BIOETHICS – LONG EXAM

1. How does Verhey trace the development of bioethics? What roles does Cahill identify for theology in contemporary
“public” bioethical discourse?

Development of Bioethics
 Jesus ben Sirach urged Jews to regard physicians and medicine as gifts from God (OT, 180 BC)
 Hippocrates saw medicine as part of religion. Nature was sacred. To study and heal nature were religious acts.
(Gk, 5 BC)
 Early church rejected magical practices (late Roman Empire) but accepted medicine as a form of healing (not
sign of a failure to rely on God). Not anything and everything medical was approved but was set in the context
of the story of Jesus of Nazareth (NT, 2nd -3rd AD)
Jesus the Healer/the Great Physician
 Provided model for physicians and called them to discipleship; medicine to serve the cause of God
 Life and health as great goods but NOT the greatest goods; pursuit of health was not to dominate life.
Jesus walked steadily and courageously towards suffering and death. Life and health are only part of a
larger good.
 Sickness and death as evils but NOT the greatest evils.
 Sickness and health to be oriented to God’s cause. God’s cause included health but not reduced to it.
Medical art was to serve God’s glory.
 adopted and adapted medical ethic epitomized by Hippocratic oath in memory and praise of Jesus the
Healer (Christian version began with doxology)

Jesus the Sufferer

 memory of Jesus prompted the “most revolutionary and decisive change” in the tradition of medicine: the
sick were ascribed a preferential position: sick were the image of the Lord; care for the sick was care
for the Lord (Mt 25:31-46)
 Christians turned to, cared for and attended the sick and dying, practicing hospitality as a duty.
 Some Christians died in caring for the sick, giving witness (martus) to their memory of Jesus and their hope
in Him.
 Since care for the sick was a duty, confession was mandatory for physician’s incompetence and
negligence. Physicians decreed by 4th Lateran Council (1215) to admonish the sick to make confession
(care of the sick not reduced to medical care)
 Since life and health are not the greatest goods, the sick may not have recourse to sinful means for
recovery.

Jesus as Preacher of “Good News” to the Poor (Lk 4:18)

 Words of blessing to and works of healing for the poor were a token of God’s promise of a good future
 Church took the lead in provision of medical assistance to sick and poor (early Middle Ages to Modern
Period)
 Hospitals originated from Christian remembrance and concern for the poor until it became a civic
responsibility.
 Origin of Church’s long tradition of charitable institutions

In summary –
 There was a long tradition of Christian reflection concerning bioethics before the field was invented.
 Christian reflection about medicine was deeply influenced by Scripture which was somehow normative for
bioethical issues.

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 Renaissance of Bioethics

Mid 20th century, new powers of medicine [experimentation and protection of human subjects; transplantation;
definition of death; kidney dialysis; allocation of scarce medical resources; prenatal diagnosis and genetic counseling]
gave rise to new moral questions and resurrected some fundamental ones: sanctity of life, death and its (in)dignity,
human suffering and the appropriate response to it, human freedom, goals and limits for human mastery over nature

Response of theologians using Christian tradition:

 God is God alone.
 Professional commitment of fidelity to patients as persons vs. reduction to pathologies; consent as fundamental
component
 Embodiment vs. reduction of patients to their capacities
 Concern for the poor and least in response to debates about health care access
Religious voices were raised in public contributing to renewal of bioethics. The indebtedness of a mind or of reasons to
a theological tradition was not assumed to limit the relevance of anyone’s normative conclusions.

Secularization of Bioethics
 Characteristics: preoccupation with moral dilemmas, focus shifted to public policy and demands of pluralism
 The enlightenment of bioethics undertook to identify (sometimes justify) and apply those moral principles that
all can and must hold on the basis of reason alone; thus universal, impartial, unbiased and compelling,
independent of any community or history; religious questions and traditions marginalized: God does not exist or
matter in the conversation. Bioethics was secularized.
 Bioethics confident in unqualified reason, scientific progress; celebrating individual preference and autonomy
against authority of priest (religion) and king (government and physician) without ensuring responsible exercise
 Discontent: faithful members of religious communities want to live and die, give birth and suffer, care for the
suffering with religious integrity and not impartial rationality; call for renewed attention to relevance of
theological traditions and religious convictions  awakening
 A. MacIntyre (philosopher) challenged theologians to: state what difference it makes to morality to be a believer
rather than a secular thinker; make a theological critique of secular morality and culture; to identify the
implications of such faith and criticism for bioethics
 D. Callahan (one of pioneer bioethicists): Secularism led to morality being confused with or reduced to legality
(minimalist) and bereft of wisdom and knowledge from religious traditions (illumination re: meaning of our shared
humanity); made us deny our moral identity and passion for the sake of a religiously neutral moral language for use
in public discourse (denial of differences does not contribute to community-building)
 Genuine pluralism will be served by sincere articulations of various points of view.

Roles of Theology in contemporary “public” bioethical discourse (Cahill)

1. Internal/identity concerns (ad intra): in interaction with other sources of moral norms, clarify the shape of the
religious community’s life in bioethics; affirm the values and commitments that should support the identity and
challenge the decision-making of its members
2. External/prophetic function (ad extra): move the religious community to active participation in the broader or
overlapping of communities through a prophetic function –
 Challenge civil community to consider neglected values and alternatives
 Introduce particular values in order to reconfigure the governing narrative
 Hone the critical edge of religious interest in bioethics by bringing in religious sensitivities to certain Biblical
themes (well-being of creation; God’s providence; human responsibility, sinfulness and finitude; love of
neighbor; preferential option for the poor; mercy) that speak to non-religious values (service, solidarity, social
integration, human dignity, advocacy for the vulnerable, sensitivity to human limitations)
 Create patterns of moral action that correspond to the community’s religious commitments

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 Also through a more precise analytic level – for traditions with a shared commitment to mutual criticism, to develop a
common language of moral analysis and progress towards consensus:
1. Construe theological contributions as overlapping with philosophical ones
2. Recognize that there is no universal and neutral language to use in ethics
3. Adopt a stance of dialogue and openness, mutual critique, commitment to consensus and refinement of
institutions and policies affecting common life
4. Enter public discourse, embodying a commitment to civil exchanges and meet on the basis of common concerns
5. Ask practical questions dealing with enabling and limiting conditions of various practical social options rather
than remaining on the level of ideals
Consensus is contingent on intelligibility and persuasiveness within a community of communities.

2. What does the Catholic Church mean to say when it upholds the “sanctity of life”? How is it qualified? What are its
implications? How can it be promoted effectively?

