Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude

Freedom to Choose God

Catholic Dossier, Vol. 6, No. 2: Mar-April 2000
Reproduced with permission

Janet Smith *

The opening line of Dignitatis Humanae states, "A sense of the dignity of the human person has been impressing itself more and more deeply on the consciousness of contemporary man, and the demand is increasingly made that men should act on their own judgment, enjoying and making use of a responsible freedom, not driven by coercion but motivated by a sense of duty." Dignitatis Humanae was written largely to defend man's right to religious liberty. Religious freedom is the most important freedom, for men need more than anything the freedom to get themselves right with God. But as we know, in our age, few employ the abundant freedoms available to us for advancing our relationship with God.

Dignitatis Humanae also states that "it is one of the major tenets of Catholic doctrine that man's response to God in faith must be free; no one therefore is to be forced to embrace the Christian faith against his own will." This means that we must not force others to make proclamations of faith. Yet freedom from such coercion, of course, does not mean that individuals are free to worship in any way they choose; child sacrifice, for instance, is not to be tolerated. We have the freedom to believe whatever we want, but not the freedom to do whatever we want.

Religious freedom, then, is not absolute. It is a fundamental human right but one subject to reasonable limitation. Let me comment on the current state of bioethics as a means of illustrating what can go wrong when we misunderstand the proper reach of human freedom and why the important element in religious freedom is not so much freedom as it is religion.

The discipline of bioethics is currently nearly obsessed with autonomy, or man's liberty to make his own choices. This liberty, however, has little to do with human dignity or duty and much more to do with a reduction in human dignity and a sense that one has few obligations other than making one's own choices.

The students in my bioethics class were recently discussing a case of a fifty-six year old man who was becoming increasingly demented. A simple operation would halt his rapid slide into complete dementia (caused by water on the brain) and perhaps enable him to regain many of his faculties. He, for no apparent reason, was refusing the simple surgery. His submissive and timid wife concurred with his wishes. Even when he was not demented he refused surgery so his physicians were inclined to respect his autonomy and not seek a court order mandating the surgery. In today's bioethical world it seems the greatest wrong is being "paternalistic" and overturning a patient's autonomous decision, even if that decision rejects simple ordinary care and leads to severe disability, dementia, or even death.

A few of the students opined that since he was so old, dementia might not be far away anyway. I put my head down on my desk and emitted a deep existential groan. When I revived, I informed them that I am soon going to turn fifty. I acknowledged that when I was their age, I thought that fifty was old and now that I am nearly fifty I am sure that it is. I am experiencing a reduction of all my powers; my hearing, sight, teeth, energy, etc. are all diminishing and I have reason to believe that I discern signs of impending dementia as well. Nonetheless, I told them that I belong to a generation that largely has not yet done anything worthwhile with our lives and that we, unlike previous generations, should not be put out to pasture to admire the daisies however attractive an option that might seem. Rather, we need time to redeem ourselves and see if we can help stall or even reverse some of the terrible forces we have unleashed. (Though I do wonder if the more pernicious of us might be better off reduced to ineffectuality.)

Such dismal moments aside, teaching at the University of Dallas is a special privilege and teaching bioethics here is even a more special privilege. By the time our students take the bioethics course, they have already had three other philosophy course, ethics, philosophical anthropology, and metaphysics. Such a background protects them somewhat from the approach of bioethics texts that inform them that they can be a utilitarian, one who seeks the "greatest happiness for the greatest number" or a deontologist (roughly, one who believes in absolutes) and more recently what is known as a "principlist" (to be described in a moment). The texts give no reason why one would choose to be either a utilitarian or a deontologist; one's choice seems a matter of preference. I point out to my students that utilitarians have virtually no metaphysics and an anthropology that seems to consist in the dubious claim that men have a natural sympathy for each other and deontologists think virtually nothing is known about the outside world and that man is a rational being who should ignore all of his natural inclinations. They are, therefore, not much drawn to either system.

