The National Catholic Bioethics Quarterly

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.

New Natural Law Theory and the Catholic medico-moral tradition often lead to similar conclusions in hard cases regarding end-of-life care. Considering the provision of artificial nutrition and hydration to patients suffering from post-coma unresponsive wakefulness, however, brings to light subtle ways in which NNL differs from the centuries-old natural law tradition. In this essay, I formalize the methodology embedded within the casuistry of the medico-moral tradition and show how it differs from NNL with respect to the role played by double-effect reasoning and the perspective for analyzing cases regarding care for those who cannot speak for themselves. Importantly, the ordinary/extraordinary means distinction has never historically been understood as an application of double effect and logically cannot be so understood. Given the outsized role that double effect plays in NNL, the theory leads to conclusions that deviate from the Catholic medico-moral tradition and creates additional burdens and duties for the sick.

In this essay, we respond to Dustin Crummett’s argument that one cannot consistently appeal to body count reasoning to justify being a single-issue pro-life voter if one is also committed to the usual response to the embryo rescue case. Specifically, we argue that a modified version of BCR we call BCR* is consistent with the usual response. We then move to address concerns about the relevance of BCR* to Crummett’s original thesis.

Cooperation in wrongdoing is an everyday matter for all of us, though we need to discern when such cooperation is morally excluded as constituting formal cooperation, as opposed to material (unintended) cooperation whether justified or otherwise. In this paper, I offer examples of formal cooperation such as referral of patients for certain procedures where the cooperating doctor intends an intrinsically wrongful plan of action on the part of the patient and a medical colleague. I also consider a case of formal cooperation where the cooperator intends a choice on the part of another person that is not intrinsically wrong, but wrong in the circumstances because the person believes it will cause serious uncompensated harm.

Recent magisterial teaching suggests that Catholics should prefer COVID-19 vaccines in which immortalized cells derived from the remains of aborted fetuses did not play a role in production, even though all of them can be licitly used. Many scholars contest any distinction between the different vaccines, in part by arguing that these cell lines have become artifacts. This argument is inadequate on a number of levels. First, these scholars have not sufficiently proven the point that the cell lines become artifacts through biotechnological manipulation. Second, considering cell lines as mere artifacts commodifies them in a way that is rejected even by secular authors. Third, this mode of commodification reinforces the technocratic paradigm. Finally, embracing this commodification of cell lines will prevent moral theology from properly judging other aspects of the growing bioeconomy. These arguments suggest that distinguishing between different vaccines remains the most appropriate course.

The essay begins with an explanation of St. Alphonsus Liguori’s understanding of the distinction between formal and material cooperation, identifying also some problems inherent in that understanding. The essay goes on to expound related ideas in the writings of St. Thomas Aquinas, ideas that are applicable to cases not easily analyzable by means of the distinction between formal and material cooperation. The essay then applies these ideas to two contemporary issues: the use of vaccines connected in some way with abortions and the objection by the Little Sisters of the Poor to the contraceptive mandate issued by the US Department of Health and Human Services.

Pregnancy causes maternal pathology by combining maternal predispositions with healthy physiology. In maternal cardiovascular collapse, previable induction of labor is justifiable despite the definition of abortion in directive 45 of the Ethical and Religious Directives for Catholic Health Care Services. Central to this conclusion, the placenta is a fetal organ, and pregnancy is a cardiovascular condition placing new demands on the maternal cardiovascular system. Previable delivery, a morally neutral separation, addresses the cause of pathology even if fetal death is anticipated. This is acceptable under double-effect reasoning. Directive 45 defines all previable deliveries as abortions, so this analysis proposes an alternative definition established by obstetrician/gynecologists.

Often-cited papal pronouncements regarding organ donation emphasize the importance of gift giving and the consent of the donor. However, a critical reading reveals an ill-defined separation of living organ donation and donation after death. Given that a corpse cannot engage in gift giving, nor can it give consent, the family, acting as good stewards, is the proper decision maker for organ donation after death. A historical examination of relics and human anatomical dissection reveals that the Catholic Church has primarily favored the decisional authority of the family over the first-person consent of the dead. Given this history, family-based consent (as opposed to opt-in or opt-out criteria) is the best model to ensure the dignity of the dead.

When threatened with rape, is it permissible for a virgin to commit suicide so that she might preserve her virginity? Both St. John Chrysostom and St. Ambrose allowed for suicide in these situations because they considered it a martyrdom, but St. Augustine argued that such an act is always illicit unless commanded by God, a teaching later adopted by St. Thomas Aquinas. In this paper, these arguments will be presented and then applied to cases of vital conflict, which involve many of the same principles disputed by these Doctors of the Church. This article contributes to the discussion of vital conflicts by reinforcing its patristic and Thomistic foundation.