Sanctity of life
 Core presupposition on immense value of human life based on the inherent dignity of the human person (created
in the image and likeness of God) which is to be respected and defended
 Donum Vitae (1978, CDF) sanctity of human life is based on: God’s creative action at its genesis; a special
relationship with God as its sole end; no one has the right to destroy directly innocent human being [guilt however
does not take away human dignity; innocence is not the basis of dignity]
 Evangelium Vitae (1995, JP II) affirms sacredness and inviolability of human life (57); Man alone, among all
visible creatures, is "capable of knowing and loving his Creator". The life which God bestows is much more than
mere existence in time. It is a drive towards fullness of life; it is the seed of an existence which transcends the very
limits of time: "For God created man for incorruption, and made him in the image of his own eternity" (Wis 2:23).
(34)
The Church affirms the sanctity and inviolability of life
- because God is sacred and inviolable (53)
- Life is sacred. God alone is Lord of life. It is outside human dominion and entrusted as a treasure. (52)
- All have equal right to life. (57) “Because there can be no freedom apart from or in opposition to the truth, the
categorical — unyielding and uncompromising — defence of the absolutely essential demands of man's
personal dignity must be considered the way and the condition for the very existence of freedom…Before the
demands of morality we are all absolutely equal.” (VS 96)

Sanctity of Life posits the Gospel of Life

- (3) stress on reverence for man; consider every neighbor without exception as another self, taking into
account his life and the means necessary to living it with dignity…whatever is opposed to life itself, such as
any type of murder, genocide, abortion, euthanasia or willful self-destruction, whatever violates the integrity of
the human person, such as mutilation, torments inflicted on body or mind, attempts to coerce the will itself;
whatever insults human dignity, such as subhuman living conditions, arbitrary imprisonment, deportation,
slavery, prostitution, the selling of women and children; as well as disgraceful working conditions, where men
are treated as mere tools for profit, rather than as free and responsible persons; all these things and others of
their like are infamies indeed. They poison human society, but they do more harm to those who practice them
than those who suffer from the injury. Moreover, they are a supreme dishonor to the Creator. (GS 27)
- Gospel of life is not simply a reflection…nor a commandment aimed at raising awareness and bringing about
significant changes in society. Still less is it an illusory promise of a better future…It is concrete and
personal…embodied in the very person of Jesus. (29-30)
- Celebration in Love through heroic actions of self-gift (86)
- Shines through even in suffering, united with Our Lord’s (67)

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 Proclamation of Gospel of Life is the Church’s mission
- Service of love committed to ensure that life may be always defended and promoted, especially when weak or
threatened; a social concern to make unconditional respect for human life the foundation of a renewed society
(77)

Qualified Value (exceptions to respect for human life)

 JP II: give up body for a greater good (martyrdom) (EV 47); self-defense (55); extremely rare use of capital
punishment (56)
 Farley names contexts which limit the obligation to preserve life: for personal integrity/faith witnessing
(martyrdom); conflict between human lives (when some but not all can be saved e.g., self-defense, war, rationing
scarce medical resources, capital punishment); respect for individual autonomy (refusal of medical treatment);
quality-of-life considerations + respect for autonomy (not force-feeding conscious patients in nursing homes);
medical futility (forego treatments that do not reasonably extend life)

Implications:
 Life is a great good that must be respected, nurtured, protected and promoted yet not an absolute value
 There are circumstances and situations that justify the giving up/taking of a life based on other values

Effective Promotion:
New contexts (from advancing technology) pose multiple threats to life: How do we decide what we ought to do and what we
should never do?
 Have a consistent ethics of life across various issues and situations: generics, abortion, capital punishment, modern
warfare, care of terminally-ill, etc.
 Cultivate a social attitude/atmosphere for sustaining the ethics of life; opposition to certain issues threatening life
must be only be seen as specific applications of a broader attitude re: respect for life
 Articulate viable principles to guide individual and institutional actions (there exists among several issues an inner
relationship not only on the level of general attitude but at the specific level of oral principles); e.g., respect for right
to life must be applied both to abortion and military attacks on civilian centers; support for quality of life
(complementary to right to life) especially for the powerless must also be part of public policy (public programs for
the old and young, hungry and homeless, undocumented immigrant and unemployed worker)
 The consistent ethics of life must be held by a constituency bound by consensus, sharing its vision to the wider
society with two distinct challenges to consider in the dialogue: the substance of Catholic position on the ethics of
life must be shaped by our religious convictions stated in non-religious but morally persuasive terms; and the style
of maintaining civil courtesy (vigorously state our case while attentively listening to the other; test the other’s logic
but not question motivations)

3. What is the nature of healthcare as mastery over life, as the exercise of human causality in health and life? What is
the manner of healthcare as mastery over life, as “playing God”?

1. What constitutes respect for sanctity of life: unrestrained human intervention to preserve or improve human life
or deliberate non-intervention to preserve the natural (divine) cause of life, sickness and death?
2. The question on human mastery over life: Is healthcare a cooperation with or a contradiction of God’s creative
plan? What we can do does not of itself tell us what we should do. Human and divine causality are seen in
opposition rather than in creative tension.

Mastery over life involves both divine and human causality.

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 3. Dualism – analytic approach that tends to split the whole into opposing parts (often one superior, the other inferior)
and stress dichotomy; the manner of determining the relationship between divine and human causality causes
problems: “God causes a fatal disease, established it as “nature” and wills it to be closed to human
transformation.” We then contradict God by trying to cure it. “God is intruding as an opposition to world and
human causalities.”
Christians must reject 2 extremes: reductionist naturalism (atheistic denial of divine causality) and reductionist
supernaturalism (against science and medicine; disasters and disease are forms of divine punishment)
4. Holism –synthetic approach emphasizing integrity of the whole and contribution of its distinguishable parts
Dangers: when used vaguely (referring to everything as good and beautiful), resists criticism and covers up sloppy
reasoning; when keeping only the part we like and calling it the whole, becomes monism
Human and divine causality are different/distinct but inseparable aspects of creative causality.
OT: God has a direct hand in wars, disasters and sickness; God praises human cooperation in the legitimacy and
conduct of kings and physicians
Catholic tradition: health care is both properly a Christian task and vocation
Aquinas: nature is not opposed to grace rather builds on it; God is primary cause but works through created
secondary causes; “conditioned necessities” can be rightly altered using patterns of causality; medicine is a skilled
art that draws on the knowledge of patterns of causality embedded by God in creation; divine and human causality
cooperate. However, Aquinas continued to think in terms of 2 separate levels/orders.
From human causality, we learn our nobility, freedom, creative energies, capacities to transform the universe and
to participate in creative energies of God.
From divine causality, we learn our limits, sinfulness, the fact that we are not God.

