Protection of Conscience Project
Issues in Depth: Ethical Commentaries

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Eamon O'Dwyer LL.B, F.R.C.P.I., F.R.C.O.G.
Professor (emeritus) of Obstetrics and Gynaecology, National University of Ireland, GALWAY

"God created man in the image of Himself" (1). By reason of this inherent dignity we are persons endowed with certain faculties, not least, the use of reason and freedom of choice.

The Book of Ecclesiasticus, written two centuries before Christ, tells us "If you will, you can keep the commandments, and to act faithfully is a matter of your own choice.

Before a man are life and death and whichever he chooses will be given to him" (2).

Against the Protestant denial of human free choice at the Reformation, the Council of Trent solemnly pronounced that humans are able to make free choices (3).

In our own time, the Second Vatican Council declared free choice to be "an exceptional sign of the divine image within man" (4) and that our power of free choice, "is in accordance with" our "dignity as persons &endash; that is being endowed with reason and free will and therefore privileged to bear personal responsibility (5). Clearly, we are free to choose good or evil.

Natural Law is rooted in history. To understand it fully and to appreciate its significance, it is necessary to trace its development from its origin in ancient Greek philosophy.

Plato defined "good" as the harmonious unity of all that is, and the "moral good "as a harmony of all the virtues under the rule of reason He believed that in knowing the "good" one would desire it for its own sake and to be virtuous one had to be aware of the "good".

This concept was developed by Aristotle who, while recognising two branches of law -- natural law on one hand and man-made law on the other --- maintained that natural law was everywhere in force. His theory was adopted by the Stoics and, in turn, by the early Roman jurists, notably Cicero who, in the 1st. century B.C. gave the clearest definition of classical natural law, when he wrote &endash; "True law is right reason in agreement with nature; it is of Universal application, unchanging and everlasting; it summons to duty by its commands, and averts from wrongdoing by its prohibitions... One eternal and unchangeable law will be valid for all times, and there will be one Master and one ruler, that is, God, over all of us, for he is the author of this law, its promulgator and its enforcing judge. (6)

As Roman civilisation expanded so did its laws, culminating in the codifying of Roman law by the emperor Justinian into the Corpus Juris Civilis (A.D.534), arguably the most important contribution, after the Bible, to Western thought.
While the jus civile was the law which Romans applied exclusively to themselves and the jus gentium generally to foreigners, the latter was gradually subsumed, in great part, into the third branch of law, the jus naturalis, as the basis of a practical law applying to all freemen, based on their freedom, and common to all mankind.

However, in the early Christian era, emperors had but scant respect for the authority of the Popes as spiritual leaders, resulting in constant friction between Church and State --- a state of affairs which persisted until the accession of Charlemagne in the eighth Century.

During the early centuries of the first Millennium the Church, for its part, was beset by a number of heresies and schisms --- notably the Arian and Pelagian --- challenging Doctrine and Scripture. Hence much of the activity of the early Doctors of the Church, Ambrose and Augustine for example, was devoted to combating and correcting error.

In addition there were problems relating to the constitution and government of the Church. New canons, binding on the faithful, were promulgated at each Ecumenical Council or Synod convened to adjudicate upon the particular heresy or schism in question.

Thus the Council of Nicea, in addition to proclaiming the Divinity of Jesus in the new Creed, issued twenty canons relating to Church discipline containing, inter alia, rules for the ordination of clergy and bishops, clerical celibacy, clerical usury and the proper posture at prayer (7).

It was only after the crowning of Charlemagne as Holy Roman Emperor by Pope Leo III (A.D.780), and with the Emperor's tacit approval, that centralised church authority, descending through the Pope to the bishops, evolved.  There was as yet, however, no complete code of canon law.

The twelfth century brought about a major revival in the study of Roman law, especially in the University of Bologna. This led a monk of the University, John Gratian, to make a collection of the Church canons which he entitled Concordantia Discordantum Canonum ---- a "Harmony of Discordant Canons" (8).

This, the Decretum Gratiani, formed the basis of the Corpus Juris Canonici, which has remained as the law governing the Church down to the present day, albeit subject to amendments in 1917 and 1983.

