Ethics & Medics

Five months into the Biden presidency, the administration has demonstrated a dedication to expanding access to and funding for abortion both in the United States and abroad. This is antithetical to the administration’s repeated claim that President Biden is a devout Catholic, as abortion is considered an intrinsic evil under Catholic teaching. His appointments, executive actions, and proposed budget all suggest that the administration will accept no limits on abortion and will, in fact, work to expand both funding and access throughout his presidency.

Attempts to find cures for neurological diseases include research proposals to create better neural organoids and neural chimeras. The primary ethical issues involved here are not so much about neural organoids, but chimeric research. Embryonic chimeras are created with human neural information such that a nonhuman animal would grow human neural components. The older frameworks surrounding animal ethics in medical research are ethically impoverished and thus are not suited to evaluating this emerging research. Consequently, we need more discussion of newer, more comprehensive frameworks that accept and provide for what is necessary for an animal to be the kind of thing that it is. Our success in finding a cure for neurological diseases will dramatically affect the lives of dozens of millions of human beings. But it is precisely when the stakes are highest that we need to be most careful about not discarding important ethical boundaries.

In two addresses given during 1957, Pope Pius XII gave key magisterial teach regarding ordinary and extraordinary means of treatment. The Pope carefully worked out that the duty of providing necessary treatment for the preservation of life and health relates to the ends for which one acts, and the liceity of providing or withdrawing treatment is contingent on whether this transgresses a moral obligation related to these ends: those that concern life and health and those that are spiritual. Thus, caring for the seriously ill should be for one’s life on earth and with God now and in eternity, and the means of treatment must be able to achieve these good purposes and be suitable to the conditions of the ill person and caregivers.

COVID-19 vaccine passports run the risk of creating a divided society where social privileges or restrictions based on “fitness” lead to discrimination based on immunization status. Individuals have a strong right to be free of coercion to take a COVID-19 vaccine, and we should be very leery of further invasion of private medical decisions. These concerns are shared both internationally and in the United States, and the World Health Organization, the Biden administration, and many US governors oppose COVID-19 vaccine credentials. In addition, regulations for COVID-19 vaccine credentials face practical barriers, including lack of access globally, especially among the poor; and lack of scientific data on the efficacy of these vaccines.

Although COVID-19 vaccine credentials for international travel are an unwelcome or dangerous concept to some in the developed world, such measures are an essential component of global public health in some of the poorest countries of the world, in particular to prevent the spread of yellow fever. If one accepts the liceity of vaccine credentials for yellow fever in the developing world, then one has to do the same with similar credentials for COVID-19. A COVID-19 vaccine credential will allow developing countries to reopen their borders and economies long before they can attain herd immunity. It will be a lifeline for economies that have been ravaged by the global pandemic. It will be part of the global common good.

This essay clarifies the author’s objections to COVID-19 vaccine credentials voiced in “The Ethics of COVID-19 Vaccine Passports.” The author’s objections centered on discriminatory practices based on vaccine status for domestic social and work activities, but he agrees with the World Health Organization that these credentials should not be required for international travel. In addition, there is a significant ethical different between currently available COVID-19 vaccines and the yellow fever vaccine because the former are produced or tested using abortion-derived cell lines. The yellow fever vaccine is much less ethically problematic. This situation could change with the approval of new COVID-19 vaccines without links to abortion-derived cell lines.

A theological and historical background is needed for understanding the terms ordinary and extraordinary regarding the care required for one seriously ill. This background is theological, since one’s care is directed to our life on earth and our ultimate happiness that comes from God. So, one needs the knowledge given by God in revelation and in natural law written in our hearts. Besides our own powers of acting, we need the help of others as well as of God, through his grace and sacraments. The historical view is given because situations change, and so our judgment must change. In God’s law, one must eat to live but not if it becomes a torture. Domingo de Soto gave the name ordinary for the former and extraordinary for the latter. With the arrival of anesthesia and antiseptics, the pain and terrible outcomes, which made amputation an extraordinary means, no longer did so.