Mastery over Life as “Playing God”: Perspectives

1. Secularist:
- highlights amazing capabilities of science without providing a helpful guide/limit for its use
- God is superfluous/ nonessential and “play” is replaced by “serious science”; science taught us we are not the
center of the universe but not where we do belong; hence, we have used science to master the world and attempt
to put ourselves at the center, to make ourselves the center, yet new human powers and their unintended/
unanticipated consequences evoked new anxieties
2. Religious reactionary:
- regards scientific inquiry and progress as threat and offense to God; “It’s not nice to fool with Mother
Nature.”
- a pious preservation of the God of the Gaps (locates God’s presence and power where human knowledge and
strength have reached their [temporary] limit; God is in miracles and the extraordinary), lamenting intrusion
into God’s domain (areas where we are ignorant and powerless) because where science can explain, God is
not needed.
- Problems: this is not the God revealed in creation and Scripture who made and sustains the order we rely on
(to describe this order in scientific terms is simply to give an account of how God orders the world and does not
to explain God away; mastery over nature is not mastery over God); the perspective is indiscriminate (there
are things we already know how to do but ought never to do; there are things we cannot yet do but must learn to
do as disciples of a God who heals and feeds)
- BUT God is not opposed to scientific progress/ Mother nature is not God.
3. Messianic: (position of Joseph Fletcher)
a. Taking over the responsibilities of an absent or dead God; “new God” is a heavenly utilitarian
b. Puts a messianic burden on science and leaves little time for play; underscore human responsibility: humanity
is maker and designer and nature must be mastered to maximize human well-being
c. Operates by a principle of utility: whatever achieves the greatest good for the grates number of people
d. Problems: discipleship and imitation as the utilitarian way is alien to the God in Scriptures; morality reduced
to consideration of consequences; knowledge is just power; nature (including human nature) is robbed of dignity

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 4. Imitation: (position of Paul Ramsey)
a. Fundamental perspective from which we interpret our responsibilities is critical: God creates and keeps a world
and a covenant and the end of all things is to be left to Him. God is in control and there can be a certain
eschatological nonchalance. Our responsibilities are great but not of messianic proportions.
b. Makes room for an ethic of means as well as consideration of consequences
c. Includes prohibitions re: what God would not do e.g., separating unitive and procreative goods of human
sexuality, reducing procreation to biology or contract, deliberate killing of patients to relieve them of suffering,
using another without consent even to help others (experimentation with human subjects that violates rights)
d. Imitation: playing God like a child “playing” a parent: therefore God is not us and we honor and nurture the
nature God gave; utility is put in its proper place and created things (especially human persons) are not valued as
means to an end; playing is serious but not purely instrumental, not reduced to the consequences of winning or
losing (morality is not reduced to a concern about consequences even when the stakes are high)
e. The God we are invited to play (Jewish and Christian tradition): Creator (delights in nature and saw it as good;
took a day off to rest/play; human creativity given for dominion is in service to God’s cause: stewardship); Healer
(intends life and human flourishing and not death and suffering; genetic contributions in medical diagnosis and
therapy are to be celebrated but not disposed to abort); Pro-poor (concerned for social justice with fair
distribution of resources and considerations of who benefits and who bears the burdens; does not use and destroy
life for learning with great benefit for a great number; concerned about use of genetic technology for market
purposes; treating all as worthy of God’s care and affection)

4. Explain each of the following bioethical principlesits values, limits, its various applications, and its
interrelationships with other principles:

Four Principles Approach – a set of bioethical principles that functions as analytical framework for expressing the central
values underlying bioethical practice
An ethical decision requires considering all four: respect for autonomy, nonmaleficence, beneficence, justice

1. Respect for autonomy

Respecting decision-making capacity of autonomous persons;
Respect is due to a substantial (not complete) autonomy and when lacking demands an appropriate surrogate;
Involves both respectful attitudes and actions; noninterference but also active fostering of conditions for
autonomy;
Crucial role of patient in decision-making since s/he bears the consequences of medical treatment
Values: recognizes person’s unconditional worth, acknowledges patient’s right to hold views, to choose and act
based on personal beliefs and values, to live out a self-plan; privacy; fosters collaborative decision-making
Limits/Dangers: excessive individualism (neglects our social nature and social impact of individual choices:
considers choices that that endanger public health, cause others harm or require allocation of scarce resources); must
not undermine collaborative nature of ethical decisions; excessive focus on reason (neglects emotions and spiritual
beliefs); undue legalism (highlighting legal rights and downplaying social practices e.g. cultural traditions,
professional codes and ethics); must not interfere with/encroach on the autonomy of others
Applications: obtaining informed consent
Interrelationships: can at times be overridden by competing moral considerations (e.g., justified lie due to
beneficence; justified paternalistic interventions); related to truth-telling, respect for privacy, protection of
confidential information, informed consent for interventions

2. Informed consent or refusal (expression of respect for autonomy)

Varieties by mode: express (explicit), tacit (implied by silence or passive omission), implicit (inferred from actions
e.g., consent to one procedure is implicit in a specific consent to another procedure), presumed (problematic when

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not based on person’s actual choices or values or based only a general theory of human good or the rational will,
e.g., organ procurement from a cadaver, HIV testing [carries psychological and social risks] of hospital admittees)
Varieties over time (beliefs and choices shift over time and prior choices can be reversed): advance directive or
living will (valid and honored if person no longer autonomous); deferred or future consent (consent to another’s
action after it has already occurred, retroactive – not really consent)
Limits/Ethical and Legal conditions:
a. sufficient information (purpose of procedure, anticipated benefits and risks, alternatives, hoped-for results)
may be withheld – if it will render patient incompetent to consent; for research purposes provided it is
essential for obtaining vital data, treatment does not cause substantial harm and patient is informed about the
withholding of information until research is over
b. comprehension: patient assisted to process the information and understand the practical and moral
implications of the decision on personal health, lifestyle, values, religious beliefs, relationships, society; when
not possible, an appropriate surrogate must act in the patient’s best interest
c. freedom: acting without external coercion or undue influence; voluntariness does not imply freedom from all
pressure or persuasion in a given circumstance

Case of Minors: Emerging capacity for informed consent/refusal

- in general, minors give assent to parental consent for treatment
- types of minors: emancipated (married, already parents themselves, living apart securely); legal minors
(granted by some states to consent to certain procedures without parental permission: abortion, contraceptives,
STD treatments, drug rehabilitation); mature (demonstrate sufficient maturity in fulfilling requirements of
informed consent)
- limitations: minors often lack capacity to comprehend because can only focus on immediate consequences of
pain and suffering rather than on integrating temporary discomfort into an overall view of life; developmental
psychology identifies 31-14 year-olds as having the capacity, each case needs careful study that considers
maturity, life experience, severity of the disease and complexity of required treatment

Consent by Surrogate or Proxy

- surrogate: a person who knows the patient well and has loving concern for his/her well-being; usually
parent, spouse or relative
- conditions for use: patient cannot give consent due to lack of comprehension and/or freedom; the surrogate is
able to determine what the patient would’ve decided based on familiarity (preferences, values, commitments,
concerns) and if that’s not possible, based on patient’s best interest (relief of pain, restoration of function,
sustaining quality and extent of life)
- limits/cautions: decisions by surrogate are for the good of the patient, not of higher good of society or a social
class (not absolute but protects the most vulnerable e.g., neonates); conflicts between potential surrogates,
questionable decisions (not in the best interest of the patient but for personal gain) where physician may
recourse to civil law

Philippine Context
- autonomy is exercised mostly by deferring to the family and its practices; the extra chair in the doctor’s office is
for the companion-relative; sometimes the relative is the primary dialogue partner rather than the patient
Role of the Family
- asks for and receives information and gives consent for treatment
- acts as patient advocate protecting patient from presumed harm of knowing his/her diagnosis and having to
decide; information is withheld from patient unless he/she asks and family judges that the person is able to
handle such or information is couched in euphemistic terms to avoid the unpleasant, painful, or frightening
reality (bukol for cancer; weak lungs for TB)

