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CHAPTER 2
HEALTH, THE PATIENT AND THE MEDICAL PROFESSION
2.A. Health, Integrity and Personal Responsibility
1. Holistic medicine. Definitions of health. Health as multidimensional
2. Principle of Totality and Integrity
3. Personal responsibility for health
(a) Stewards of our bodies
(b) Balanced lifestyle and preventative medicine
(c) The will to be healed
2.B. Principle of Informed Consent
1. Truth in the doctor-patient relationship
2. A delegated authority - the therapeutic relationship as contract
3. Rules of consent (presumed, unconscious, irrational, minors)
4. Role of the individual conscience - ultimate responsibility belongs to the
patient.
2.C. Problems of honesty and confidentiality
1. Listening and truth telling
2. Confidentiality and the medical secret
3. Exceptions to medical confidentiality
4. Lies or false speech?
5. Dilemmas in nursing practice
2.D. The ethos, ethical code and the morality of the physician
2.E. The medical profession in the modern world
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Objectives in this chapter:


1. To consider the various dimensions of health.
2. To understand the concept of the individual's personal responsibility for his/her
own health, as the foundation for the contract made with any healthcare
professional.
 3. To examine the duties of truth-telling and confidentiality in medicine.
 4. To reflect upon the ethos of medicine as a profession, and the need for
medical ethics.
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2. A.
Health, Integrity and Personal Responsibility
2.A.1. Holistic medicine - definitions of health
-----------------------------------------------------------------------------------------------------------------------SELF-CHECK 2.1
 Before we begin, write down a definition of what you consider health to be.
 Is there any necessary connection between holiness and health?
-----------------------------------------------------------------------------------------------------------------------T
he historical and philosophical approach has demonstrated that medicine needs to be holistic
and treat the whole human person with his/her aspirations and needs. The sick person is
neither a mere collection of organs nor just an interesting pathological sample. He/she is a
human being made "in the image and likeness of God", with physical, mental, spiritual and
social needs deserving of respect.
T
hese various dimensions are not all the immediate concern of the doctor or surgeon.
Nevertheless the healthcare professional must respect these aspects of human personality and
not adopt a reductionist or materialistic mentality, which dehumanises the patient and treats him
as an object.
M
edicine is about the recovery and preservation of health. The World Health Organisation in 1958
declared "Health is a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity." Etymologically "health" derives from Anglo-Saxon Háelth
based on the root hál (whole), hálig (sound) giving also haelan (to make whole). Compare
modern German heilen (to heal) and heilig (holy).
Fr
om a purely medical viewpoint the W.H.O. definition is over-ambitious. Your hard-working GP
will hardly want to take on board full responsibility for your "mental and social well-being."
Nevertheless the definition does rightly points out the interplay of physical, mental and social
factors. To the old adage "Mens sana in corpore sano" it adds "et in societate sana." "To view
health in a purely negative sense as merely freedom from disease leads to a focus on curative
rather than preventative medicine and neglects the social causes of some illnesses.
A
purely economic model of health would view disease only in terms of loss of workers and
output, absenteeism, sick-pay and legal liability for compensation if injuries are sustained in the
workplace. On the level of the national economy it would calculate the loss of G.N.P. caused by
illness, and N.H.S. costs. Such a narrowly financial attitude is inadequate. It fails to take into
account the fact that good health and access to medical services is a major contributor to the
overall quality of life of the populace. It may also open the way to calculated neglect of
unproductive members of society. Nevertheless it would be naive to imagine that such
considerations do not occasionally pass through the minds of company accountants, Treasury
Officials and Chancellors of the Exchequer.
In
the last chapter we looked at some Biblical terms in Christian anthropology: sarx, soma,
psyche and pneuma. Related to these, but in a more modern schema Ashley and Maslow list
the following:
Dimensions of personality:




(i) The biological level - respiration, nutrition, excretion, movement, reproduction,
temperature balance etc. Physicians treat malfunctions at this level.
(ii) The psychological level - need for security, a sense of belonging, intimacy or
love (in its emotional aspects) Psychologists and psychotherapists operate at this
level.
(iii) The social level encompasses the need for esteem and respect, for love and a
sense of belonging (in their more developed cultured aspects). This includes the
behaviour and self-control of the individual within society. It is the domain of law,
politics, and the clergy as moral guides.
(iv)The spiritual or creative level - persons criticise, transcend and re-create the culture
around them in artistic and scientific endeavours. Religious activity extends to one's
relationship with God and the ultimate meaning of life. The spiritual guide. artist. poet and
inspiring thinker operate at this level.
------------------------------------------------------------------------------------------------------------------------SELF-CHECK (2.2):
 Consider which level is the focus of the work of (a) a Macmillan nurse
(b) a consultant dermatologist (c) a school psychiatrist
(d) a lawyer (e) a G.P.
------------------------------------------------------------------------------------------------------------------------Th
ese four levels are inseparable and merit consideration in all healthcare decisions. Healthcare
must serve human persons, not only their biological functioning. All ethical decisions should
respect the innate and cultural needs of the human person as a member of the world
community, as well as of his/her own nation and family. Human health is different from merely
vegetative or animal health because it involves personality and the sharing of intellectual and
spiritual goods (primarily truth and love).
M
oreover people may lead very fulfilled and valuable lives despite serious physical defects Beethoven's deafness, Milton's blindness, Stephen Hawking's motor neurone disease.
Conversely physical perfection is no guarantee against social and spiritual sickness as typified
by Hitler's SS troops. Even apart from the extremes, Paul Tillich suggests that many mistake for
genuine health what he terms "unhealthy health" (quoted in AO'R p.30):
''It
comes about if healing under one dimension is successful but does not take into consideration
the other dimensions in which health is lacking or even imperilled by the particular healing.
Successful surgery may produce psychological trauma; effective drugs may calm down an
uneasy conscience and preserve a moral deficiency; the well-trained athletic body may contain a
neurotic personality; the healed patient of the analyst may be sick through lack of an ultimate
meaning to his life; the conformist's average life may be sick through inhibited self-alteration; the
converted Christian may suffer under repressions which produce fanaticism and may explode in
lawless forms; the same society may produce psychological and biological disruptions by the
desire for creative insanity."
Authentic health must be a multidimensional wholeness.
2.A.2. Principle of Totality and Integrity
As we have seen, the human person functions simultaneously at four levels - biological,
psychological, social and spiritual. Each level can be subdivided. For example the human body
contains several organ systems - nervous, endocrine, skeletal and muscular, integumentary
(skin), alimentary, respiratory, circulatory, excretory and reproductive. The psychological level
is differentiated into external senses, emotions, conscious and unconscious awareness,
memory, will etc., or id, ego, superego etc.
T
he integrity of these hierarchically linked systems requires that each part is fully differentiated
yet operates as a part of the whole . An important ethical question arises when one organ or
function has to be sacrificed in the interests of another or to save the whole, as in surgery,
sterilisation or organ transplants.
S
t Thomas Aquinas stated the Principle of Totality thus - "Since any member is part of the whole
human body, it exists for the sake of the whole as the imperfect for the sake of the perfect.
Hence, a member of the human body is to be disposed of as it may profit the whole. Per se
each member of the human body is useful for the welfare of the whole body; Per accidens
however it can come about that it is harmful, for example, when a diseased member is injurious
to the whole body. If therefore a member is healthy and continuing in its natural state, it cannot
be cut off to the detriment of the whole." (II.II.q.65,a.1,c.)
Mutilation without due cause is immoral, but the donation of a kidney, say, to a relative
undergoing thrice-weekly dialysis, is a pre-eminent form of Christian charity. A person
sacrifices part of himself to bring life to another. Hence Aquinas' formula requires adaptation.
The welfare of the body refers to the "good of the whole person." That good is not found in
splendid isolation but in relationship and communion with others. In a similar way a mother
might spend money on a child's education rather than on some desirable but expensive
medical treatment for herself.
----------------------------------------------------------------------------------------------------------------------TO THINK ABOUT:
 Would the father of a very poor family be justified in selling a kidney to organ traffickers in
order to earn money to pay for one of his sons to be educated through the seminary to
become a priest? Is this heroic virtue or participation in intrinsic evil?