Conscience rights and public health often come into conflict. Both Catholic social teaching and the natural moral law give primacy to conscience and religious freedom. Those who put public health on a par with conscience and religious freedom, or who imply an equivalence among them, as if they were comparable elements of public policy, are misguided, however well intentioned. Ironically, the common good that is the foundation of the right to public health is harmed by violating conscience and religious freedom. The principle should be clear: all of society, not solely the state, should promote the common good through public health and safety measures insofar as doing so does not violate the dignity of the human person, especially in matters of conscience and religious freedom.

Some Catholic institutions have adopted policies of using persons’ preferred gender pronouns. But is this the best response? The use of preferred gender pronouns would constitute formal cooperation in a falsehood about a person because the body is an integral part of the revelation of who the person is both to himself or herself and to the other. Similarly, the principles of toleration and totality do not justify preferred pronoun usage. Pastoral care of transgender persons ought to seek to balance truth and respect of the human person in order to facilitate real friendship which leads to true healing.

The NCBC recognizes an ethical hierarchy among COVID-19 vaccines. Vaccines that do not use abortion-derived cell lines in any phase of design, manufacture, or testing are the best ethical choice if they are reasonably available, safe, and effective. Vaccines that do not use abortion-derived cell lines in the manufacturing process but did use them at one point in development, such as for confirmatory testing, are preferable to those that utilize abortion-derived cell lines in more than one phase of development and, in particular, in the manufacturing process. Nonetheless, for grave reasons, people could decide in good conscience to accept vaccines that use abortion-derived cell lines in their development and production to protect their own lives and health and that of others in the absence of any satisfactory alternative. The use of an ethically problematic vaccine, however, may be done only “under protest.”

Conscientious discernment—which involves the ability to see right and wrong clearly—is an important task that all people must undertake on a daily basis. It is difficult to properly form one’s conscience, which is not a feeling or a mere moral intuition. To the contrary, it is rooted in object truth and reason; and through conscience, a person recognizes the morality, or immorality, of an act. As a result, moral education—teaching the difference between virtue and sin—is a crucial responsibility of parents. But young people are highly sensitive to hypocrisy, so we must live as examples, resisting complacency and continuing to form our consciences throughout our lives.

Patients with disorders of consciousness have been at the heart of some of the most heated debates on so-called right-to-die cases such as the Terri Schiavo case. People with DOCs occupy a spectrum of disorders from coma to the minimally conscious state. Recent advances in neuroscience have led to insights on the mechanism of these disorders as well as to the revelation that some patients might have a greater degree of awareness than previously believed. These scientific developments have paralleled long-term clinical follow-ups, which have also shown more positive outcomes than expected.

The materialistic premise supposes that a patient’s reduced brain activity indicates that the mind is beginning to approach nonexistence. Such persons may not be brain dead, but they have a life that is close enough to death to allow us to treat them with a certain disregard. For the Catholic, this overlooks the enduring presence of the soul and its two spiritual powers of intellect and will. St. Thomas Aquinas is our best guide to exploring the implications of this view for patients in states of diminished consciousness. The externally observable activity of the brain, even when dramatically lessened, does not represent any loss of the powers of the soul, which continue to function through a combination of natural and divine influences.

The serious concerns associated with abortion may have a technological solution. Artificial wombs, it is argued, offer a compromise to disburden woman of the bondage of pregnancy and to ensure the child’s survival. This essay argues against using artificial wombs to solve the abortion problem because using artificial wombs violates the principle of human embodiment. Artificial wombs cannot participate in the intimacy of human embodiment and therefore deprive the children of the intimacy of their embodiment.