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 - selects the physician based on familiarity (usually a relative or friend regardless of the illness of the patient and
the expertise of the doctor) : personalism
- competes with the physician in giving medical advise
- provides social support (money, time, religious connections)
Role of the Patient: to recover from the illness and leave the rest to the family

3. Nonmaleficence (primum non nocere): refrain from intentionally causing harm and do not impose risks of harm
The principle and its rules present negative prohibitions of action that must be followed impartially.
Harm: not limited to unjust or maliciously intended rather whatever thwarts, defeats or sets back one’s interest
In general, acts of harming are prima facie (first sight) wrong regardless of any justification or relativity (not wrong
on the whole).
Applications:
Rules deriving: Do not kill, cause pain/suffering, incapacitate, offend, and deprive others of goods of life.
Standards of due care i.e., sufficient and appropriate to avoid causing harm and risks of harm insofar as
circumstances reasonably permit or dictate; failure amounts to negligence and example of which is professional
malpractice
Provides moral basis for legal action when not followed
Informs treatment and nontreatment decisions: Medical goals must justify the risks imposed.
Limits: The principle and its derivative moral rules are not absolute. Their weight varies in different
circumstances.
Interrelationships: Generally obligations of nonmaleficence are more stringent than beneficence and in cases of
conflicts, overrides them even if acting beneficently yields the best utilitarian outcome (cf. a surrogate cannot decide
in favor of society or social goods if the treatment will harm the patient e.g., high risk experimental therapy; use of
and eventual disposal of in-vitro babies for genetic studies). However, there are instances when obligations of
beneficence can override those of nonmaleficence (public health programs yielding major benefit for many
people while causing minor harm for a few).

4. Beneficence
moral obligation to act for the benefit of others taking into consideration the risks; the principle and it rules present
positive requirements of action at times need not be followed impartially
Obligatory beneficence: arises out of special relationships (family, friend, professional)
Nonobligatory moral ideals: specify the maximum
Conditions for use:
It is generally impossible to act beneficently toward all persons all the time. Beyond the obligation stemming from
the context of special moral relationships, it exists only when the following conditions are met:
Assuming X is aware of relevant facts -
1. Y is at risk of significant loss of or damage to life/health.
2. X needs to act (alone or with others) to prevent this loss and damage.
3. X’s action has high probability of preventing it.
4. X’s action would not present significant risks, costs or burdens to X.
5. The foreseen expected benefit to Y outweighs any harms, costs or burdens X is likely to incur.
Condition 4 is critical because if all conditions can be met except this one, the action would not be
obligatory on grounds of beneficence.
Applications:
- Rules deriving: protect and defend rights of others; prevent harm towards others; remove conditions that will
cause harm; help those with disabilities; rescue the endangered
- Justification for preventive medicine and active public health interventions
- Helps differentiate obligations towards society, strangers in general or those in particular circumstances, and
persons with whom one has special moral relationships (kinship, professional contract/agreement)

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 Limits: determine which actions produce benefits sufficient to warrant their costs; not absolute; rarely provide
reasons for legal punishment when not followed
Interrelationships: Principle of utility is an extension of positive beneficence that involves balancing probable
outcomes (benefits, harms, costs) to achieve the highest net benefit but does not determine the overall balance of
obligations. Conflicts between beneficence and autonomy (paternalism) arise when physicians think a patient’s is
not medically sound; neither has the overriding authority but beneficence provides the primary goal and rationale
for medicine and healthcare while respect for autonomy (with nonmaleficence and justice) sets moral limits on the
professional’s actions in pursuit of this goal.

5. Justice (distributive): fair, equitable and appropriate distribution of what is owed to persons
Problems arise under conditions of scarcity and competition to obtain goods or to avoid burdens
Material principles proposed to specify the relevant characteristics for just treatment: To each person an equal
share, according to [fundamental] need, to effort, to [social] contribution, to merit, to free-market exchanges;
these identify relevant properties persons must possess to qualify for a particular distribution; each identifies a prima
facie obligation whose weight is assessed within the particular contexts where they are applicable; these are plagued
by many theoretical and practical difficulties
Theories of Distributive Justice attempt to connect properties of persons with morally justifiable distributions of
benefits and burdens, to balance competing claims resulting of these properties:
1. Utilitarian – maximizes [net] public utility/overall good
2. Libertarian – emphasizes rights to social and economic liberty (fair procedures rather than substantive
outcomes)
3. Communitarian – stress traditions and practices of justice/solidarity in community
4. Egalitarian – emphasize equal access to goods in life based on need and equality
Distribution of or access to health care can be based on other values and realities besides justice:
Filipino examples: priority given to relative/friend or a referral from one; more care and attention to a “kababayan”,
cultural values of “hiya, utang na loob, pakikisama”, economic needs (selling a kidney to a higher bidder;
government support of doctors’/nurses’ exodus while ignoring local needs for them)
Applications: regulations of research on human subjects (especially nontherapeutic type) with its risks and burdens;
public health policies and programs, resource and budget allocation
Limits: beyond individual good to a serious consideration of the common good – How can individual needs and
interests fit into or impinge upon needs of the larger community? How must public policy respond particularly in
terms of budget allocation and research directions?

6. Confidentiality: principle based on the expectation that private information disclosed within a relationship of
confidence will be protected and not divulged without first party consent; healthcare information is mostly private
Application:
- Operates on a heath care need-to-know basis
- Health care providers may not discuss patients as a pastime or in public places
- Physician has no right to access health care information of a patient (regardless of their relationship and
proximal location of the person) not under his/her professional care
Limits (exceptions that allow breaking of confidentiality): according to law (injuries resulting from abuse of
rights, incidence of communicable diseases and poisoning, accidents require medico-legal reports) when public good
outweighs right to privacy; arising from peculiar physician-patient relationship (patient is treated by the company
physician for a work-related health condition); existence of a proportionate reason (when keeping confidence
threatens more than the good of isolated individuals e.g., HIV-related contact-tracing and consequent counseling);
cultural practices like giving healthcare information to family/relatives in Filipino context (routine breaking of
confidentiality may undermine trust in the profession); media publicity for public concerns (it is the decision of
the of the publicly-relevant patient – not the physician - to disclose information; physician has neither obligation nor

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 right to make disclosure without explicit permission of the patient or the proxy; exceptions can be made only with
proportionate reason e.g., true health status of GMA that influences the conditions of her political confinement)

Filipino context: strict rules of confidentiality are difficult to accept and practice; family presumes a right to
know about the patient and uses that knowledge to allocate (time and material) resources, seek aid, sympathy and
prayers from relatives and friends; family also keeps confidentiality to protect patient and family from shame