If the highest functions of the human person are spiritual and intellectual, might one
sacrifice the biological level in order to maintain these alone? Imagine it were
technologically possible to extract the brain undamaged from a terminally ill Nobel scientist,
float it in a nutrient medium and communicate with it electronically, even enhancing its
intellectual performance. Would this be an enrichment or impoverishment of human
existence? Would it be morally legitimate?
-----------------------------------------------------------------------------------------------------------------------
Human health is not solely a matter of organs but of the capacities to function humanly. Any
particular capacity may be sacrificed when necessary for the good of the whole person.
Secondary functions can always be sacrificed for more basic ones e.g. amputation of a
gangrenous finger to save the hand. However the basic functional capacities cannot be
sacrificed unless this is the only way to preserve life. The good of the human person requires
that all the basic aspects of the human person be simultaneously respected, even when it is
necessary to subordinate or even in some measure to sacrifice a lower function to a higher
function.
Reflection on the two questions above. As to the former, one is not allowed to commit that
which is intrinsece malum even for a noble cause. Nor are there any guarantees that the organ
traffickers would pay up, nor that the son would make it through to ordination. Would it not be
better to pray that somehow, the Lord Himself might provide through the generosity of
others?
T
o the second, consider that to be a perfect human being is not merely to have the higher level
functions, but to have all the basic human functions in harmonious operation. Bodily functions
do not merely support the physiological structures necessary for brain function. They also
supply part of the human experience necessary for freedom and intelligence. A "brain-person"
would be deprived of normal human relations and bodily experience of the world around, as
well as those corporal activities - eating, drinking, work, sports and recreation - which provide a
bedrock of common human experience.
2.A.3. Personal Responsibility for Health
(a) Stewards of our bodies
Consider the claim: "It's my body. I can do what I like with it." Indeed the body belongs to the
person in a more fundamental way than any external possessions. My body is me, or at least a
dimension of me. More accurate than "I have a body" is "I am body (as well as soul)." The body
is not an instrument or tool but an integral aspect of my person.
----------------------------------------------------------------------------------------------------------------------TO THINK ABOUT:

Analyse the slightly different meanings of the possessive adjective 'my' in: my body, my
money, my time, my wife, my God, my dog.
----------------------------------------------------------------------------------------------------------------------Are we then free to do whatever we want with our bodies? What about our responsibilities to
other people? Some philosophers assert that man is totally autonomous and free to make his
own decisions. Is that not what free will implies?
It is here that the fundamental division opens up between those who recognise no creator, and
postulate the absolute dominion of the individual over his/her own life and sexual faculties, and
those who recognise God as Lord and Giver of life. This chasm runs through the middle of
much modern ethical debate. Democratic society attempts to straddle the abyss and reach a
compromise between irreconcilable standpoints, in order to maintain a pseudo-peaceful
co-existence.
As Christians we believe that our persons, body and soul, are gifts from the Creator. He
addresses us: "Be fruitful and multiply; fulfil the earth and subdue it. Have dominion over the
fish of the sea, the birds of the air, and all living things on earth." (Gen 1:28) Fundamentally
therefore we are stewards, not owners, of creation. One day we must give a reckoning of our
stewardship. We are responsibIe to God for our body-soul persons. Voluntarily we align our
wills with the will of the Creator. For God's laws, properly understood, do not destroy but
perfect human freedom.
T
he fifth Commandment of the Decalogue, "Thou shalt not murder" [lô tirtsach] forbids all
cruelty, anger and abuse of our bodies by excessive drink, harmful drugs, suicide,
unnecessary risks to life and limb, or the failure to take proper care of our health.
---------------------------------------------------------------------------------------------------------------------SELF-CHECK (2.3):

Read the Catechism of the Catholic Church 2258-2330.

Under what circumstances can it be morally permitted to take the life of another human
being?
 How is the New Law of the Sermon on the Mount superior to Old Testament Law in this
regard?
 What duties does the Catechism allocate to the State in these paragraphs?
---------------------------------------------------------------------------------------------------------------------(b) Balanced lifestyle: The responsibility for one's personal health belongs to the individual
themselves and cannot be off-loaded onto someone else. Sufficient exercise, work and rest,
and a healthy diet are a basic necessity and our own responsibility. Modern medicine focuses
more on curing diseases than on preventing them through a healthy regimen at an early stage.
Stress is a major killer in modern western societies. Erosion of the Sabbath rest further
imperils the nation's moral and spiritual health. Environmental pollution and junk foods overprocessed and artificial - undo some of the benefits brought by improved hygiene and diet.
The widespread lack of physical work and exercise predisposes to illness. Some dull the pain
of modern living by resort to drink, drugs, overeating, tranquillisers or sexual indulgence. Cities
are often ugly and noisy, compared to the quiet beauty of the countryside, which some
consider to be habitat the Creator designed for men.
As regards mental health, how many live in the artificial world of the T.V. and computer screen,
which for them has replaced the natural world? Youngsters often have a short attention span,
sated as they are with the instant excitement of computer games and videos. The symbols and
archetypes of modern culture are poisoned by advertising and commercialism. Videos
featuring violence, horror or sex are widely available to defile and damage the imagination.
Unless children are from a counter-cultural or religious family, it may be a long time before they
discover more health-giving myths and role-models. Society is polluted not only by chemicals
and radiation leaks but also by harmful images and nihilistic philosophies breeding death.
Body-ecology is all the rage, but few consider the ecology of the soul. As Christians we realise
that mental and spiritual hygiene are important as well as physical hygiene.
To be healthy today requires the courage to criticise such accepted norms of modern life and
to face the ethical dilemmas presented by modern technology. Of course many factors
detrimental to health are beyond personal control. Miners suffer pneumoconiosis but we all
suffer car fumes and noise. Dyestuff factory workers run the risk of bladder cancer, but we do
not know the effects of the combinations of artificial colourings, flavours and preservatives we
all consume. Even after taking reasonable care, an element of risk remains. Often it is the poor
who bear the brunt of poor environmental conditions, but we all have a social responsibility to
ensure health and safety at work.
(c) The Will to be Healed
Whatever medical treatment is prescribed, the patient's attitude of mind strongly influences the
rate and chances of recovery. There is a profoundly subjective element in healing. "Do you
want to be welI again?" the Lord asked the 38-year cripple by the Sheep Pool (Jn 5:7). Some
use their illness to manipulate others and be the centre of attention, or prefer to wallow in
self-pity rather than to make the effort necessary to recover. Maybe a sedentary or horizontal
life seems more attractive to them than an active existence, but such emotional blackmail
should be resisted.
The psychotherapist too has to remind his clients repeatedly, "Ultimately no one can help you if
you refuse to help yourself." The patient needs to co-operate with his doctor and nurses. They
cannot force him to take tablets, stick to a diet or take regular rest and exercise. Most
healthcare staff believe that a patient's fighting spirit is a critical factor in recovering health. A
terminal cancer patient usually dies soon after giving up the struggle, exhausted.
A personal commitment to life and health is therefore essential. We applaud someone who
bravely recovers the use of their limbs and speech after a severe stroke (C.V.A.). Society
rewards with honour a man like Leonard Cheshire, who despite the loss of both his legs spent
his life serving others. Both the prevention of sickness and the recovery from disease require
this freely willed commitment of an indomitable spirit.
Conversely there are those who exhibit self-destructive tendencies, who are repeatedly
admitted to hospital for drug overdoses, wrist slashings or drink abuse. Self-hatred is manifest
as self-pity and a craving for attention. Some enjoy being sick, or at least enjoy their
hypochondria, constant complaining, obscure ailments, medication and the whole drama of
supposed illness. This can be a way of avoiding responsibility and self-sacrifice in family life or
at work, a means of escape from a world they have not courage to face.
Some individuals suffering chronic neurosis or hypochondria adopt their medical condition as
their favourite hobby and seduce medical professionals into pandering to their desires. Doctors
acquiesce either for financial gain or out of a misplaced 'need to be needed', even deluding
thmselves into thinking they can be the medical Saviour for this person. Christian love in such
cases may require the telling of some hard truths with the risk of a direct clash. Only the truth
will set anyone free.
----------------------------------------------------------------------------------------------------------------------SELF-CHECK (2.4):

Read B. Häring, Medical Ethics Ch. 8, pp.142-154, and/or Basterra pp.39-55.
