition relative.
As utilitarian, the general norm or standard against which one determines if an individual
action is right or wrong is "utility"; i.e., if that action is useful to
achieving good consequences, those being defined as "the greatest good for the
greatest number". The principle of Justice, too, is ultimately defined along
utilitarian lines. Even the principle of Autonomy eventually ends up serving
"the greatest good" - as I will indicate in a moment.
At any rate, after all is said and done, bioethics is reduced to some form of
utilitarianism or relativism, where "consequences" are the only morally relevant
condition and the "good" of the individual person is clearly not top priority.
There are several misconceptions about bioethics I would like to clarify.
First, bioethics is not really just the "general moral consensus of the
people", but rather it is an idiosyncratic systematic academic theory of ethics
alongside many other such academic ethical theories or systems vying for recognition in
the universities - bioethics simply being the one that was made up by the National
Commission.
Second, bioethics should not be equated with the entire field of "ethics"
per se, as often seems to be the implication today, but again, it is only a sub-field of
ethics.
Third, bioethics is not a "neutral" ethical theory at all, but defines
itself as "normative" - i.e., it takes a stand on what is right or
wrong.[4] In fact, there is no such thing as a "neutral" ethics - and that
includes utilitarianism, consensus ethics, Kantianism, cultural relativism, emotivism,
casuistry, and communitarianism as well.
Eventually, as with most made up theories, bioethics is now in fact dysfunctional - it
doesn't work, as admitted in publications by even many of the founders themselves - the
best kept secret in bioethics! For example, Daniel Callahan (one of the founders of
the bioethics "think tank", The Hastings Center, and former Director of the
American Eugenics Society[5]) conceded in the 25th anniversary issue of The Hastings
Center Report celebrating the "birth of bioethics", that the principles of
bioethics simply had not worked. But not to worry, he said, we'll try communitarianism now: "The range of questions that a communitarian bioethics
would pose could keep the field of bioethics well and richly occupied for at least another
25 years"![6]
Al Jonsen, one of the original members of the National Commission, admitted in his
"Preface" to the first serious book confronting the myriad inadequacies of
"bioethics principlism", that there were really only two real ethicists on that
Commission, that they had essentially made the principles up, and agrees with the premise
of the book that bioethics should now be regarded somewhat as a sick patient in need of a
thorough diagnosis and prognosis:
A fairly widespread perception exists, both within and without the bioethics community,
that the prevailing U.S. approach to the ethical problems raised by modern medicine is
ailing. Principlism is the patient. The diagnosis is complex, but many believe
that the patient is seriously, if not terminally, ill. The prognosis is
uncertain. Some observers have proposed a variety of therapies to restore it to
health. Others expect its demise and propose ways to go on without it.[7]
Gilbert Meilaender's early and incisive suspicions about the consequences of the several
"mind/body splits" inherent in bioethics theory emerged in yet another important
book, in which he explains "how easily the 'soul' - attention to the meaning of being
human, a meaning often illuminated by religious and metaphysical insight - can be lost in
bioethics."[8] Other controversies and battles over the validity of the
bioethics principles on many levels are documented and collected in an already classic
tome edited by Rannan Gillon,[9]
in which 99 scholars from around the world jump into the
fray.