Interrelationships: may reinforce or clash with respect for autonomy

7. Principle of a well-formed conscience: patient obligation to inform own conscience as completely as possible, to
judge (decide) based on it, to act according to the judgment and assume responsibility for the action
This is the Catholic version of autonomy. With this principle, the teaching of the Church, the good of the
community and the fruits of discerning prayer factor in the heath care decisions and are made in the context of
a loving relationship with God.
Application: Because of the primacy of conscience (and its consequent inviolability), a person may make a
conscience decision that conflicts with that of family and doctor, and at times with that of church teaching;
examples: choice of pregnant mother to delay cancer treatment in order to give birth to a healthy baby, refusal of
expensive treatment to allocate family resources to meet other needs, choosing to give birth to a severely disabled
child instead of abortion
Limits: due respect for a patient’s conscience decision must be equally rendered to that of the physician’s

8. Totality and integrity: sacrifice of anatomical integrity (removal or impairment of a part) of a person’s body
may be permitted to preserve the functional integrity (systemic efficiency), health or life of the same person; it
protects totality and integrity even I it means the loss of a part/s. The body that is harmed is the same body that
benefits to ensure that the body is not treated as a means to benefit others.
Applications: total or partial removal of cancer-invaded organs; amputation of a trapped or gangrenous limb
Limits: does NOT justify organ transplantation from one live person to another, direct sterilization for birth
control, castration to overcome sexual temptation
N.B. donating one’s organ to another is justified by the principle of fraternal love or charity, provided the donor
incurs limited harm and maintains functional integrity

5. Explain the significance of each of the following distinctions in healthcare ethics:

Language and its distinctions can be useful for moral reasoning but cannot substitute for it.
Mere classification of medical actions/treatments cannot determine the judgment regarding its suitability or
reasonableness.
1. Actions/omissions
 Doing – not doing; performing – not performing
 Distinction problematic in situations where these give rise to foreseen unwanted outcomes
 Underlying assumption: omissions are easier to justify than actions contributing to death
 Omissions can be as immoral as actions.
 Significance: The distinction blinds us to this and makes us evade moral responsibility for foreseen bad
outcomes following an omission.

2. Withdrawing/withholding treatment (subtype of action/omission distinction)

 Withdrawal – stopping treatment that has already begun
Withholding – not starting a treatment at all
 Problematic in situations when distinction unclear. Both can be moral in some situations and immoral in
others.

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  Psychologically, more difficult to withdraw than to withhold but does not mean it is more difficult to establish
moral justification for withdrawal than for withholding.
 Moral standpoint: often easier to justify withdrawing because of added information (re: effects of the
treatment on patient’s condition) to use for making a moral decision about benefits and burdens.
 Significance: the distinction with its moral preference for withholding can lead to:
 Withholding treatment that can truly benefit a patient; depriving of a needed benefit
 Not withdrawing a burdensome treatment

3. Intentionally causing death/letting die (subtype of action/omission distinction)

 Physician causing death – physician letting the disease cause death
 Distinction problematic because: often physician’s actions have definite causal role in patients’ deaths; forces
physicians to think of actions that have a causal impact on a patient’s death as if they are not causal in any
way (thus deceitful/insincere)
 Realistically: both the disease and the physician’s withdrawal of treatment led to death but neither
alone caused it
 Significance: Moral analysis must go further to ask whether the physician’s action was morally justified
in the circumstances.

4. Paternalism/autonomy
 Paternalism – physician behaves as a wise caring father to his child (patient); embodies medicine’s goal of
beneficence; primary good considered is positive clinical outcome
 Autonomy – patient values and choices take precedence; considers personal commitments that might
conflict with good clinical care
 Distinction rests on who gets the power of authorizing medical treatment and the relationship between what
the doctor thinks is good for the patient and what the patient wants; problematic because they are presented
as either-or choices
 Both are important: paternalism with beneficence as its driving force and autonomy & self-determination
with its recognition that persons have the responsibility and freedom to make important personal choices;
neither alone can be the criterion of what is morally right
 Significance: the ideal is shared or collaborative decision-making of physician and patient

5. Ordinary/extraordinary means of preserving life

 Ethics does not require extraordinary means to preserve life. (non-obligatory)
 Foregoing ordinary treatment is not morally justifiable. (obligatory)
 Distinction problematic because definitions of what is ordinary and extraordinary vary according to
situations and circumstances: technology of the treatment, availability, affordability, benefit
(success/failure rate), risk to and burden on the patient, duration, expertise of physician, etc.
 Distinction ultimately not helpful for moral deliberation and reasoning.
 Significance: Moral analysis must determine what achieves the (best possible) human good in any
situation (“golden mean”).

6. Futile/effective treatment (subtype of paternalism/autonomy distinction)

 Futile treatment – one that provides no benefit
 Futile treatment non-existent when physician was sole decision-maker because she would simply not initiate
one. There is no obligation on the physician to provide futile treatment; at times morally obligated NOT to
provide such.
 Futility is complex; involves more than just medical effectiveness
 Distinction problematic with a disagreement between doctor’s and patient’s assessment of futile treatment
and patient (surrogate) autonomy’s demand for it

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  Distinction not helpful because it is too controversial: may falsely justify physician’s unilateral decision to
withhold or withdraw treatment or force her to act against her professional judgment and reduces her to an
unthinking hired hand
 Significance: An assessment of medical futility is only one out of many moral considerations. In addition
to it, consider all relevant values and circumstances to reach a morally sound decision.

7. Direct/indirect results
 All foreseen outcomes are morally relevant. We are responsible for all known effects of our actions.
 At times, one and the same action causes (multiple) both good and bad effects. (same causality not
sequential/consequential)
 The world is sometimes ambiguous: some actions are morally justifiable despite their bad effects.
 Distinction gave rise to principle of double effect: direct effect is good and desired; indirect effect is bad
and undesired; Distinction is grounded on intention: direct effect is intended; indirect effect is unintended
and regrettable. Intention is only one of 3 considerations in determining moral objectivity.
 Principle of double effect is a principle of moral realism (and compromise): we must be prepared to do
bad things for good reasons [or perhaps this is better stated as:] we need justifying reasons to compensate
for the foreseen bad effects of the good we are trying to do.
 Significance: Foreseen indirect effects are morally relevant. Using prudential reasoning, determine the
most reasonable action given the circumstances and consequences (whole picture). Reasonable action
results when good reasons override the bad effects.

8. Immoral/intrinsically immoral (evil)

 Morality of actions is determined by: actual physical act, intention, circumstances and consequences.
 Intrinsically immoral – actions that by their physical nature alone are immoral regardless of other
components; no exceptions allowed (moral absolutes deemed necessary to prevent degeneration into
situation ethics that may justify the worst evils)
 Distinction is problematic in light of a sometimes morally ambiguous world; tends to objectify an action by
its physical component alone; the term carries a moral judgment that precedes the situation requiring a moral
decision; results in ethical difficulties/ contradictions (killing is intrinsically evil but self-defense causing
death is acceptable)
 Significance: in moral analysis, use prudential reasoning, deliberation and judgment.

9. Reasonable/unreasonable
 Aquinas: what is according to reason is ethical (not according to it, unethical) and what is reasonable is
whatever achieves true good/our happiness (or at least avoids the worst) in the circumstances
(unreasonable is whatever undermines this).
 Ethics does not have definitive answers for every particular case. It is complex because it involves at least
two major moral agents: physician and patient who must determine what is reasonable to do.
 Significance: the distinction is crucial and universal. In a situation of moral conflict, all moral agents
must be involved in prudently figuring out what is reasonable.