 What connections does Häring make between sickness and sin?
-----------------------------------------------------------------------------------------------------------------------
2. B.
Principle of Informed Consent: The Doctor - Patient Relationship
2.B.1. Truth in the doctor-patient relationship
A
t the heart of the healing process lies the relationship between doctor and patient, which is
based on trust. The patient approaches the doctor trusting in his medical expertise. He
believes that the doctor has his patient's best interests at heart - that he is not out to make lots
of money by recommending inappropriate treatments, for example. Implicitly they both make a
contract to work together for the patient's health.
F
or this contract to operate well, it requires truthfulness and co-operation on both sides. The
patient must try to describe his symptoms accurately to the doctor. He must not hide areas of
his life (e.g. a drink problem) which may have contributed to his ill-health. He must be willing to
accept the doctor's advice (e.g. referral to a consultant, a weeks total rest) and medication.
Secondly the doctor must tell the patient the truth, insofar as he can diagnose it, and in such a
way that the sick person can face it and come to terms with it. Where the truth is concealed, the
patient may begin to lose trust in the doctor. A growing mistrust and suspicion severely
damages the therapeutic relationship.
2.B.2. A delegated authority
It
is important to note that the doctor has no absolute authority over the patient. Human life is a
gift. Man has stewardship of his body and health, but not unlimited possession. Absolute
dominion over human life is an exclusively divine prerogative. Therefore the physician must
remember that the lives and bodies of his patients are subordinated, not to himself, nor to the
state, nor to medical science, nor even to the patient himself, but to God alone.
A
ny authority which a doctor has over his patient is an authority delegated to him by the patient.
The physician has a right to act only within the limits of this delegation, and therefore he must
have the consent of his patient in some way for whatever he does.
P
ope Pius XII when speaking about the morality of medical experimentation, expressed the
argument this way: "In the first place it must be assured that as a private person, the doctor can take no
measure and try no course of action without the consent of his patient. The doctor has no other rights or
power over the patient than those which the latter gives him explicitly or implicitly and tacitly." (Sep. 14
1952)
2.B 3. Rules of Consent
1. By entering into the doctor-patient relationship, the patient normally implies consent for the
standard diagnostic and therapeutic procedures in common use.
2. The unconscious patient's consent for necessary therapy or even surgery may be presumed
in some cases e.g. the person who collapses in the street with a cardiac arrest, or during an
operation for which consent has been explicitly granted, when it becomes apparent that more
extensive surgery is urgent. However, doctors have rightly been sued for performing non-urgent
operations (e.g. sterilisation) without permission.
3. Sometimes patients are of unsound mind and unreasonably refuse the indicated lifesaving
treatment, which they would probably accept if they were behaving rationally e.g. the attempted
suicide or the psychiatric patient who resist urgent therapeutic measures. In most such cases
the reasonable consent of the patient may morally be presumed, though the consent of the
next-of-kin or legal guardians should be sought. The doctor must also be careful to satisfy legal
requirements.
4. In dealing with minors the consent of parents or guardians must be obtained. With older
children and teenagers their agreement should also be forthcoming.
-----------------------------------------------------------------------------------------------------------------------TO THINK ABOUT:

Consider the case of the daughter of a Jehovah's Witness family who desperately needs a
blood transfusion. The family refuses to allow it, but the 14-year old girl herself confides to
the nurse that she would rather have the transfusion than die. What action should the
medical staff take?
-----------------------------------------------------------------------------------------------------------------------2.B.4. The Role of the Individual Conscience
E
very person has primary responsibility for his or her own health, and cannot simply delegate all
medical decision-making to the professional on the grounds that "the experts know best."
Ethical norms may be involved as well as medical facts e.g. the woman advised by her
physician to have a tubal ligation (sterilisation by tying the fallopian tubes) needs to understand
the moral and personal issues also at stake. Usually good medicine is good morality, but in a
number of modern instances bad medicine is confused with good on account of deficient or
distorted value systems.
Who has full knowledge of all the medical facts, ethical norms, and the patient's own situation
in order to make a correct decision. The doctors may know the diagnostic data and suggest
treatments. They are not infallible in ethics, nor will they understand every patient's personal
situation in detail. Christian theology insists that every normal individual has the capacity and
the responsibility to judge and act on his own judgement - according to his own conscience.
This responsibility cannot be delegated or abrogated to another. Therefore people have the
duty to inform themselves - to develop a well-educated conscience in accordance with
objective moral norms - and to apply that special knowledge to their own situation. This is
where a hospital chaplain or spiritual adviser can help the patient to arrive at a decision which
takes into account all the ethical and spiritual dimensions, as well as the purely medical facts.
The patient who consults a doctor about a course of treatment.
 (1) needs to be given the facts about his own medical condition, his prognosis and
chances.
 (2) should determine, with respect to objective values, the needs and the rights
of the
persons involved (principally himself, but also his family and the medical
staff)
 (3) has the responsibility to come to a concrete decision despite disagreement or pressure
from others.
The doctor has the duty to inform his patient about the medical facts truthfully and in language
adapted to his listener's understanding. This leads us on to the next section.
---------------------------------------------------------------------------------------------------------------------SELF-CHECK (2.5):

Consider these criteria with respect to a pregnant 17-year old who is told that in her
womb "it's only a lump of jelly up to 16 weeks." What counselling does she need? Check
up on the meanings of vincible and invincible ignorance in Chapter 5 of Module 1, and
revise the other impediments to correct moral decisions.
FURTHER READING:
B.M.A., Medical Ethics today: its Practice and Philosophy, pp.1-35 for a detailed treatment of
"Consent and Refusal."
Basterra, Bioethics, pp.221-31 and 237-46.
----------------------------------------------------------------------------------------------------------------------
2. C. Problems of Honesty and Confidentiality
2.C.1. Listening and truth-telling
How can we ensure a good quality of communication between the patient and the doctor,
nurse or health visitor?
The first obligation of the professional is to listen to the patient. The medical professional
filters out the relevant physiological information from the extraneous material. One of the arts
of medical dialogue is to repeat back to the patient what seems significant and to ask whether
this is what the patient means. Such feedback both reassures the patient and gradually trains
him/her in the art of giving the relevant information.
The work-pressured doctor cannot however afford to sit through every long and rambling
discourse from a self-pitying or hypochondriac patient. He has to cut through the verbiage to
the real message. Nevertheless the patient's mode of delivery may itself he the most
significant system. It is wise if the doctor or a nurse explains the purpose of questions since
unexpected or unusual questions may worry or threaten an anxious patient.
Un
less the patient loses her right to be believed, by clearly proved deception, the healthcare
professional should believe them. Even if he is inclined to suspect that the patient is malingering,
he ought not to jump to a conclusion. What a patient reports may not be objectively
demonstrable, but if it expresses what he/she is actually feeling then it is subjectively true.
Therefore it is medically significant.
As
mentioned already, deliberate deceit by the patient is a breach of the patient-doctor contract.
More likely, however, it is a distortion of communication by unconscious elements of
self-deception, denial, confusion or panic. The professional is also influenced by unconscious
fears. Physicians often excuse a lack of frankness as a concern to spare the patient. It may
however, be because they have personal difficulties in communicating the truth to an incurable
or dying patient.
"Psychiatrists advocate honest and open communication by physicians with patients, but
too often they do not practice what they preach. Their reasons for silence include uncertainty
about the cause, treatment, and prognosis of psychiatric illnesses, and unwillingness to depress,
demoralise, anger or alienate their patient." (Appleton, Am. Jour. Psy. 129 (1972), 743)
------------------------------------------------------------------------------------------------------------------------SELF-CHECK (2.6):
 Nursing Times (1973) 442-43 reveals in a survey that 80-90% of doctors would not usually
tell the patient that they had cancer, while 60% would want to be told themselves if it ever
happened to them. Any comment? Do you think the situation has improved since that date?
FURTHER READING:
Duncan, Dunstan & Welbourn, Dict. Med. Ethics, pp. 87-93 on "Communication." Basterra,
Bioethics, pp.226-31; 237-49, on "The truth", "Informed consent" and "The right to turn down
treatment"
-------------------------------------------------------------------------------------------------------------------------
2.C.2. Confidentiality and the Medical Secret
Th
e converse of the patient's right to truth is their right to privacy and confidentiality. Breaches of
confidentiality destroy trust and threaten the doctor-patient relationship. The International Code
of Medical Ethics states categorically, "A doctor owes to his patient absolute secrecy in all that
he has confided to him or which he knows because of the confidence entrusted to him."