Describing Natural Law as the "Golden Rule" Gratian wrote -- "Mankind is ruled by two laws: Natural and Custom. Natural Law is that which is contained in the Scriptures and the Gospel. Natural Law absolutely prevails in dignity over customs and constitutions. Whatever has been recognised by usage, or laid down in writing, if it contradicts Natural Law, must be considered null and void". Not only did Natural Law overrule all other laws but it was antecedent to them because "it came into existence with the very creation of man as rational being, nor does it vary in time but remains unchangeable" (8).
It was not surprising therefore, that in the Middle Ages, the doctrine and principles of Natural Law, in the understanding of the day, should have been embodied in the Code of Canon Law even though there was, as yet, no clear definition of law in general, or of Natural Law in particular. Religious thought had been dominated by the writings of St. Augustine, for example De Civitatis Dei, where in contrast with the "Heavenly City" the Christian could see in the earthly city only a world of corruption.

It was into this milieu of pessimism ---- the "Dark Ages " ------ that St. Thomas Aquinas was born in 1224. At the age of twenty he joined the Order of St. Dominic, studying especially theology and philosophy, before reconciling Aristotelian philosophy, as expressed in the Ethics and the Politics, with Christian belief, reaching fulfilment in the Summa Theologiae, wherein he set down a series of questions which he answered in the light of philosophy and theology, maintaining throughout that the testimony of reason did not conflict with the truths revealed by Christian doctrine, and the grace did not abolish nature but perfected it. (9)

Not without significance, at the very beginning of the Summa he first poses the question ---- Does God Exist ? ----- answering in the affirmative in five different ways.

Defining Law as nothing else but a rational ordering of things which concern the common good, promulgated by whoever is charged with the care of the Community, he described the nature of Law and its object which, in essence, was the well-being of the whole community. He held that there were three different types of Law: Eternal Law, Natural Law and Human Law.
Of Eternal Law he said --- "The rational guidance of created things on the part of God, as the Prince of the Universe, has the quality of law. .. this we can call the Eternal Law", adding, "all laws, so far as they accord with right reason, derive from Eternal law" (9).

In recent times the Second Vatican Council declared that "the highest norm of human life is the divine law --- eternal, objective and universal --- whereby God orders, directs and governs the entire universe and all the ways of the human community according to a plan conceived in wisdom and love" (10) .

"Rational creatures", Aquinas maintained, "have a certain share in the divine reason itself, deriving therefrom a natural inclination to such actions and ends as are fitting. This participation in the eternal law by rational creatures is called the Natural Law" (9).
Vatican II referred to Natural Law also, in Gaudium et Spes. --- "Deep within his conscience man discovers a law which he has not laid upon himself but which he must obey. The voice of this law, ever calling him, to love and to do what is good and to avoid evil, tells him inwardly at the right moment, do this, shun that. For man has in his heart a law written by God. His dignity lies in observing this law, and by it he will be judged. His conscience is man's most secret core, and his sanctuary. There he is alone with God, whose voice echoes in his depths." (4) Acknowledging the necessity for human laws, Aquinas said "The validity of all law depends upon its justice. But in human affairs a thing is said to be just when it accords aright with the rule of reason and as we have seen the first rule of reason is the Natural Law. If human law was at variance in any particular with Natural Law it was no longer legal but rather a corruption of law". The primary precept of the Law, which is universal, everlasting and immutable -- the first principle of practical reason -- was that Good should be done and pursued and Evil avoided. .. "and in this are found all the other precepts of the Law of Nature" (9).

These, in the order of man's natural inclinations, he listed as:

- 1. Preservation of Human Life and opposition to its dissolution
- 2 Procreation and the Rearing of Offspring
- 3. Knowing the Truth about God
- 4. Living in Society in harmony with others.
- 5. Avoiding Ignorance.

All basic, or fundamental human rights, such as the right to life, to procreation, to a livlihood, to bodily integrity, derive from the intrinsic inalienable dignity of the human person as a gift from God; they are not bestowed by any huamn agency and, like Natural Law, are antecedent to all positive law.

The "Charter of Fundamental Rights of the European Union", adopted last December deals at the outset with Human Dignity, and states "Human dignity is inviolable. It must be respected and protected. Everyone has the right to life". These are noble aspirations but, are they just pious platitudes? (11)

To return to the original question ---- what is Natural Law?

It has been defined as "the participation of the eternal law in rational creatures" (9). Through the use of reason, people can discover that part of the eternal law which governs human activity.