10. Prudence/judgment
 Prudence – moral reasoning by the moral agent enmeshed (directly involved) in the situation and faced
with deciding on what to do or not to do to achieve good
 Moral judgment – moral reasoning by those reviewing a situation wherein they are not actually involved;
does not involve decision-making but making judgments about what people who are involved must do to
promote living well.
 Significance: practice/development of prudence enhances the ability to make good moral judgments and vice
versa; assists in the development of a well-formed conscience

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 11. Descriptive/evaluative language
 There is no purely descriptive/factual language even in science and ethics. It is always biased to some degree
by social, historical and personal perspectives. There are no pure facts; every fact is theory-laden.
 Descriptive – language that does NOT carry bias or moral judgment (relatively neutral; less prejudicial)
and allows for deliberation and discussion of an issue
 Evaluative – language that communicates a moral judgment prematurely and makes dialogue impossible
 Significance: striving for use of descriptive and avoiding evaluative language in situations of moral
dilemmas/disagreements/controversy allows for authentic dialogue that results in sound moral judgment

12. Premoral/moral evil

 Premoral evil – bad; nonmoral/ontic evil; anything damaging to life, particularly human life
 Moral evil – immoral/unethical; anything harmful or damaging to life as a consequence of morally
unreasonable human choice
 Bad is not of itself immoral particularly when caused by nature, unintentional human behavior or
intentional but reasonable human behavior
 Moral evil – bad caused by intentional behavior without adequate reason/s
 Significance: ultimate moral issue is not deliberateness of an action but whether there are or aren’t
overriding reasons for causing /allowing bad outcomes.
 Guideline: Whenever an action/omission will result in bad, then avoid it unless there are overriding reasons
to proceed.
 Adequate healthcare ethics avoids the bad and promotes the good whenever possible.

6. What is contraception in its basic sense and what are the various means by which it can be achieved? Describe the
methods of natural family planning as an area of particular interest for the Catholic Church.
Contraception: deliberate prevention of conception/fertilization by preventing the meeting of ovum and spermatozoa.
Means:
a. Complete abstinence from sexual intercourse
b. Folk methods: withdrawal (before ejaculation), postcoital douche (water/vinegar/feminine hygiene products),
prolongation (of exclusive) breastfeeding/lactation
c. Natural family planning: limit intercourse to infertile periods/abstinence during fertile periods
Involves establishing the woman’s fertile and infertile periods to determine timing of intercourse (avoiding or
aiming for pregnancy)
Basics of a woman’s fertility cycle:
 covers period from one menstruation to the next
 ovulation occurs only once per cycle
 estrogen progressively increases prior to ovulation, triggers production of cervical mucus (facilitates sperm
survival and fertilization of the ovum) and rebuilds the endometrium following menstruation
 sperm can survive 3 days (rarely up to 5) while the ovum only for 12-24 hours and dies if unfertilized
 within two weeks after the death of the ovum, the endometrium is shed at the next menstruation
 cycles are regular in most women but variations occur as a result of stress, illness, routine change, lactation and
the pre-menopausal stage)
Indicators of fertility:
 cervical mucus become more abundant, takes on a watery to raw-egg-white-like consistency, and stretches up to
an inch or more between fingers
 body basal temperature will rise by a few tenths of a degree, and stay elevated, after ovulation
 Fullness and increased sensitivity of the vulva
 Others: Increased libido; breast tenderness; mood swings; bloating

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Billings Ovulation Method
Foundation: a pattern observable in sensations at the vulva and character of cervical mucus which must be carefully
recorded nightly
1. Menstruation is usually (not always) followed by a Basic Infertile Pattern (BIP) with minimal/absent cervical
mucus or vaginal discharge and dry sensation at the vulva.
2. Ovulation is preceded by changing character of cervical mucus from thick, sticky and cloudy becoming wet,
clear, and stretchy like egg white. Vulva feels wet and slippery.
3. Last day of this type of discharge indicates the peak of fertility when ovulation occurs. Vulva feels swollen, soft
and slippery. After the peak, vulva feels sticky or dry.
4. Remains mostly dry and beginning of Day 4 after the peak until the end of the cycle is infertile.
Two rules to avoid pregnancy:
1. Early Day Rules (between menstruation and the peak)
 No intercourse during heavy menstrual bleeding
 Intercourse allowed on alternate evenings of BIP days
 No intercourse whenever there is a change in the BIP (sensation, appearance or bleeding). Wait and
see. If there is no peak and the BIP returns, wait 3 more days before resuming intercourse.
2. Peak Rule (once the peak is identified)
 Beginning Day 4 after the peak until the next menstruation, may have intercourse all days at all times

Standard Days Method (SDM)

Foundation: observes a standard rule or fixed window of fertility (period when pregnancy is likely) by noting the
first day of menstruation
Application: only reliable for women with regular cycles that range from 26 to 32 days (about 80%)
Procedure:
 Mark 1st day of menstruation on the calendar as Day 1. Mark the
same day of the week, one week later as Day 8.
 Count forward to Day 19 and mark it.
 Those who wish to avoid pregnancy are advised to abstain from
intercourse on days 8-19 of their cycle. These are the days,
according to the method, when they are most likely to conceive.
All other days within each cycle present a low risk of conception. You
do not need to abstain from sexual intercourse on days 1 through 7, nor
on day 20 through the end of each cycle. The number of days available
for intercourse using this method is 16 -20.
 Alternative: CycleBeads is a color-coded string of beads that
represents the days of a woman's cycle: red for 1st day of
menstruation; 6 brown beads for infertile days; 12 glow-in-the dark
beads for fertile days; another 13 brown beads for remaining infertile
days till next cycle. a woman simply moves a ring over the beads to
track each day of her cycle. The color of the beads lets her know whether she is on a day when pregnancy is
likely or not.

Two Day Method

 determines the probability of pregnancy based on the presence or absence of cervical mucus; it does not
involve analyzing the characteristics of the secretions (e.g., amount, color, consistency, slipperiness,
stretchability, or viscosity)

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  works best for a woman who is sure she can tell whether she has secretions or not (does not include
menstrual bleeding)
 practical for women who may have unusually long cycles (over 32 days), unusually short cycles (under 26
days), or irregular cycles
Procedure: A woman asks herself two questions: "Did I notice any secretions today?" and "Did I notice
any secretions yesterday?" If the answer is “yes” to both, she is potentially fertile. If “no” (two consecutive
days with no secretions), her probability of becoming pregnant is very low and she can have intercourse that
day. The number of days available for intercourse using this method is 10.

d. Artificial contraception
Traditional: condom, cervical cap, vaginal diaphragm, sponges, spermatocide (foam, cream or gel)
Modern: oral contraceptives (combined estrogens-progestins, mini pill is of progestin-only, morning-after
pill/emergency contraceptive/post-coital pill [PCP] which must be taken within 12 hours post-coitus); long-acting
progesterone injections/implants; IUD and surgical sterilization
N.B. Some modern methods are more interceptives/contragestive (prevents implantation of the zygote) and this
abortifacient: IUD. PCP

e. Irreversible sterilization

N.B. The efficacy of contraceptive methods is indirectly measured by their failure rates (the incidence of pregnancies
that can be expected during the first year of its use). Factors that may affect efficacy: simplicity/complexity of procedure
involved; commitment of the couple; individual anatomy/physiology, etc.