Th
e doctor is under a twofold obligation: (1) that of the natural secret. All are bound in justice to
refrain from revealing any secret which may injure a fellow human being in their natural rights (2)
the professional secret, regarding all knowledge acquired in the exercise of their medical office,
entrusted to them by the patient because of their medical status.
W
hen reporting a medical case in a seminar, for instance, the patient's identity should be
safeguarded out of fundamental respect for the person, who may not want their intimate
disorders revealed publicly to an audience of strangers. The patient has the right to permit
revelation of medical information to close relatives and next-of-kin. Usually this permission is
presumed by the medical staff - provided the information is non-injurious - in order to allay the
anxieties of close family. It may not be presumed where the illness has moral overtones: drug
addiction, illegitimate pregnancy, HIV+ etc.
O
n the hospital wards all reasonable means should be used to ensure confidentiality e.g. privacy
for interviews, safekeeping of case records and documents, the assured trustworthiness and
understanding of confidentiality by all assistants who handle the records (ward clerks, medical
students. physiotherapists, chaplains etc.)
If
professionals are convinced that they need to discuss a patient's medical condition with other
consultants or with a medical team, the patient's informed consent to this should be obtained.
Physicians do not have the right to publish books about their famous or notorious patients, living
or dead, without explicit consent of the individual or their close family. For epidemiological
studies, researchers need access to medical records, but patients' names should be removed or
coded so as to guard privacy.
2.C.3. Exceptions to Confidentiality
Th
e individual's right to privacy and confidentiality is not absolute. It is limited by the rights of others
and by the individual's own limited rights of self-disposal. Therefore a medical secret may be
revealed:(i) When society would otherwise be greatly harmed. Just as the doctor must by
statute notify births, deaths, infectious diseases to the civil authority, he could also notify the
manager of a residential hostel if patient X had typhoid or diphtheria but refused hospitalisation.
He could notify transport authorities about an epileptic bus-driver who refused to inform his
employers. However the doctor himself must first try to persuade the patient to behave
reasonably. If a patient is threatening to commit a crime e.g. to feed a drug habit, the doctor may
warn that he will disclose the fact of addiction to relatives or to the police unless the patient is
willing to co-operate with treatment.
(ii) Where there is the likelihood of serious harm to an innocent third party e.g. a
man with infectious syphilis or HIV+ is about to marry and has not spoken of the disease with his
fiancée. The doctor should urge the patient to be honest, but if he refuses the doctor may be
obliged in charity and in justice to reveal some of the information directly e.g. telling the fiancée
that her life and health may be endangered by sexual intercourse and that she should ask him
about his medical condition and insist on knowing the full truth (c.f. American Medical
Association Code 11.2)
(ii
i) When the good of the patient himself requires it e.g. suicide threats. If the patient is of
unsound mind, the doctor may reveal medical information to his guardians or next-of-kin. He
will have to, when consent for surgery is needed.
(i
v) When the doctor himself is threatened with harm e.g. falsely accused of indecent
assault by a patient who has let slip that she has made similar ill-founded accusations against
other professionals in the past. If it is strictly required, he may use such evidence in his
defence.
(
v) When in court a doctor called to witness must observe medical secrecy with the above
exceptions. If his patient is the defendant, the doctor should limit his answers to his particular
medical speciality, and not reveal personal information which he has gathered in his surgery, or
join in probing the character of the accused in open court. These are grave problems in
jurisprudence. The medical profession must resist inroads being attempted by civil authority
into the medical secret. Otherwise this risks undermining the therapist-patient relationship.
N
ote that the medical secret is not absolute in the way that the sacramental seal of confession is
absolute for a priest.
--------------------------------------------------------------------------------------------------------------------FURTHER READING:
Haring, Medical Ethics, pp.183-8 and/or
Basterra, Bioethics, pp.232-6.
Ashley & O'Rourke, Healthcare Ethics (3rd ed.) pp.103-7; (4th ed.) pp.99-102 .
Peschke, Moral Theology Vol II. pp. 574-594
--------------------------------------------------------------------------------------------------------------------2.C.4. Lies or false speech?
H
ow is a professional to respond when questioned by others about a patient's condition? Can
confidentiality be protected by lying, when the questioner is someone who has no right to the
information? Firstly we will look at the Catholic moral evaluation of untrue statements. Some
theologians consider that any lie is: intrinsically evil and never permissible for the following
reasons:
 (a) A lie misleads one's neighbour and undermines mutual confidence. The imparting of
wrong information makes realistic and efficient action impossible and may cause serious
mistakes. Lies destroy the basis of individual security and fruitful work. Mutual confidence is
necessary for reasonable co-existence within society.
 (b) A lie is a breach of faith. Any human statement implicitly carries with it the assurance
that the speaker's perception of reality corresponds to the statement (except in obvious jest
- the so-called "jocose lie"). In any human conversation there is an implicit contract rooted in
truth. Otherwise the conversation is simply a waste of time and breath. Lying insults the
listener and offends his human dignity.
 (c) A lie abuses the faculty of speech. God gave us the power of speech so that we might
express to one another our inward thoughts and judgements. An untruthful statement
therefore contradicts the whole purpose of speech. For Aquinas this proves the intrinsic evil
of lying.
O
ther theologians (e.g. Curran) distinguish between false speech and a lie. A lie is a false
statement made to someone who has the right to the true answer. It is the refusal to render a
veritas debita, an owed truth. If, however, the person asking had no right to the truth (e.g. a
nosy neighbour), or there is a reasonable suspicion that he wishes to know in order to commit
some crime ("They've gone away on holiday for a few weeks at No. 19 have they?" with the
intent of robbing the house) the misleading answer is reckoned as false speech.
In
medical contexts it is difficult to see the need for "false speech." The doctor or nurse can
always say to an over-inquisitive relative - "I'm sorry, but I'm not at liberty to discuss the
patient's condition with you. It is confidential." Or merely, "I'm afraid I wouldn't be able to make
a definite statement about that." However, if the questioner, perhaps as next-of-kin, does have
the right to unambiguous and: accurate information, either at the behest of the patient or
because the patient has lost consciousness and important decisions must be made, then the
healthcare personnel have no right to equivocate but must answer frankly.
In the Accident and Emergency Department of a general hospital the medical staff
themselves will often be unsure whether a particular patient admitted with a suspected heart
attack (M.I.), stroke (C.V.A.) or in a road traffic accident, is going to survive. In extending
sympathy to relatives it is necessary to keep the balance, neither raising undue expectations
nor dashing all hopes. In the end honesty and an admission of one's limited knowledge is
probably the best policy.
The traditional classification of lies distinguishes:
 (a) The jocose lie for amusement or joke. This escapes censure except from the most
humourless moralists. However, if it contains a streak of malice or deliberately insults or
humiliates somebody, then it comes into the category of the pernicious lie (see below).
 (b) The officious lie. told to achieve some useful good or to avoid misfortune e.g. the
grandmother who tells her daughter that the grandchildren have behaved well. In fact they
have been very naughty, but she wants to spare them punishment. It is not good to teach
the young that responsibility for one's actions can thus be avoided.
 (c) The pernicious lie is deliberateIy harmful and malicious and hence always sinful.
The moral debate centres upon category (b), the officious well-intended lie. Consider an
example. Imagine a nurse alone one night on a hospital ward who is threatened by an intruder
armed with a knife. He demands that she hand over the morphine supplies in the pharmacy
cupboard, where in fact there are substantial quantities of narcotics. How does she answer?
 1. "I haven't got the keys. Only Sister has them and she's on her break."
 2. "There aren't any narcotics in there. They are kept on a different ward."
 3. She opens the cupboard but gives him laxatives in a morphine bottle.
 4. She tells the truth and hands over £2000 worth of morphine and derivatives.
T
he attacker has evidently no right to the truth about the whereabouts of the morphine. Is the
nurse to tell the truth but refuse to hand over the keys and be stabbed? Is she to deceive him
by word (1,2) or action (3). Is she to practice the "mental reservation" advised by Jesuit
theologians: "There aren't any narcotics in there (for you). They are kept on a different ward
(as well as on this one and many others in the hospital)."