Equally problematic is the fact that only a very tiny percentage of "professional
bioethics experts" have any academic degrees in bioethics at all, and even for those
few that do there is no uniform or standardized curriculum, most teachers don't really
know the subject matter themselves, the courses vary from institution to
institution, there are no local, state or national boards of examinations, and no
standardized professional responsibilities are required. There is not even a code of
ethics for bioethicists. Most "bioethicists" by far have never taken even one
course in bioethics.[10]
Regardless,
these bioethics principles of autonomy, justice and beneficence were made the explicit
basis for many major governmental regulations, private sector and industry guidelines,
even international guidelines still in use today - e.g., the federal OPRR regulations on
the use of human subjects in medical research, The Common Rule, Institutional Review Board
Guidebooks, Hospital Ethics Committee Guidebooks, most policies for hospitals and other
health care facilities, the international CIOMS/WHO Guidelines for the use of human
subjects in Third World countries, etc.[11]
The bioethics principles now literally redefined the "ethics" of other
disciplines, e.g., business ethics, and ethics in engineering. Even our country's
military schools have restructured their ethics courses and essentially reduced them to
courses in bioethics. Many colleges and universities already require a course in
bioethics in order to graduate. More recently, the proposed statute concerning the
use of "decisionally incapacitated" human subjects in medical research,
introduced in the State of Maryland legislature in early March 1999, is grounded on these
same three bioethics principles, as its first drafts explicitly states. This
proposed statute purports to"respect the autonomy" of mentally ill human
subjects to such an extreme that it would allow them to give informed consent to choose
"research agents" who would then "substitute their judgments" as to
whether or not these mentally ill persons would have wanted to participate in even high
risk, no direct benefit medical research for "the greater good of society", were
they competent[12] - an absurd and dangerous interpretation of autonomy and altruism,
indeed.
Although bioethics wants to claim that it does not embody any anthropology - or definition
of a "person" - it obviously does. One of the most popular by far comes
from one of bioethics' most infamous practitioners. Australian animal rights
philosopher/bioethicist Peter Singer, President of the International Institute of
Bioethics under the United Nations, and the newly appointed director of Princeton
University's Center for Human Values, defines a "person" as something actively
expressing "rational attributes" (autonomy, choosing, loving,
self-consciousness, relating to the world around one, etc.), and "sentience"
(feeling pain and pleasure). Therefore, he enthusiastically advocates infanticide of
even normal healthy newborn human beings - in fact, even older children. Why?
Because they do not actively express "rational attributes" or
"sentience", and therefore they may be human beings, but not
"persons".
On the other hand, he claims that the higher primates, e.g., apes, monkeys, dogs, pigs,
chickens - even prawns - are persons because they do actively exercise "rational
attributes" and "sentience":
... For on any fair comparison of morally relevant characteristics, like rationality, self-consciousness, awareness, autonomy, pleasure and pain, and so on, the calf, the pig and the much derided chicken come out well ahead of the fetus at any stage of pregnancy - which if we make the comparison with a fetus of less than three months, a fish or even a prawn would show more signs of consciousness. Since no fetus is a person, no fetus has the same claim to life as a person.[13]
... Now it must be admitted that these arguments apply to the newborn baby as much as to the fetus. A week-old baby is not a rational and self-conscious being; and there are many nonhuman animals whose rationality, self-consciousness, awareness, capacity to feel, and so on, exceed that of a human baby a week, a month, or even a year old. If the fetus does not have the same claim to life as a person, it appears that the newborn baby does not either, and the life of a newborn baby is of less value that the life of a pig, a dog, or a chimpanzee. ... In thinking about this matter we should put aside feelings based on the small, helpless and - sometimes - cute appearance of human infants. To think that the lives of infants are of special value because infants are small and cute is on a par with thinking that a baby seal, with its soft white fur coat and large round eyes deserves greater protection than a whale which lacks these attributes. Nor can the helplessness or the innocence of the infant homo sapiens be a ground for preferring it to the equally helpless and innocent fetal homo sapiens.[14]
But if it is true that a "person" is defined only in terms of the actual
exercising of "rational attributes" and "sentience", then the
following list of human beings are also not human persons, and therefore not due the same
ethical and legal rights and protections as persons: the mentally ill, mentally
retarded, patients with Alzheimer's or Parkinson's disease, the comatose, alcoholics, drug
addicts, the frail elderly, paraplegics and all other disabled human beings, patients with
nerve damage or disease, etc.
Philosopher/bioethicist R.G. Frey[15] correctly pushes Singers logic to its inevitable
conclusion: the mentally ill, etc., who are not "persons" should be
substituted for the higher primates, who are "persons", in purely destructive
experimental research. This is ethical - even morally required for "the greater
good".
