The National Catholic Bioethics Quarterly

Meeting the needs of individuals who experience vulnerability due to cognitive impairment presents significant challenges to caregivers. Primary caregiver responsibility is often relegated to professionals in hospitals or long-term care facilities, while proxy decision-making responsibility lies with families. The complex relationship among patients, professional caregivers, and families may be further complicated by the relative cognitive capacity of different patients. While some experience diminished cognitive capacity to such an extent that they cannot make any informed voluntary decisions, others may be able to express global preferences and participate more actively in rehabilitative efforts. With reference to Catholic social teaching, I briefly establish the intrinsic dignity of human persons who experience cognitive impairment and then analyze how the web of relationships and responsibilities among patients, professional caregivers, families, and communities ought to be defined. Finally, I consider how these relationships may be optimized to enhance participation in mutually reinforced caregiving and decision making.

Informed consent in research among people with intellectual and developmental disabilities presents challenges for inclusive research—some particular to the IDD community, and some shared with other vulnerable populations. This essay uses my experiences with qualitative research among the IDD community to raise questions about our understanding of consent and about the principle of justice (given the deep-seated inequalities of power and privilege that may exist between a researcher and someone with IDD). I draw on Franklin Miller and Alan Wertheimer’s fair transaction model of informed consent (a response to Ruth Faden and Tom Beauchamp’s autonomous authorization model) to reflect on how structural issues of injustice affect the possibility of fairness in consent transactions with people with IDD. The work of inclusive research requires identifying structural and organizational avenues that can improve fairness in informed consent and assent, as well as improve justice for the IDD community more broadly.

In this paper, I discuss prenatal screening, testing, and diagnosis, before highlighting the literature on the incidence of selective abortion after prenatal diagnosis. For Catholic health care professionals and institutions, the correlation between prenatal diagnosis and abortion is highly problematic. Several authors have discussed the concern of illicit cooperation with selective abortion in this context; and while avoiding any illicit cooperation is necessary, it is not sufficient. Given the biases against disability that exist in both medicine and society, Catholic health care professionals and institutions are called to witness to the ontological and moral truths of our faith regarding the unborn and persons with disabilities by offering prenatal genetic testing and counseling in a radically transformed way.

This essay aims to show why it is important to ask questions about the way Christians raise the question of disability. The central, animating concern has to do with metaphysically thin and philosophically problematic understandings of disability and the way that concept is inflected within contemporary Catholic moral discourse in the areas of biomedical ethics and social theorizing. The essay has three parts. First, through the lens of Gaudium et spes, the author discusses the source of our contemporary questions about disability and related themes. Second, the author surveys overlapping ways of framing the concept disability, as formulated within biomedical ethics, American jurisprudence, the social critique from disability studies, and the sociopolitical subversion of the biomedical outlook from critical disability theorists. Third, given those contemporary frames and in conversation with Fides et ratio, the author sketches some preliminary considerations relevant to a faithfully Christian and distinctively Catholic account of disability.

This essay examines St. Thomas Aquinas’s views on different types of impairment. Aquinas situates physical and moral impairments in a teleological account of the human species, and these impairments are made relative in light of our ultimate flourishing in God. For Aquinas, moral and spiritual impairments are of primary significance. Drawing on Philippa Foot’s account of natural goods, we describe what constitutes an impairment for Aquinas. In the Thomistic sense, an impairment is a lack or privation in relation to that which is appropriate to the human being, known by our nature and ultimate perfection. For Aquinas, perfection lies in the transformation necessary for union with God.

The privation theory of evil (PTE) states that evil is the absence of some good that is supposed to be present. For example, if vision is an intrinsic good, and if human beings are supposed to have vision, then PTE implies that a human being’s lacking vision is an evil, or a bad state of affairs. The mere-difference view of disability (MDD) states that disabilities like blindness are not inherently bad. Therefore, it would seem that lacking sight is not a bad state of affairs. Thus PTE and MDD seem to be in tension. This essay discusses that apparent tension and explains how it might be resolved without doing violence to either view. Given the prominence of PTE in the history of Christian theology, and the wide support for MDD among disability theorists, it is worth finding a way to harmonize these two views.

There is no paucity of academic studies, medical literature, or media attention given to concerns about gender ideology and being transgender. When reporting their findings, however, some researchers and practitioners working from a purely secular perspective overstep medical observations to make metaphysical pronouncements. This causes considerable confusion and stifles dialogue that could occur if the line between medicine and philosophy were clearly delineated. Properly understood, transgender describes an observable distress due to incongruence between one’s birth sex and gender identity. Conversely, gender ideology is a metaphysical conclusion, which argues that a person’s gender is fluid and open to personal choice. Clearly distinguishing between these can help families, clinicians, and society provide medically appropriate and culturally competent care to those with gender dysphoria, especially children.

Academic medical ethics must be a bulwark against a disturbing trend toward post-truth cultures. Activism of course has its place in massive cultural debates like abortion. The fact that so many people care so deeply about these debates is part of what makes them so important. But especially when coming from clinicians, academics, and others to whom we entrust the care of our public discourse, interventions into the debates must be disciplined by a thoroughgoing commitment to engage with the available data to back up the central claims even when those claims seem like common sense—perhaps especially when they seem like common sense.