Even theologians who absolutely prohibit all lies agree that a lie is not a serious sin unless it
causes grievous harm to a fellowman or grave dishonour to God. Others would advocate 'false
speech' in these circumstances, and would not class (1) or (2) as lies.
----------------------------------------------------------------------------------------------------------------------SELF-CHECK (2.7):
Read the Catechism of the Catholic Church 2482-2492, on lying and respect for the truth.
What advice would you give if the following student approached you?
"I
am a woman, 21, beginning vacation after my third year of college. I have tested and re-tested
HIV-positive. . . May I keep my condition secret from the college administrators and my fellow
students? If I say nothing, I will live in a dormitory suite with three other women, all close
friends, sharing a bath and kitchenette. Also, I will be playing basketball, since I have a full
basketball scholarship. The doctors tell me that if I am careful, the living arrangement will
involve virtually no risk for the others, but continuing to play will involve minimal risk . . . "
-----------------------------------------------------------------------------------------------------------------------
2.C.5. Dilemmas in nursing practice
N
ursing staff often build up a much deeper relationship with patients than do doctors and
consultants, and know them much better. They spend far more time with the patient and
perform various medical procedures previously reserved to doctors.
When a consultant has withheld the truth from a patient about the seriousness of his/her
condition, and has ordered the nursing staff to say nothing, this can place nurses in an
invidious position. Suppose the patient asks to be told the truth, but they fear a reprimand from
on high. The primary duty rests upon the Sister, the Ward Manager, to remonstrate with the
consultant to persuade him to be more open. If he still refuses, but she judges that the patient
can face the truth, in moral terms the latter's right to know takes precedence. Consider this
case:
A
patient whose illness was likely to prove terminal asked a nurse what were her chances of ever
leaving the hospital alive. The doctor had not discussed the patient's medical condition fully
with her. The family were reluctant to tell her for fear of upsetting her and had expressed this
reluctance to Sister. The patient one day said to a particular nurse whom she knew well and
trusted: "I want to ask you because I know you wouldn't lie to me." The nurse assured her that
the medical staff were doing all they could, and that she could help by cooperating fully with the
treatment, so that one day she might be able to leave hospital. Is this response adequate?
FURTHER READING: F.J. Fitzpatrick, Ethics in Nursing Practice, pp.l63-183, "Problems of
Honesty and Confidentiality". He observes that the major dilemmas for nursing staff usually
centre around:(i)
Giving the patient information which one has been told to keep from them.
(ii)
Confusion about what the patient knows and does not know.
(iii)
Handling confidential information about patients.
(iv)
Truth-telling in obtaining consent for treatment.
(v)
Truth-telling to the dying. (See Ch.7).
2.D. The ethos, ethical code and morality of the physician
-----------------------------------------------------------------------------------------------------------------------SELF-CHECK (2.8):
Read B. Haring, Medical Ethics, Ch.4, pp.22-38. Please make notes on the distinctions
between
(a) ethos
(b) ethical code
(c) medical ethics
(d) morality of the physician
(e) rights of conscience of the physician.
------------------------------------------------------------------------------------------------------------------------
2.E. The medical profession in the modern world
M
edicine we call a profession. That term today is used for any prestigious occupation engineering, architecture, the arts and business. In the middle ages only divinity (theology),
physic (medicine) and the law ranked as professions. Their distinctive quality is that they are
"person professions" centred on a counsellor-client type relationship, not on abstract knowledge
nor on the productivity of an impersonal system.
Th
e increase in knowledge and technical skill has increased the physical power of the medical
profession but risks turning them into technocrats, adept at electronic instruments, nuclear
magnetic resonance scans, laboratory tests, and gradually more and more distant from the
patient:
(1
) The hospital patient is now seen and his tissues analysed by a whole battery of specialists.
There is a risk of fragmentation of treatment. He may be perceived as a collection of organs,
rather than as an individual personality. The sheer volume of modern medical knowledge
necessitates specialisation. If a patient has several ailments, or one which defies clear
diagnosis, he may end up being shunted round from the cardiology ward to the lungs-and-chest
ward to the gastro-ward. Such splintering of the medical team with no-one able to take overall
responsibility for the treatment of a complex illness can be very demoralising for the sick person.
(
2) The doctor's roles are divided. His diverse functions lead to stresses and tensions. Besides
his ward rounds dealing with patients and emergency calls, he may teach junior doctors and
medical students, keep in his hand at research, keep up with reading the recent literature,
attend hospital administration meetings and make sure he is working within budget restraints. It
all adds up to a punishing schedule of which the patients occupy only a minor fraction.
(
3) The medical profession is often suspected of erecting barriers to preserve its privileges,
ranging from the proverbially illegible script on chemist's prescriptions to the use of exotic
acronyms (C.V.A., C.O.A.D., I.T.U., M.I., S.A.H. etc) and the deliberate exclusion of highly
qualified foreign doctors from posts in Britain. Medics easily become an elite on whom the
public is dependent. Their professional registering body is inclined to defend its members'
interests even against the common good. When a doctor is found guilty of negligence or
culpably incorrect diagnoses, the sanctions imposed are not usually very punitive.
A
shley and O'Rourke (Healthcare Ethics 3rd ed. pp.78-80, 4th ed. pp.69-73) suggest that the
ancient professions (priest - doctor - lawyer) are distinctive in that they are concerned with
deeply personal matters, in particular problems of life and death. Their focus is upon practice
and people, not as research scientists or scholars. The person-professional must symbolically
or literally "get inside the chest" of the client and become privy to his personal world, in order to
resolve the problem which falls within his professional mandate.
A
shley and O'Rourke consider that the indiscriminate use of the term 'profession' for other
high-ranking occupations signals the obliteration of an important distinction between these and
the person-focused professions. It is a symptom of industrial society and the dehumanisation
of the professions. The genuine doctor must be person-centred, not science-centred,
machine-centred, career-centred or money-centred.
Healthcare is not a business or marketplace trade. If it were, there would be no responsibility to
treat the elderly, the chronically sick or troublesome, or other unremunerative patients. But we
expect any doctor to come to help in an emergency (Is there a doctor in the house?) without
first asking ''How much will I get paid if I treat this emergency?"
It
appears that the philosophical, ethical and religious dimension is often unfortunately lacking in
medical education. Ask a newly qualified doctor how many courses of lectures he had to take
in medical ethics and philosophy. In some cases there has been none or minimal coverage.
The time spent on ethics is generally minuscule compared to that spent imparting technical and
biological knowledge. Scientific facts are taught in a clear, definite and precise manner. Morals
and ethics are left vague, subjective and seemingly a matter of private opinion in a pluralist
society, except where legal constraints apply. An inbuilt bias arises from such a training. It
fosters a very pragmatic view of medical ethics, and the tendency of doctors to make their own
minds up as they go along, in accordance with their own inevitably limited experience, the
prevailing ethos of their peers, and current opinion in society and the medical journals. This
does not make for in-depth moral analysis or searching examination of society's or one's own
philosophical prejudices. On the job, there is usually just not time for all this . . .
Studies of American doctors reveal that their basic attitude is to see themselves "as
professionally competent persons who are in a social position to apply scientific knowledge and to
exercise impartial control over the situation in order to achieve the rational goal of curing or helping a sick
patient. The patient's part of the job is to trust the doctor and co-operate with him." This is a
science-based and mildly paternalistic approach to the patient, who has come to resemble an
object of investigation for the natural sciences. Physicians on the whole see themselves as
applied scientists.
I
n fairness it must be added that doctors gain much satisfaction from their therapeutic work and
from their professional status as a badge of achievement. They do not usually regard money
as their primary motivation, although they resent the failure of certain patients to pay, or
insufficient remuneration for the long hours, arduous years of study and burdens of
responsibility which they carry. They also resent restrictions on their independence as
something of a slight on their professional competence.