Similarly, Norman Fost defines cognitively impaired human beings as "brain
dead". Singer, who also enthusiastically promotes eugenics, uses all
three bioethics principles at will, depending on which one gets him where he
wants to go. Thus adroitly he appeals to our autonomy - e.g., if the
parents of a defective newborn, or even a normal newborn, autonomously
"choose" to kill their child, then that is ethical. However, if the
parents won't do this on their own accord if it is for "the greater good",
then the government has the duty to force them to do it, particularly if the
child is defective!
However, if the parents won't do this on their own accord if it is for "the greater good", then the government has the duty to force them to do it, particularly if the child is defective! So much for rights; in fact, Singer does not even believe in rights at all![16] His colleague R.M. Hare is just as articulate when he discusses the role of the government in such issues. For Hare, the maximum duty that is to be imposed by the government is to do the best impartially for all the "possible people" there might be by having an optimal family planning or population policy, which means necessarily excluding some possible people. Indeed, he argues, the best policy will be the one which produces that set of people, of all "possible sets" of people which will have in sum the best life, i.e., the best possible set of future possible people![17]
No wonder Singer has been run out of Germany, Austria, and France, and is picketed just about every place he lectures. I worry how Singer will define "human" values at his new Princeton post - will it include the values of only some human beings and not others? Isn't this establishing a category of sub-human human beings? Haven't we been there before?At any rate this explains in essence what bioethics is, what its ethical principles are, and why it comes to the conclusions it does in these medical ethics issues. Given that secular bioethics comes to so many conclusions opposite from those of Roman Catholic medical ethics, I would suggest that we reconsider using the term "bioethics" to refer to Roman Catholic medical ethics. One is definitely not the other.
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.[18]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, it transcends 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 nature[19] - whether we happen to be exercising it or not. Nor is "person" the same as "personality".[20]
It is because we knowingly and willingly choose to
perform certain actions that they 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".[21] 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;[22] 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.[23] 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.[24]
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 - the Bible, the Word of God (not, by the way, to be equated with theological theories). We know it by and 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?[26] 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[27](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."[28] 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.[29] Choose well, my friends.Notes:
[1]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).
[2] 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).
[3] 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).
[4] See Beauchamp and Childress, pp. 7-9; and,
Beauchamp and Walters, pp. 1-3.
[5] Mary Meehan's interview with Daniel Callahan, in
"Eugenics: Still alive and well", National Catholic Register, August
8, 1993.
[6] Daniel Callahan, "Bioethics: Private choice and common good", Hastings
Center Report (May-June 1994), Vol. 24, No. 3, p. 31.
[7] 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.
[8] Gilbert c. Meilaender, Body Soul, and Bioethics,
(Notre Dame, IN: University of Notre Dame Press, 1995), p. x.
[9] Raanan Gillon (ed.), Principles of Health Care Ethics
(New York: John Wiley & Sons, 1994).
[10] See Dianne N. Irving, "Scientific and philosophical
expertise: An evaluation of the arguments on 'personhood'", Linacre
Quarterly (1993), Vol. 60, pp. 18-47.
[11] 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).
[12] 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.
[13] 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.
[14] Ibid., Singer, Practical Ethics, p. 123.
[15] 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.
[16] David S. Oderberg, "A messenger of death at Princeton", Washington Times, July 30, 1998, A17.
[17]
H.R. Hare, "When does potentiality count? A comment on
Lockwood", Bioethics (1988), Vol. 2, No. 3, p. 214.
[18] 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).
[19] See John Finnis, Natural Law and Natural Rights
[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.
[21] See Kevin Doran, "Person - a key concept for
ethics", Linacre Quarterly (1989), Vol. 56, No. 4,p. 39.
[22] See Vernon Bourke, Ethics (New York: The
Macmillan Company, 1953), pp, 172-179.
[23] See Jacques Maritain, Person and the Common Good
[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).
[25] See Declaration on Euthanasia (Boston: St.
Paul Books & Media, 1980); Declaration on Procured Abortion (Boston:
Daughters of St. Paul, 1974).
[26] Romans 2:14-15.
[25] But see Veritatis Splendor (Boston: St. Paul
Books & Media, 1993).
[27] ST, I-II, q.91, a. 2.
[28] Matthew 25:40.
[29] See Evangelium Vitae (Boston: St. Paul Books &
Media, 1995).