The National Catholic Bioethics Quarterly

Physically enhancing brain–machine interfaces communicate elec­tronically with the patient’s mind in both directions. They present significant opportunities to improve a patient’s health and to restore his or her physical function, but they also present problems for the patient’s sense of agency and self. This is exacerbated by notions of extension and enhancement that are not grounded in an authentic human anthropology that describes the inherently dignified person as an integral union of body and soul.

An exchange between Christopher Tollefsen and Steven Jensen highlights the contrast between a theory of natural law that relies purely first-person account of intention and one that relies more on elements from the physical world. Tollefsen, a proponent of New Natural Law theory, argues that the fetus’s death in the Phoenix case was an unintended side effect of saving the mother’s life. Jensen criticizes NNL generally and particularly for this conclusion. He argues that facts outside the agent make this procedure immoral. This essay provides a more neutral perspective on the debate by laying out each argument clearly and identifying the fundamental issues present in the discussion. A fundamental and probably irreconcilable difference involves whether certain intentions should be included in the species of an action or characterized as fairly or unfairly accepted side effects. Nevertheless, the differences between these two accounts are not as great as they initially appear.

Female genital mutilation/cutting is a multifaceted, culturally entrenched issue. In response to the United States Conference of Catholic Bishops’ resources dealing with the issue of FGM/C, this paper explores what resources sexual ethics can provide Catholic hospitals facing this issue, specifically with regards to the request for reinfibulation (the restoration of infibulation, also called FGM Type III). FGM/C ought not to be treated as a univocal medical practice; rather, in natural law evaluations of the act, the practice of reinfibulation ought to be separately acknowledged. Reinfibulation cannot be properly considered a mutilation in the same way that other types of FGM/C are. Thus reinfibulation should be performed in Catholic hospitals for those women who request it, as part of delivering culturally competent care, justifiable through the principle of material cooperation.

Body identity integrity disorder (BIID) is experienced by a small percentage of the population, whose idea of how they should look does not match their actual physical form. The most common manifestation of BIID is the desire to have a specific limb amputated. In a small number of cases, the desire is not for the removal of a limb, but to be blind or paralyzed. There has been a lot of discussion regarding the possible physiological, neurological, or psychological etiologies of BIID. This paper examines the ethical implications of the different approaches to help those with BIID. These approaches and the dilemma that doctors face in cases of BIID are the subject of the final section, which offers some tentative ethical conclusions regarding this disturbing disorder.

Contemporary mental health professionals exhibit interest in integrating spirituality into the services they provide to clients. This clinical integration raises questions about both the goals of mental health services and the professional relevance of mental health providers’ spiritual competency. Drawing on the Christian anthropology of St. Thomas Aquinas, Benedict Ashley’s approach to psychotherapy differentiates psychopharmacological, psychotherapeutic, and spiritual approaches on the basis of the different domains of a client’s personality. These domains are the focus of different professions, and Ashley’s account suggests that mental health providers who lack additional spiritual-moral training should adopt a clinical model that recognizes their work is spiritually oriented but not spiritually directive.

In 2018 the Congregation for the Doctrine of the Faith issued a responsum ad dubium, addressing the question of whether a hysterectomy is morally licit in cases wherein miscarriage is foreseen with medical certainty if the woman were to conceive. The CDF responded in the positive, explaining that “it does not regard sterilization.” The responsum provoked great controversy, with some commentators wondering at the prudence of issuing the teaching, and others questioning whether it represented a departure from the Catholic moral tradition. This paper looks at a further area of concern in the reasoning of the responsum, namely that it departs from an essentialist account of the human person and of the organs and systems within the human body, and it moves toward a functionalist account of the meaning of the body and bodily systems as arising from whether they are functional. This represents a distressing shift in language from the previous hermeneutic employed by the magisterium, which could open the door to further controversy.

The National Catholic Bioethics Center’s (NCBC) commentary on the Congregation for the Doctrine of the Faith’s 2018 responsum concerning hysterectomy fails to address the explicit reasoning that the CDF offers to justify its response. The CDF does not condone the hysterectomies in question as indirect sterilizations, justified by double effect. Rather, it defines procreation—and consequently sterilization—such that the moral categories of direct and indirect sterilization are not applicable in such cases. The CDF responsum is far more radical and consequential than the NCBC commentary acknowledges. The responsum provides Catholic ethicists with an occasion for a necessary conversation that can be had only once the reasoning of the 2018 responsum is taken seriously in its own right.

In Evangelium vitae, Pope St. John Paul II addresses euthanasia and physician-assisted suicide by striking a balance—maintaining the inherent dignity of all persons while considering the lived experience of those struggling to see dignity amidst suffering. Subsequently, a debate about the word dignity has led to clarifications from the President’s Council on Bioethics (under President George W. Bush) regarding different uses of the word. This essay relies on the work of the council, especially an essay by Edmund Pellegrino, to provide a basis for reflecting on John Paul II’s approach to dignity in Evangelium vitae in terms of concept and lived experience. To further develop these insights, an alternative framework is proposed for thinking about dignity in the practical setting.