The National Catholic Bioethics Quarterly

Although there is discussion among ethicists about the permissibility of actions on the antenatal placenta, these discussions rarely take seriously the metaphysics involved. Rather, authors resort to opinion on how the placenta comes to be and for whose good it exists. This paper takes these metaphysical questions seriously. Through discussion of the biology of the placenta, I conclude that it is a shared organ of the mother and the fetus. In an analogy to the ethics of conjoined twinning, I conclude that actions on the placenta must take the good of both the mother and the fetus into account.

Abortion jurisprudence in the United States has been criticized by many for allowing the destruction of millions of lives. What many may not know is that the Supreme Court decision which legalized abortion in all fifty states was very similar to another Supreme Court decision, namely, Dred Scott v. Sanford. The parallels between these two cases are astounding, revealing how dehumanization, while a very old idea, is almost always achieved through the same means. A legal analysis of Roe v. Wade, and subsequently Planned Parenthood v. Casey, shows that these cases are both morally and legally unjustified. Just like Dred Scott, Roe, by dehumanizing a specific group of individuals, is a case which does not belong in the American legal system.

The question of when human life begins is critical in debates related to life issues. While there are a variety of proposals as to how an organism should be defined, many biologists and ethicists, particularly Catholics, have approached this issue by arguing that fertilization defines the beginning of a new organism. Examining the processes of fission and fusion, which take place before gastrulation, provides strong evidence for when human life beings and therefore how it should be defined. Among the four dominant theories, regulative fission and fusion are the best explanations in terms of being the most consistent with the biological data. This explanation of twinning provides compelling evidence that fertilization is not a necessary condition for human generation, although it may be a sufficient condition. While fertilization generates the vast majority of human beings, additional human beings may rarely be generated during fission events.

When discussing the morality of gonad transplantation for procreative purposes, it can be tempting to examine the act solely qua reproductive technology. This paper, instead, compares the gonad to the kidney and evaluates the act qua organ transplantation. First, the author expounds a hierarchy of organs in relation to personal identity. Next, after considering an organ’s subjective effect on identity, the author elucidates an organ’s objective effect by ranking the powers of the soul and the goods of the human person. The hierarchy of organs shows the gonad to be among the highest organs and most perfective of the human person. Because of the gonad’s highly personal nature, it cannot licitly be directed to another’s good.

The preferential option for the poor is a concept and set of ideas in Catholic social teaching that is highly relevant to bioethics scholarship and practice. The option for the poor is mentioned frequently in the bioethics literature but with little specification of its history and implications for ethical and theological analysis. This article examines the origins and implications of the preferential option; compares it to critical race theory, which dominates current debates about discrimination and oppression; and proposes a set of principles for further application in bioethical scholarship and discussion.

In this paper, the author takes the perspective of the patient who is very ill and facing death and examines the traditional ethical question of whether forgoing medical treatment, including artificial hydration and nutrition, is equivalent to suicide. She approaches this question by way of a discussion of St. Thomas Aquinas and Aristotle and via a critical look at David Hume. At the end, she turns to Elizabeth Anscombe for the light that this twentieth-century philosopher sheds on the question.

This essay criticizes the subjective understanding of “best interests” adopted by the United Kingdom’s Mental Capacity Act 2005 and by the 2018 guidance of the British Medical Association and the Royal College of Physicians on the provision of clinically assisted nutrition and hydration to incapacitous adults. The key criticism is that such an understanding wrongly values people’s preferences above their lives.

Clinical decisions about medically assisted nutrition require practical wisdom: a goal-directed virtue that makes decision-making purpose-oriented rather than intervention-focused. This deliberative process includes seven basic dimensions: diagnosis, prognosis, test or treatment, burdens, probabilities, goals of care, and clarification of diagnosis or prognosis. These must be integrated within a larger framework of meaning constituted by foundational beliefs and values—for example, social, philosophical, or theological perspectives on human identity, dignity, and purpose—that are substantive enough to explain the clinical context and clear enough to guide a reasoned response to it. This framework, which combines goal-oriented reasoning with empirical data, can clarify the assessment regarding the benefits of percutaneous endoscopic gastrostomy for persons with advanced dementia.

This essay claims that one can consistently maintain a sanctity of human life principle that is explicitly grounded in theology, while making a kind of quality-of-life judgment regarding withholding or discontinuing life-sustaining treatments for those with advanced illnesses. For those who embrace them, resources that are specific to the Christian tradition delineate the parameters of responsibility for people dying with advanced illness and those who care for them. Those who embrace the sanctity of human life for the theological reasons provided in this essay are under no moral obligation to continue merely to sustain life at the end of life—that is, when, in view of our best available judgment, the human being (who remains inherently valuable nonetheless) will not ever be able to exemplify other human values that contribute to human flourishing, theologically understood.

In this essay, I discuss the role that vocation plays in assessing the proportion of burdens to benefits in end-of-life options. I then look at the case of patients in a persistent vegetative state. What vocational considerations are relevant for persons considering what care to accept should they ever be in a PVS or for those caring for patients in such a state? Ultimately, I argue that the vocational shape of a patient’s life ought not to be a consideration for a caregiver in favor of removing artificial nutrition and hydration.