I
n the Anglo-Saxon world doctors incline towards immediate practical solutions to problems of
illness. Understandably they do not wish to become too involved in the emotional or the social
problems of the patient, and do not see the wider social problems of health, law and society as
their particular responsibility. They may resent interference in their medico-ethical judgements
and feel they should be trusted to act decently and humanely. Conflict with nurses, chaplains,
relatives, philosophers or, worst of all, lawyers, is unwelcome, especially in a busy hospital
environment. The physician's approach is to "help the patient" in the sense of "do everything
possible to improve the épatient's physiological condition." If that is not feasible, then "to make
him as comfortable as possible." Thereafter the doctor can rest assured and without guilt, that
he has done everything possible. Such an approach can however lead to a simplistic ethics
which artificially resuscitates a very sick person who was ready to die naturally, or deprives a
dying person of consciousness before certain family and spiritual duties have been
satisfactorily completed.
Finally, physicians may justifiably feel it is unfair that they are now expected to be competent
not only in their medical speciality, but also to be cognisant of a long list of sociological,
religious, psychological and relational factors. They need to realise that they are only one part
of the total healthcare team, and that they can learn and be supported by other professionals
who have different areas of expertise. If the doctor tries to be the Saviour it will prove too
heavy a burden for him. A raising of standards in the ethical areas of medical education would
well serve the noble profession.
FURTHER READING:
 B.M.A., Medical Ethics Today, pp.36-68, "Confidentiality and Medical Records"
 T.L.Beauchamp & J.F.Childress, Principles of Biomedical Ethics, pp.395-453
"Professional-Patient Relationships"
 T.J.O'Donnell, Medicine and Christian Morality, pp.243-261,"Professionalism in Medicine
CHAPTER 3
RESPECT FOR HUMAN LIFE IN ITS ORIGINS
3.A. Theological Perspective
3.B. Definition of Abortion
3.C. Pro-life or Pro-choice? An analysis of the arguments



1. Polarisation in society
2. Presuppositions underlying the condemnation of abortion
3. Presuppositions underlying the acceptance of abortion
3.D. Indications used for abortion in contemporary society:
1. medical
5. eugenic
2. psychiatric
6. social
3. ethical
4. psycho-social
7. population control
3.E. Legal and demographic aspects of abortion
3.F. The Position of the Catholic Church and other Christian denominations
on Abortion:
1. Roman Catholic
Scotland)
2. Church of England
4. Methodist
5. Baptist
3. Presbyterian (Church of
6. Eastern Orthodox
3.G. The medical reality of abortion in terms of methods used
3.H. Appendix 1 - Declaration of Oslo (1970)
-----------------------------------------------------------------------------------------------------------------------
OBJECTIVES OF THIS CHAPTER:


To analyse the arguments offered for and against abortion
To understand better the occurrence of abortion among the population and the situations
which pre-dispose women towardds abortion.
 To appreciate the unique steadfastness of Catholic teaching on abortion, upholding the
Hippocratic tradition alone within an ecumenical perspective.
-----------------------------------------------------------------------------------------------------------------------
3.A.
Theological orientation
As Christians we speak of the sanctity of human life. Sanctity denotes something set
apart, cut off from the everyday mundane world or scale of values. It comes from the Latin
'seco - I cut', found in words such as secateurs and sanctions. To stress the sanctity of human
life is to recognise that it has a very high value. It is a precious thing, not an everyday
commodity which can be traded off against other objects. The religious overtones of the word
link human life to the All-Holy, Sanctissimus, Almighty God. "The life of every individual, from its
very beginning, is part of God's plan" (EV44).
"Human life is sacred because from the very beginning it involves 'the creative action of God' and
it remains forever in a special relation with the Creator who is its sole end. God alone is the Lord of life
from its beginning to its end . . " (Donum Vitae intro.5)
The right to life of the innocent human being is the first and most important of all human
rights, because all others depend upon it. What use the right to free speech, to association, to
decent living conditions, if the right of life is not secure? It is the prerequisite, the sine qua non
of all other human rights.c.f. (Pacem in terris 11)
Moreover the Scriptures teach us that every human person is uniquely intended by God and
called into existence by Him (e.g. Ps 139:11). Every human being is precious and unrepeatable
in God's plan and has a task to do, that no-one else can do in this life. Therefore the creation
through sexual intercourse of a new human life, endowed by God with an immortal soul capable
of knowing and loving Him for all eternity, is never merely a coincidence or an accident or just a
physical consequence of a physical act. It is the point where human responsibility and divine
creativity are most closely wedded together. In God's plan the conception of a child is intended
to be the fruit of the spiritual and physical union of man and wife, His blessing upon a faithful
and lifelong communion of life and love. Although the human body grows from the biological
materials provided by the parents, the human soul is immediately and directly created by God.
The exact time at which this happens has long been a matter of debate. (see below)
The varying attitudes towards sexuality and procreation so prevalent today evidently
give rise to divergent moral norms regarding the first stages of human life, especially when
considering infertility treatments, artificial insemination, in-vitro fertilisation, pre-natal
diagnosis, and most acutely and visibly, procured abortion. It is to this that we shall turn first,
but the same basic moral principles and values apply to all the other subjects too.
B
esides its intrinsic moral importance the question of abortion provides a critical testing ground
for other conceptual tools of moral theology - the principle of double effect, rules on
co-operation, the concept of intrinsic evil. It should enable us to see these in action so that we
are better able to apply them accurately in moral decisions elsewhere. Our treatment of unborn
life will be an extended one, because this is the single most important issue in medical ethics
today, where the secular viewpoint diverges most markedly from the Christian world-view and
Hippocratic medicine, and the debate (or battle) is most sharply polarised.
3.B. Definition of abortion
Abortion is the termination of a pregnancy, either spontaneously or by intervention, before the
foetus reaches viability.
N.B. Latin 'fetus' - offspring. Fetus denotes the young animal in the
egg or in the womb after its parts are distinctly formed.
Viability is the point at which the fetus can survive if expelled from the womb.
Spontaneous abortion of an intrauterine pregnancy is common (20% of all pregnancies or
more) and usually referred to as a miscarriage. Nature itself seems to act in cases of
anencephaly (a foetus with no brain) or gross chromosomal disorders.
Induced abortion is deliberately brought about by surgery or medication or other techniques.
It is called 'therapeutic abortion' if it is done in order to save the mother's life or health. Or it
may be criminal. In most civilisations abortion has been an offence. In England and Wales it
became a statutory crime in 1803 after a long history as an offence in canon law. The Offences
against the Person Act of 1861 characterised it as a felony punishable by life imprisonment. It
prohibited the administration of noxious substances or the use of an instrument with intent to
procure the miscarriage of a woman. The Abortion Act (1967) removed this protection of
unborn life under certain conditions.
The Declaration of Oslo (1970). The World Medical Association declared that in view of the
fact that abortion had by then been legalised in a number of countries, there existed "a
diversity of attitudes towards the life of the unborn child" (para.3) and that when there was a
conflict of interest between the pregnant woman and her unborn child, it was up to individual
conscience to decide for or against an abortion (paras. 2,3). Until this moment the medical
codes in the Western World had protected foetal life. The Oslo Declaration represented a
decisive break with 2,300 years of Hippocratic medical tradition. You will find the text in
Appendix 1. to this chapter. It is now estimated (IPPF Annual Report 1991-2) that each year
some 50 million women have an abortion. The average American woman is 46% likely to
experience an abortion during her life.
Abortion is direct when the expulsion of the non-viable foetus is deliberately provoked
immediately (in the causal sense), either as the only purpose of the medical intervention or as
the means to another end e.g. the uterus is emptied because the mother has a heart ailment.
A
bortion is indirect when the medical intervention is aimed at some good purpose, but as a
secondary and undesired side effect the abortion is caused (with the same or lesser
immediacy) e.g. a cancerous uterus is removed and the foetus inside dies. The moral
judgement here involves the principle of double effect.
Pastoral note on spontaneous abortions:
P
arents are deeply grieved if they lose a child by miscarriage. Very many women have suffered
this trauma at some point in their family life. Those involved in pastoral care should assure the
parents of the efficacy of "baptism by desire" i.e. that God takes into account their desire that
the baby be baptised into eternal life (CCC 1261). They should be offered prayers and Funeral
Rites by the church if they so wish:
"
Lord God, ever caring and gentle, we commit to your love this little one, quickened to life for so short a
time. Enfold him/her in eternal life. We pray for his/her parents who are saddened at the loss of their
child. Give them courage and help them in their pain and grief. May they all meet one day in the joy and
peace of your kingdom. Through Christ our Lord. Amen." (Order of Christian Funerals no.581.15)
Let them trust the Lord Jesus that in some way their baby will grow to maturity with Him and
one day they will be reunited. Through prayer, and even maybe a dream, they will find
reassurance of this. A Mass may be celebrated for the repose of the soul of the child, either in
the home or as for a private intention in the parish church.