Their formulation of the results of this "Natural Law"; as professor d'Entreves explains "Reason is the essence of man, the divine spark which makes for his greatness. It is the 'light of reason' which enables us 'discern good from evil'. (12)
Natural Law, however, is not just a theory of natural rights. It is the Golden Rule which "contains all that makes for the preservation of human life, and all that is opposed to its dissolution" (9).

As we have seen, men and women enjoy freedom of choice but this is not the same as the "right to choose" as, for example, in the case of procured abortion. There can be no right to choose if, in exercising that right, one deliberately kills an innocent human being.

There are practices in Obstetrics and Gynaecology which offend against Natural Law --- I shall consider just two of them --- emergency contraception and procured abortion.

Emergency contraception, so-called, involves the administration of two doses of 100 mcg of Ethinyloestradiol and 1 mg of norgestrel, 12 hours apart, to women who had had unprotected intercourse in the previous 72 hours, the Yuzpe regimen.
There are differing views as to its precise mode of action.

While it has generally been accepted that when administered before ovulation an oestrogen / progestogen combination may inhibit ovulation, an anti-ovulation effect has been found in less than 30 per cent of women.

Studies involving the administration of ethinyloestradiol and levonorgestrol at or before the LH peak showed significant alterations in endometrial development with dissociation of the glandular and stromal components indicating that post-coital contraception prevents implantation of the fertilised ovum.

Most researchers support the view that the morning - after pill acts through modification of the endometrium.
Schering AG, the manufacturer of Schering PC4, concede that it "prevents pregnancy by producing transient changes in the endometrium, making it unsuitable for a fertilised ovum to implant. Ovulation may be delayed if the pills are given in the first half of the menstrual cycle, or the corpus luteum function may be altered if given after ovulation. There is no evidence that Schering PC 4 is abortifacient (13).

The data sheet accompanying the preparation states "Schering PC4 is primarily aimed to prevent implantation of the fertilised ovum in the endometrium".

The claim that the morning-after pill is not abortifacient is spurious. In 1963 the United States Department of Health, Education and Welfare described abortion as "all the measures which impair the viability of the zygote at any time between the instant of fertilisation and the completion of labor" (14).

With the shift from contraceptive to abortifacient methods of birth control it became expedient to change the definition of "conception" from fertilisation to implantation. The change was endorsed by the American College of Obstetrics and Gynaecology (ACOG), which stated in 1965 -- "Conception is the implantation of a fertilised ovum" (15).

Accordingly, relying on this terminology, those advocating emergency contraception deny its abortifacient effect.
Recently Schering has produced a preparation containing 750 micrograms of levonorgestrel, where one tablet is to be taken within 72 hours of unprotected intercourse, to be followed within 12 hours by a second. Schering estimates that such dosage "prevents 85% of expected pregnacies." (Data sheet)

Schering is more circumspect about its mode of action than in the case of PC 4 --- "It may also cause endometrial changes that discourage implantation" (Data sheet)

However, almost certainly, it acts in exactly the same manner as the combined ethinyloestradion / norgestrel preparation. The Irish Medicines Board --- the Government drug regulating agency --- has declared it to be abortifacient.

The scientific evidence is that human life begins at conception. I believe that emergency contraception prevents the continuation of pregnancy because it hinders implantation of the fertilised ovum and hence it has to be abortifacient.

Notwithstanding, the morning-after pill is now widely available, in the United Kingdom at any rate, over the counter in pharmacies, to all women over sixteen years of age.

Certain actions are intrinsically evil. As the Church teaches -- "there exist acts which per se, and in themselves, independent of circumstances, are always seriously wrong by reason of their object" (16) . Deliberate, intentional destruction of unborn human life, i.e. procured abortion is one such act., and is never morally justifiable.

As Pope Paul VI stated in Humanae Vitae "though it is true that sometimes it is lawful to tolerate a lesser moral evil in order to avoid a greater evil or in order to promote a greater good, it is never lawful, even for the gravest reasons, to do evil that good may come of it" (17). Pope John Paul II reminds us in Evangelium Vitae "The second Vatican Council defines abortion together with infanticide as an 'unspeakable crime' (G.S. 51) (17) .

The pro-choice, pro-abortion lobby, while not admitting that its real aim is abortion on demand, argues that abortion is necessary in certain circumstances, especially where it is claimed that for the pregnancy to continue, the mother's life would be endangered.

Unfortunately, in many predominantly Catholic countries, the myth persists that pregnancy may pose a risk to the mother's life, and legislation to permit of procured abortion in such circumstances, been enacted, ignoring completely the question of morality.