The moral act consists of object, intention, and circumstances. The word intention, as commonly used, is often mistaken for the technical meaning of the word intention as employed by philosophers. This produces confusion in the description of moral acts. The common use of intention signifies motive, or one's reason for action. We commonly say that someone has a good intention even though what he or she does is wrong. For example, we describe someone who wants to alleviate suffering, and so euthanizes a patient, as having a good intention. To the contrary, in the Catholic moral tradition, intention means an action that is done voluntarily and knowingly. A nurse who kills a patient has a bad intention because he or she acts freely and with knowledge. Alleviating suffering is indeed a good motive for action, but motives are formulated through deliberation prior to action.

Embryo models are aggregates of pluripotent stem cells that exhibit aspects of embryonic development. Investigators use embryo models to study mammalian development and prevent adverse outcomes in pregnancy. However, researchers have called for debate on ethical guidelines for the use of embryo models. In addition, the International Society for Stem Cell Research (ISSCR) has announced that it will update its research guidelines to more fully address embryo models. If embryo models are equivalent to human embryos, then they deserve the respect afforded to all humans. The definition of the organismic potential of an embryo model should not require complete mature development or the presence of all of the typical organism’s parts. There are explanatory gaps in the ISSCR’s published recommended guidelines. The research needed to determine the nature of the human embryo model places the model in danger; thus, principled caution is needed in moving forward.

The effects of the novel coronavirus have raised questions about the extent to which social shutdowns are appropriate. We have a responsibility to protect the lives of others and an obligation to maintain our lives and health when possible, but there are circumstances when it is just to decline certain measures that are considered extraordinary to the situation. Measures taken to protect life must be proportionate. That is, they must offer a reasonable hope of benefit and not impose excessive burdens on individuals, families, or the community. The measures enacted during the COVID-19 pandemic are not proportionate. Restrictions on family and religious activities are disproportionate to the benefit they provide, particularly to the extent that they obstruct the Church in its duty to tend to the health of souls and salvation of its members.

The effects of the novel coronavirus have raised questions about the extent to which social shutdowns are appropriate. We have a responsibility to protect the lives of others and an obligation to maintain our lives and health when possible, but there are circumstances when it is just to decline certain measures that are considered extraordinary to the situation. Measures taken to protect life must be proportionate. That is, they must offer a reasonable hope of benefit and not impose excessive burdens on individuals, families, or the community. The measures enacted during the COVID-19 pandemic are not proportionate. Restrictions on family and religious activities are disproportionate to the benefit they provide, particularly to the extent that they obstruct the Church in its duty to tend to the health of souls and salvation of its members.

Meeting the right of the faithful to receive the sacraments can be difficult, especially during the COVID-19 pandemic. The Church needs opportunities to minister to the faithful, especial when there is a danger of death. Remission of sins is of vital importance in these cases. To gain a plenary indulgence, three specific conditions must be met: sacramental confession, Eucharistic communion, and prayer according to the Holy Father’s intentions. A special kind of plenary indulgence, the apostolic pardon, is administered to someone who is in danger of death. It is advantageous because it can be done without making physical contact with the sick or impaired, but also because in times of great need, an apostolic pardon can be prayed for in absence of a priest. Family members and health care professionals can help a patient pray for the apostolic pardon even if he or she is not fully conscious.

Pandemic precaution policies—in particular, extreme restrictions on visitors—have caused a failure of spiritual care for hospital patients, especially those not diagnosed with or at high risk of the disease in question. Many hospitals make significant pastoral efforts for patients. But phone conversations with ordained chaplains and visits by lay chaplains cannot substitute for Confession, Communion, and Anointing of the Sick. It is unreasonable to exclude clergy who have taken appropriate precautions to protect themselves and others, and no urgent medical reason exists to justify denying patients access to sacraments; doing so violates civil rights and religious liberty. Crises calls for greater accommodation of believers in danger of death, who may need a priest even more than a doctor. Serious consideration has to be given as to when the costs of a precautionary policy can no longer be ethically justified.