3.C.
3.C.1.
Pro-life or Pro-choice? An analysis of the arguments
Polarisation in society
T
he subject of abortion arouses strong emotions and provides a test case for a society which
claims to be democratic and pluraIistic. There is little common meeting ground between pro-life
and pro-abortion lobbies - or should that be anti-abortion and pro-choice. All our terms are
value-laden: do we say 'termination of pregnancy' or 'killing a baby '~ The opposing camps
glare at each other across the deep chasm which separates them. We have reached the limits
of legitimate pluralism in a pluralist and democratic society. No observer can remain neutral in
this debate because it touches the roots of human life and society itself. To claim to have no
position, to be an independent observer, cool, objective and detached is a fiction. To have no
position is to acquiesce in the status quo, whichever status quo holds for the time being, be
that in England, Ireland, Poland or Iran (where: the Shah allowed abortion and Ayatollah
Khomeini banned it).
Which is the more genuine and fundamental right? - the right of the innocent child in the womb
to life, or the woman's right to have control over her own body? Every independent observer is
somebody's child, and probably also one day' somebody else's parent, if not already.
Within the pro-life movement too there are divisions over strategy, especially when it comes to
voting tactics. Should abortion a single issue voting matter, or is it one element of a seamless
robe, a broad spectrum of pro-life issues which includes Third World Development and nuclear
disarmament (c.f.The Common Good). Or is it an issue sufficient to disqualify any pro-abortion
candidate, whatever his party, as SPUC suggest? Is it 'just a Catholic issue', as some
pro-choice groups try to label it, or is it a human issue which involves all the human race?
Should pro-lifers work only via the Parliamentary process and civilised debate, or is it right to
take to the streets, to picket or blockade or mount prayer vigils outside abortion clinics - even
subsequently to suffer in gaol as a witness to the sanctity of human life? Has any really
significant social or political change to our laws and constitution come about without public
protest, demonstrations, gaolings and so on? One thinks of the anti-slavery campaigns, the
suffragette movement, the civil rights movement in the U.S.A.. and the ending of apartheid in
South Africa.
--------------------------------------------------------------------------------------------------------------------SELF-CHECK (3.1):

Read Evangelium Vitae 72-4. Does Pope John Paul II countenance breaking the civil law
over the abortion issue?
---------------------------------------------------------------------------------------------------------------------
3.C.2.
Presuppositions which underlie the condemnation of abortion.
Given the inflammatory nature of the abortion issue, it is all the more important to clarify
coolly and rationally the conflicting value judgements and principles which underlie the
dispute. The condemnation of abortion rests upon the following presuppositions.
 (a) The foetus or embryo is an innocent human being in the full sense of those words i.e. a
human person, not a 'pre-human' or 'potential human'.
 (b) To kill an innocent human being intentionally is always a grave moral evil and can
never be justified. This is a universal and exceptionless moral norm, binding in all cases,
whatever the consequences. In the Judaeo-Christian tradition it is
grounded in the fifth commandment of the Decalogue: "Thou shalt not murder." It is
presented as part of the Catholic Church's infallible teaching in EV57: "By the
authority which Christ conferred upon Peter and his successors, and in communion
with the Bishops of the Catholic Church, I confirm that the direct and voluntary
killing of an innocent human being is always gravely immoral. . . . The deliberate decision
to deprive an innocent human being of his life is always morally evil and can never be licit
either as an end in itself or as a means to a good end. It is in fact a grave act of
disobedience to the moral law, and indeed to God Himself . . "
 (c) In a direct abortion a weak and defenceless human foetus is intentionally killed.
 (d) Therefore direct abortion is always and everywhere a grave moral evil and regardless of
consequences can never be justified. (EV58)
T
his position rests on deontological reasoning. It points to a binding duty to protect innocent
human life. It answers 'Yes' to the question - is the foetus truly a human being with full human
rights? It also assumes that there do exist absolute and binding moral laws valid for every
situation, and that certain actions can be labelled 'intrinsically evil', that is, never morally
justified under any circumstances whatsoever. This particular issue has been much debated in
recent decades by theologians of the mixed consequentialist school (see Module 1). However
they too usually concede that it is hard to imagine any possible situation in which rape, the
torture of children, paedophilia or bestiality, might ever be morally justified. In other words, they
would effectively class these as intrinsically evil actions. The deontological approach includes
the killing of an innocent human being, born or unborn, among the list of intrinsically evil acts.
T
eleogical reasoning, which weighs up the consequences of a proposed action, might arrive
at the same resuIt if all the consequences were foreseen and integrated into the moral
calculus. Of course the pertinent question is whether man with his prejudices, innate biases
and blind spots born of Iimited experience and culture, ever reaIly can predict all the
consequences? In any case, the spiritual consequences of our actions in eternity are not
deducible other than from Revelation, which brings us back to the deontological approach.
A
complete teleological approach needs to have clear perception of the impact of abortion upon
(i) the child (ii) the mother, in physical terms, in emotional costs, in psychological terms and in
spiritual effects now and hereafter, (iii) the family and friends (iv) society as a whole (v) the
Church. If all these were fully and accurately taken into account with supernatural insight, one
would find a remarkable convergence of teleologically-derived norms and deontological norms.
--------------------------------------------------------------------------------------------------------------------SELF-CHECK (3.2) :
Read Veritatis Splendor paragraphs 71-82. What are the principal criticisms the Pope targets at
consequentialism or proportionalism?
-------------------------------------------------------------------------------------------------------------------If
it could be proved that the foetus were not a human being, or that for some reason it could not
be the subject of full human rights, or that it were not innocent, then the anti-abortion case
might fall to the ground. Alternatively a rejection of the Decalogue veto on murder leaves the
way open to abortion. However, once the 'right to kill innocent human beings' has been
enshrined in legislation by society, its extension to other groups, classes, races, religions can
only be halted with difficulty. The acceptance of such a 'pseudo-right' is liable to further the
disintegration of civilised society, because nobody is safe any longer. If they can kill him, they
can kill you and me too.
P
ay heed to the important word "innocent" in the above principles. The Church does not prohibit
the taking of guilty human life in self-defence, in a just war, or in capital punishment, when
there is proportionate reason. Aquinas argues that a murderer, in shedding another's blood,
deprives himself of his own right to live. Legitimate public authority, after a fair trial, can in
retributive justice take the guilty life. The State does not deprive him of the right to live: he
forfeits that by his own action. "He who sheds man's blood, by man shall his blood be shed."
(Gen. 9:6) The death sentence restores the moral order after the gross violation committed,
and by its very severity witnesses to the supreme importance of moral values. Arguments
based on deterrence and revenge cannot justify capital punishment: only considerations of
retributive justice can achieve that. This is not merciful, but it is just.
----------------------------------------------------------------------------------------------------------------------SELF-CHECK (3.3)
 Read EV 57-62. Compare the language of the Pope's declarations with that for general
infallibility in Lumen Gentium 25. Is it clear what he is intending to say?
 For a full doctrinal and historical summary of the Church's position, read the document from
the C.D.F., Declaration on Procured Abortion, 18.11.1974, in Flannery, Vatican Council II,
More Post-conciliar Documents, pp.441-53.
 Read EV 56. Is John Paul II changing the Church's teaching on the subject of capital
punishment?
----------------------------------------------------------------------------------------------------------------------3.C. 3. Presuppositions which underlie the acceptance of abortion
I
nduced abortion does not occur within a cultural vacuum. It exists within a culture sympathetic
to new rules and expectations concerning personal freedoms and "reproductive rights".
Yankelovich in the USA has analysed these as follows:
 1. A culture-free independence i.e. value-freedom versus value-direction.
 2. An affirmation of the legitimacy of temporary commitments to others (i.e. sexual
relationships) dependent upon the degree of self-enhancement (pleasure?) realised.