7. What is the moral evaluation of sterilization according to the Church’s Magisterium? According to some
contemporary moral theologians? Take into account the various means and purposes of sterilization.

Sterilization – irreversible/reversible termination of the capacity for reproduction

Means/methods: surgical castration (removal testes/ovaries); other surgical forms (hysterectomy, salpingectomy, tubal
ligation, vasectomy); radiation-induced; chemical-induced
Purposes: birth regulation (most common); eugenic (prevent conception of those with genetically-based mental and
physical defects); crime prevention (reducing sex drive or as deterrent i.e., punishment for sexual offenders); medico-
social (prevent pregnancy in the mentally and psychologically incompetent vulnerable to seduction and rape)
Moral Evaluation
 HV 14 (unlawful birth control method) condemnation of any direct sterilization (as means or ends, man/woman,
temporary/permanent) without exception (even when pregnancy endangers life/health because the danger arises
from free sexual activity not from condition of the healthy organ); indirect sterilization resulting as a side effect of
medical treatment aimed at a specific pathology is permitted
 Contemporary moral theologians argue that sterilization may be chosen based on
1. proportionate reason, under certain circumstances, and at the service of humanization
2. principle of totality affirms that the health and integrity of an organ is not an end in itself but meant to promote
the good of the whole being
3. Guidelines: respect for autonomous conscience; consider harms (different methods have different effects
e.g., castration is only justified for the preservation of a person’s life and basic health not for birth control);
consider benefits less serious than life and health preservation e.g., avoid worsening socio-economic hardship;
avoid pregnancy in the mentally and psychologically incompetent (compromised care of the child); consider
alternatives to sterilization with less grave consequences

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8. What is the moral evaluation of the use of artificial contraception according to Humanae Vitae? How different is it
from the practice of limiting sexual intercourse to the infertile periods? What are the arguments and counter-
arguments made on the issue?

Moral evaluation of Artificial Contraception (Humanae Vitae)

Premise: (HV 12) inseparability of the unitive and procreative meanings of every conjugal act
Consequence: (HV 14) contraception is intrinsically wrong
Exception: (HV 16) If there are well-grounded reasons for spacing births, arising from the physical or psychological
condition of husband or wife, or from external circumstances, married people may take advantage of the natural cycles
immanent in the reproductive system and engage in marital intercourse only during those times that are infertile.
Difference: in method only and apparently not in intention of preventing the transmission of life
Inconsistency: sex using artificial contraception and sex during infertile periods have the same intention but are
evaluated differently; moral difference, if any, is key to HV

Moral reasoning/analysis: arguments (A) and counterarguments (CA)

Re: Unitive and Procreative Meanings

A: HV 12 claims inseparability of the two meanings of the conjugal act as nature established by God
CA: BUT they can be and are separated by nature: infertile couples (biological sterility); cyclical infertility of women
and at menopause.

A: HV 12 The two meanings must not be separated (an act of mutual love rendered incapable of transmitting life) by
humans using artificial contraception (14) as this frustrates God’s design…contradicts His will. NFP acknowledges
that one is minister and not master of God’s design (16).
CA: If the design of fertility cycles and inseparability of the two meanings are God’s design, then respecting the design
means sex is permissible/valid only during fertile periods.

A: Using artificial contraception actively separates unitive from procreative in specific acts (impedes and obstructs
nature); NFP involves passive separation, reserving sex to when nature separates the two meanings (uses nature).
CA: There is the underlying assumption that omissions (noninterference) are morally easier to justify than actions
(interference).Yet NFP can be seen as activity; waiting is an action! Vigilance for the infertile periods can hardly be
considered passivity.

A: Intercourse during infertile periods is nonprocreative (expressing the unitive while not deliberately trying to
suppress the procreative) while intercourse regardless of the woman’s cycle using artificial contraception is
anti-procreative (directly prevents conception thus choosing against the obligation to transmit life even during
fertile periods)
CA: The act of intercourse during infertile periods does not of itself release one from the obligation to transmit life. In
NFP, the obligation is acknowledged and remains but is naturally impossible in the particular act. If, however, in the
absence of “well-grounded reasons”, a couple were to engage only in nonprocreative sex as a pattern, each act
becomes anti-procreative because it betrays a mentality that claims freedom/release from the obligation. Perhaps
more than the physical act and immediate intention of the moral object, one must determine the long-term
intention/motivation for the moral act. [This CA is not in Fr. Peter’s notes. They’re my personal musings.]

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 Re: Intrinsic Wrongness of Artificial Contraception
A: HV 14 use of artificial contraception is of its very nature contradictory to the moral order and thus intrinsically
wrong. (This argument flows from the claim of inseparability.)
Consequently, it can never be justified even by: a good intention that chooses it as a lesser evil; taking the
perspective of the totality of marriage (vs. individual acts) as procreative. [An act-oriented vs. character-oriented
(fundamental option) morality; both are important and must be balanced]
JP II in Veritatis Splendor; intrinsically evil acts are of themselves wrong independent of the ulterior intentions of
the one acting and the circumstances.
CA: The nature of using artificial contraception bears a disvalue insofar as it contradicts the physical nature of the
act (procreative) but it is an ontic (damaging to human life in general, e.g., physical/emotional problems, side
effects of some methods) not a moral evil (damaging to the same as a result of morally unreasonable human choice)
unless adjudged to be such based on circumstances and intention.
The Church names official exceptions to the use of artificial contraception: lawful therapeutic means where
contraception is not directly intended (indirect effect) e.g., the Pill to regulate fertility cycle; preventive
humanitarian means e.g., the Pill for nuns in danger of rape; the condom to prevent spread of HIV.
If use of contraception is intrinsically evil, it cannot be justified by the principle of double effect.

Re: Causes and Effects of using NFP and Artificial Contraception

A: NFP proves love. HV 21 and 16 Periodic abstinence requires sacrifice, complete mastery over self and emotions
which are proofs of a true and authentic love.
CA: True for some, not for all. Conversely, not all who use artificial contraception have a false and inauthentic love.

A: NFP has more benefits: helps solve difficulties of other kinds; fosters thoughtfulness and loving consideration of
the other; repels excessive self-love; arouses consciousness of responsibilities; confers on parents a deeper and more
effective influence in their children’s education; greater shared responsibility and creativity in family planning.
CA: Artificial contraception has important benefits: spontaneity, sensitivity to affective needs, and more convenient
family planning. Its use does not necessarily imply excessive self-love.

A: Artificial contraception may promote degradation and objectification of women. HV 17 the husband may lose
respect for the wife.
CA: The argument presumes that contraceptive sex is mainly remedy for the husband’s lust. This contradicts the
actual experience of some couples and overlooks benefit for intimacy.
NFP has a very unnatural effect, requiring women to be abstinent during their fertile period when most
experience a peak in sexual desire. Periodic abstinence adds psycho-emotional strain on spouses under
circumstances (physical distance e.g. OFWs who go home for a very limited period of time; some illnesses that
remit and relapse) that render periodic abstinence more of perpetual.