Actually, one wonders who outside of professional ethicists is drawn to either system. In fact, few of them seem willing to identify themselves with either system; in reading bioethics commentaries one is hard put to find any ethicist who identifies him or her self as a utilitarian or a deontologist. Reigning today are is the "system" coming to be known as "principlism." Two bioethicists, Tom Beauchamp and James Childress, seem to have devised this "system" as a compromise (one claims to lean towards rule utilitarianism, the other towards deontology); it evaluates bioethical issues in terms of the principles of autonomy, beneficence, nonmaleficence, and justice. These "principles" are loosely grounded in whatever grounds rule utilitarianism and deontology but mostly are meant to stand alone, as rather obvious principles for those in the health care profession.

Because physicians have historically and one might say naturally been thought to have the function of healing their patients or reducing their pain, beneficence, nonmaleficence, and even justice seem natural principles for bioethics. But the truly reigning principle is the principle of autonomy. We must be free to make our own decisions - and such freedom is much more important than the rightness or wrongness of any choice that we make. We value our right to be wrong much more than our responsibility to be right. Physicians are frequently forced in our culture to abandon beneficence, nonmaleficence and even justice to protect the autonomy of their patients (we need look no further than the legalization of abortion and the growing support for assisted suicide).

One might hope that the dominance of autonomy as a value is rooted in the notion of human dignity, of man being made in the "image and likeness" of God. Natural law ethics and personalism justify a strong interest in helping patients be self-determining for these reasons, but bioethics texts rarely mention natural law and have no awareness of personalism (though feminist and environmentalist ethics occasionally merit a mention.) Rather, the commitment to autonomy seems based primarily on the fact that we are living in an age of moral pluralism; we have so little if any means of coming to any agreement on moral issues. When we are so confused that we cannot agree that partial birth abortions are wrong, what can we agree upon? So, we slide more and more into a culture that permits almost anything - even the "right" to kill others and certainly the "right" to kill one's self.

Although bioethics is dominated by the advocates of the principle of autonomy, more and more it has its critics if only because it is so difficult to honor it in clinical situations. Patients want to trust their doctors; patients often don't know what they think is right, and some of them who do make choices that will cause them great harm and threaten to compromise the moral commitments of the physicians. Physicians are generally at a loss of what to do, besides hoping that their patient will fail the too frequently requested psychiatric consult when their patients make what they think are harmful, foolish, and sometimes immoral choices. They do not want to operate as simple technicians who are there strictly to do the patient's bidding. So sometimes it seems that the battle in bioethics is not between utilitarians and deontologists but between wannabe paternalists and autonomists.

The real opponents, however, are those who think that man is just a more highly developed animal particularly attached to his freedom of choice and who will face no eternal consequences for those choices, and those who think man is made in the image and likeness of God. In this view, since man is rational, free, and relational, he must use his reason and freedom to fulfill his obligations to himself, others, and his God.

Studies show that most Americans are religious and at the bedside priests and ministers are generally very welcome, but from reading bioethics text books one would rarely get the idea that patients are to be urged to draw upon their religious beliefs to help them make their decisions. The Kantian view that one should not let others influence one, that one has to make one's own decisions for them to be fully respectable, lingers in bioethics.

Catholic physicians must take the lead in helping other physicians and bioethicists as well realize that autonomy or freedom is not the greatest good; it is a good only if used to perform one's duties. They may be aided by a close reading of Dignitatis Humanae with its understanding of the balanced interplay between freedom and responsibilities, and rights and duties. We must realize the source of man's freedom: it is a gift from God and the reason for man's freedom: so that we can love and obey God because we ourselves recognize His sovereignty. If so, we must certainly want patients (and seekers after truth) to make their own decisions, but we will also want to help them make the right decisions. If by no other means, physicians can do so by refusing to perform operations and provide treatment they know to be immoral and by being willing to attempt to get patients and their fellow physicians to take into account the possible eternal consequences of their choices. To refuse to do so is to let ignorance rather than truth guide one's decisions and there is no point to freedom unless it is used to grasp and live by the truth.