Leaving morality aside for a moment however, one may ask "is procured abortion ever necessary?" --- in other words "are there any medical indications for procured abortion?"

I firmly believe that the honest answer has to be "No".

After forty years as a Consultant Obstetrician / Gynaecologist in major teaching hospitals I cannot recollect a single instance where a mother's life could only be saved through the deliberate destruction of her unborn child.

Statistics support this view. In Ireland, where abortion is illegal, the question of procuring an abortion so as to protect the mother's life does not arise, and yet Ireland, together with Malta, I believe, has the lowest maternal mortality in the world, at less than four maternal deaths for every 100,000 births.

Furthermore, in over three - and - half million successive abortions carried out in England and Wales under the Abortion Act, 1967, in barely 150 cases was risk to the mother's life the indication for the abortion. This means that only one abortion in every 23,000 was carried out because it was felt that the mother's life was in danger (18).

Recent figures from the United Kingdom are even more convincing ----- of 5.3 million abortions performed since 1967 only 212, i.e 1 in 25,000, invoked danger to the life of the mother as the indication (19) .

There can be no doubt, whatever, that almost all abortions are carried out for quasi-social reasons; in effect, abortion on demand.

But then, procured abortion is big business and is an "economic service" under European Union law.

It is worth recalling that the World Medical Association Declaration of Geneva in 1948, which was adopted by successive World Assemblies in 1968, 1983 and 1994, states &endash; "I SOLEMNLY PLEDGE myself to consecrate my life to the services of humanity: "I WILL MAINTAIN the utmost respect for human life from its beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity" (20) .

While procured abortion is to be condemned, on no account should an expectant mother be denied all necessary treatment during pregnancy in the fear that it might kill or damage her child. To withhold such treatment is unethical.
Obstetricians have responsibility for the well-being of two persons, the mother and her unborn child. In protecting one, they may not deliberately... destroy the other ----- "primum non nocere".

George Bush, in a message to the annual March for Life in Washington, shortly after his inauguration as President of the United States of America, said that they shared a common goal "to work toward a day when every child is welcomed in life and protected by law. This will not come easily, or all at once, but the goal leads us onward to build a culture of life, affirming that every person, at every stage and season of life, is created equal in "God's image" (21) .

Has the time not come -- indeed is it not long overdue ? -- when we obstetricians, should let our voices be heard, collectively, in promoting the culture of life, and in defence of the unborn?
We have remained silent for far too long.

I would like to see emerge from this meeting the acceptance of MaterCare International, in witness to Pope John Paul II's Encyclical Evangelium Vitae, as the authority in matters relating to the practice and training in obstetrics and gynaecology.

1.  Genesis 1.27

2.  Ecclesiasticus 15 11. 20

3.  Denziger - Schonmetze 1955 / 815 cited by Grisez G. The Way of the Lord Jesus Vol. 1 p. 43, Franciscan Herald Press, Chicago (1983) [Back]

4.  Second Vatican Council ---- Gaudium et Spes 12

5.  Second Vatican Council ---- Dignitatis Humanae 2

6.  Cited by Finnis J. Natural Law and Natural Rights (1980) Clarendon Law Series. Oxford University Press

7.  Alzog J. Universal Church History (1874) Vol 1 p. 452 et seq. Gill & Co.Dublin

8.  Coriden J. A. An Introduction to Canon Law (1990) Geoffrey Chapman

9.  Summa Theologiae 1 -- 11 q. 2 a 3

10.  Second Vatican Council ---- Dignitatis Humanae

11.  Charter of Fundamental Rights of the European Union (2000)

12.  D'Entreves A.P. Natural Law, an Introduction to Legal Philosophy p. 40 Hutchinson University Library, London

13.  Schering Ltd. --- Personal Communication

14.  Public Health Services Leaflet No. 1066 U.S Department of Health, Education and Welfare 1963 p. 27

15.  American College of Obstetrics and Gynecology Terminology Bulletin -- Terms used in Reference to the Fetus Chicago, A.C.O.G. September 1965

16.  Pope John Paul 11 Veritatis Splendor (1993) 80

17.  Pope John Paul 11 Evangelium Vitae (1995) 58

18.  Hansard, May 13, 1992

19.  Northern Ireland Assembly Debates June 20, 2000

20.  World Medical Association Declaration, Geneva (1948)

21.  President George Bush -- Message to Annual March for Life Washington, 2001