Conclusion: the causes and effects cannot be universalized and presumed true for all cases. Ultimately, it is the
couple’s responsibility to judge which is/are true in their particular situation and act accordingly. HV should’ve
focused on helping couples detect and challenge the “contraceptive mentality” rather than quibbling over
methods.

9. What is the moral evaluation of abortion, as it is affirmed in official Church teaching and as it is understood in its
nuanced form? Explain the challenges of moving from teaching to practice, particularly the fundamental issues of
abortion that require consensus-building in a pluralistic society.

Abortion – the expulsion of the live embryo (from fertilization up to 8 weeks old) or a live but unviable (will not survive
outside the womb) fetus (more than 8weeks old) from the body of a pregnant woman resulting in death of the
embryo/fetus.

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 Types (according to presence of deliberate human intervention): spontaneous (without) and induced/procured (with)
Induced:
 Further distinguished by the principle of double effect into: direct (the only intended effect or as a means to reduce
some other harm) and indirect (undesired but unavoidable effect of treating a serious pathology in the mother)
 According to purpose or indication (reason given for justification): therapeutic (performed when continued
pregnancy endangers the mother’s health/life); elective (performed without a therapeutic indication); eugenic (to
prevent birth of those with risk or certainty of congenital anomalies); psychosocial (most common; performed for
social, economic or psychological reasons); humanitarian (performed when the pregnancy resulted from serious
victimization of the mother e.g., rape, incest, seduction of minors/the mentally deficient; note that rape seldom
results in pregnancy [but please also note that abortion in these cases is not humanitarian per se; a true humanitarian
approach in such cases calls for a holistic intervention to bring healing; the trauma is not eliminated and may even
be aggravated by a so-called “humanitarian” abortion])
 According to duration of pregnancy at time of abortion: early (1st trimester; if before implantation,
microabortion or interception [preferred by those who hold that right to life begins only at implantation or later]);
late (2nd and 3rd trimester)

Moral Evaluation –

Premise:
Human life begins and deserves respect from the time of fertilization, when there comes into existence, a reality distinct
from that of parents, with unique genetic endowment and a capacity for continuous self-directed development.
Viability and birth (of ethical and legal importance) are not the starting points but are further stages in humanization and
in the process of becoming a bearer of full legal rights and responsibilities.

Teaching: GS 27(1965), CDF Declaration on Procured Abortion (1974), EV 62 (1995)

 Human life should be protected from time of conception.
 Doubts about personal character of the embryo in the 1 st weeks of life must be given benefit of the doubt.
 Embryonic and fetal development realizes potentialities already present at the time of zygote (fertilized ovum) formation
 The Church permits justified indirect abortion; condemns all forms of direct abortion irrespective of indications.
 Canon 1398: latae sententiae (automatic, incurred at the moment of committing the offence) excommunication on
those who procure an abortion.

Nuanced form:

ETHICAL NEGATIVITY
MORE LESS

Motives: psychosocial eugenic therapeutic/humanitarian

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From Teaching to Practice
Debate Status: Impasse
 Approaches to policy have been combative not cooperative, widen divisions with “bad faith” on either side

THE CHALLENGES
Pro-LIFE (anti-abortion) Pro-CHOICE (pro-abortion)
 Refuse to recognize that pregnancy can at times  Refuse to confront the significance of the
create/exacerbate devastating circumstances for fact that abortion destroys a developing
women, not easily resolved by heroism or human life
emergency aid
 Believe that if abortion were outlawed, the well-  Believe a right to abortion gives women
being of women and children would access to true reproductive choice
automatically be improved

If the impasse is prolonged, it can contribute to: deepening moral anguish or growing moral apathy/an overall societal
fragmentation or self-deception as millions of abortions happen annually, with a significant percentage involving women
below 24 years old. The permissive attitude of ‘abortion on demand” exists in some places and is cause for serious
concern.

Moving forward: consensus-building on fundamental issues

ISSUE
Status and  Has genetic uniqueness and  Criticism that against fetus as a “person” from
value of completeness conception:
FETUS (the  Has intrinsic capacity to develop into a 1. It can still split into more than 1 individual
category of baby if left undisturbed in natural up to 2 weeks post-fertilization
“person”) environment 2. Embryos and fetuses that do not survive
until birth (especially from spontaneous
abortion) are not treated religiously or
culturally as babies
3. A potential state is not the same as an actual
one

 What moral status do they have in the early stages of development?

Recommended conclusion: The integral relation and interdependence of human embodiment and
human identity means that the moral status of developing life also develops.
[Question: Can moral status be determined by the stage or state of one’s embodiment?
 Human identity is undeniably influenced by one’s embodiment yet there is no fixed
correspondence between one’s embodiment and the identity that will develop from this given.
 Farley’s notion of transcendent embodiment proposes that the common destiny of the aspects of
personhood (body/spirit) is transcendence which she links to two capacities (freedom and
relationship) not fully realized before, at birth, or even later in one’s lifetime.]
 So far, there has not been a conclusive persuasive philosophical argument that determines with
precision and clarity the status and value the fetus has, as member of the human species.
Equality of  Ethos of liberal individualism corrupts  There are moral bonds arising not from free
WOMEN both sides; it focuses on individual rights (of individual consent but from reciprocal
mother or the unborn) while overlooking relatedness. The mother-fetus relation (all
societal duty to provide welfare for mothers parent-child relations) is characterized by
and poor families such bonds.
 There is the need for an ethos of solidarity based on the common good (persons are interrelated
in a social whole that constitutes the condition for individual and communal well-being)

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The vision for both pro-life and pro-choice must go beyond outlawing or preserving legal abortion.
It needs to include advocating and fortifying social programs that will reduce the need and demand for abortion e.g.,
affordable housing, perinatal care, day care, adoption services, recruitment of foster parents, job and educational
opportunities)

Moving forward: Church

 assertion that parenthood be a shared responsibility of men and women must be supported
 correction of its ambivalent record on sex and women’s roles
 improvement of its political commitment to reform discriminatory social institutions
 recognition of women’s right to control their fertility and seek roles beyond motherhood as important to their
identities
Theology: constructive participative theological bioethics to contribute by analysis and critique of the status quo and
providing alternatives that make both “choice” and “life” meaningful.

Moving forward: Law and Policy

 enforcement of negative obligation prohibiting killing of the innocent must be matched by vital positive obligations
to assist the weak and vulnerable
 law must function as “police officer” (restraining function to prevent harms), “moral teacher” (teaches social
virtues) and “social enabler” (enables transformative collaborative by creating expectations and institutions in which
social virtues are put into practice)
 religious traditions must
- support laws that make the choice for abortion rare (requiring parental involvement in abortion decisions of
minors; specifying a waiting period intended to induce serious reflection about abortion and exploration of other
options)
- institutionalize and clarify the occasionally necessary exercise of abortion

20