 3. A permanent commitment to self-actualisation (doing my own thing!)
 4. The psycho-social transformation of desires into needs (What I want becomes a need
which others must recognise.
Hence American children, born or unborn, because of the personal burdens and interference
they are perceived to cause their parents/step-parents, are subject to "private violence" to an
alarming degree.
While only a few people argue for abortion on demand right up to birth, substantially more
consider abortion to be a unfortunate but lesser evil in an inconvenient and unplanned
pregnancy - or even as morally neutral in the very early stages when the embryo is not visibly
human (under a microscope). Others argue for abortion if a severely handicapped child is
involved, if rape has occurred, if the mother-to-be is experiencing severe social or
psychological problems. Abortion is seldom seen as a good thing in itself, although the right to
choose is given a very high value by feminist and liberal writers. The pro-abortion arguments
include the following.
 (a) The foetus, and a fortiori the embryo or zygote, is not a human being in the full sense of
the term, but only a potential human being. It should be respected but not accorded human
rights equal to the mother, who is fully a human person. It is a matter of debate at which
point during pregnancy - quickening, detectable brain impulses, consciousness or viability
- the foetus allegedly "becomes" a human being with human rights.
 (b) The women's rights argument. From the dawn of history women have laboured under
the burden of sexual inequality. Usually their lives have been an uninterrupted succession
of pregnancies and childbirths - not infrequently to the point of exhaustion and early death.
Male sexual demands, domestic violence and patriarchal cultures have suppressed
womankind and driven many women to early graves. Against this background of
exploitation and abuse, the contraceptive pill and easy, safe abortion have at last given
women the possibility of regulating their own fertility. Such hard-won rights are never to be
surrendered. Religious patriarchies, like the Catholic Church and Muslim fundamentalists,
are trying to turn the clock back and subject women once again to dogmatic inequalities.
Women have the right to choose to do what they like with their own bodies, and no man
shall interfere. An unwanted foetus may be regarded as an unjust aggressor, a parasite
invading a woman's body, against which she has the right to defend herself.
 (c) The "hedonistic mentality unwilling to accept responsibility in matters of sexuality"
(EV13). A "self-centred concept of freedom . . regards procreation as an obstacle to
personal fulfilment. The life which could result from a sexual encounter thus becomes an
enemy to be avoided at all costs, and abortion becomes the only possible decisive
response to failed contraception." Abortion is thus the sine qua non of a permissive society
which demands unlimited access to recreational sex free of consequences. It operates as
a necessary backstop to failed contraception.
 (d) Human life is a high value but not the only value. The costs of preserving the foetus
need to be weighed against other factors: the mother's mental or physical health, the
effects on other children, the social conditions of the family. Once all these consequences
have been taken into account, abortion, although sad and unpleasant, may be the best
option in a difficult situation.


(e) Unwanted pregnancies produce unwanted children, born into misery. Every child should
be a wanted child, so undesired births should be prevented.
(f) Quality of life considerations: a child with Down's Syndrome or spine bifida would enjoy
such a poor quality of existence that it is better to avoid their birth in the first place.
Families find it very difficult to cope with severely handicapped or sick children. If Nature
herself spontaneously aborts 20% (some claim up to 50%) of fertilised ova, probably
because they are defective, why can man not do the same when necessary?
3.D.
Indications used for abortion in contemporary society
T
he following indications (proposed justifications) are currently advanced as grounds for direct
abortion :(i
) medical
(ii) psychiatric
(iii) ethical
(iv) psycho-social
(v) eugenic
(vi) social and financial
(vii) demographic population control
(
i) Medical indications are presumed when non-interruption of pregnancy will cost the mother
her life or her health. A few decades ago there were many cases of heart, kidney or lung
disease, or indeed cancer of the womb, which posed an agonising choice between the life of
the mother and the life of the child. Medical advances have reduced such cases to a tiny
number. A cancer amenable to treatment can almost always be treated without disturbing the
pregnancy. If a cancer is advanced and terminal and only palliative care is possible, then
abortion is pointless in any case and may be spiritually and psychologically very damaging to
the dying mother. Strenuous efforts should be made to keep the mother alive until the child is
sufficiently viable to be delivered by Caesarian section.
We shall meet other conflict situations and the principle of double effect later. Suffice it here to
say that the Church does not teach that the child's life is more important than the mother's, a
popular pice of misinformation. The Church recognises both lives as equally valuable and
opposes the direct killing of either. It would oppose a prejudice which allotted automatic priority
to the mother's life. The medical task is to save both lives if possible. If not, then save one
rather than let both die.
T
he refusal of the Church to allow an "easy way out" of such dilemmas by killing the child, has
forced surgeons to develop their skills to a point where now usually both lives can be saved.
Good morality fosters good medicine. The Church does admit as licit certain indirect abortions,
where the child's life cannot be saved but the mother's can, and the abortion happens as an
unintended and unwanted side-effect of treating the mother.
(
ii) Psychiatric indications postulate severe damage to the woman's mental health if
pregnancy is not interrupted. Morally we must note that life is a higher value than health.
Moreover, abortion is seldom, if ever, the only way of avoiding serious psychiatric illness. In
fact, most of the evidence suggests that abortion is in the long term likely to be far more
psychologically damaging than childbirth.
Sometimes women refused an abortion make desperate suicide threats. Dr. Myre Sim
(Toronto), a psychologist with wide experience of patients suffering from puerperal psychosis,
says he has never found a valid psychiatric indication for abortion. Suicide is extremely rare
among pregnant women. In addition, post-abortion psychosis is a far more difficult condition to
treat than post-natal psychosis. Hook (1963) studied 294 Swedish women who were refused
abortions. Although 10% of them had threatened suicide, he found in fact not a single suicide
or attempted suicide among them. The professional health worker needs to recognise and
resist such attempts at moral blackmail. (c.f. Maurice Reilly (ed), Ethical Issues in Reproductive
Medicine, p.24 ff.).
P
sychiatrists' opinions vary widely.: Some believe abortion is never indicated. Others consider
that the pressures of an inconvenient pregnancy represent an emotional risk to the patient and
that termination is therefore indicated.
(i
ii) Ethical indications are invoked where the pregnancy is a result of severe trauma involving
rape or incest. Almost inevitably the mother initially rejects the child as an unjust burden
violently forced upon her. How can she love the child of a man who has so violated and
defiled her? In its face and eyes she will see the form of her aggressor. The child's very
existence exposes her to serious moral stress and social shame.
T
his is one of the most difficult problems. Nevertheless, we should remember that every
Christian is called to be a saint. God may set an heroic challenge before us. Whatever He
commands, He simultaneously offers the grace to fulfil that command. Therefore drawing close
to the merciful Heart of Jesus, and with the deserved support of a loving family and parish
community, the victim of rape should be encouraged to bear the child to term. Later she can
decide whether to give the baby for adoption, bringing joy and happiness to a childless couple.
Indeed there are 700-1200 couples wanting to adopt for every child available.
T
his course, although no easy and quick solution, could leave a woman with infinitely more
self-respect at the end. She has risen above the cruelty and tragedy and brought a new life into
the world. From horrible evil, she has brought forth a blessing. Good has triumphed over
wickedness. On the other hand an abortion is likely to compound the trauma of rape.
(i
v) Psycho-social indications: the mother's environment suggests that a pregnancy would
cause insuperable psychological conflict. Perhaps she already has more children than she can
cope with, the flat is too small, or her husband is unreliable or absent - or she is an unmarried
mother facing social opprobrium (see EV59). Pregnancy is a period of great vulnerability, mood
swings and emotional turmoil, when a mother badly needs her spouse's support. The plight of
unmarried mothers is aggravated when the sexual partner has distanced himself. She feels
utterly unable to go through with the pregnancy alone. Charities such as LIFE aim to provide
the kindness, reassurance and practical help she needs. That quick way out for £300 offered
by the pregnancy advisory bureaux which may scar her emotionally for life. 63% of British
abortions are performed on single women.
(
v) Eugenic indication: It is foreseen that the child will be born with some physical or mental
handicap, often diagnosed by amniocentesis (see Ch.5), Down's Syndrome or damage from
rubella (German measles). In China a sexual eugenics operates. There is strict population
control supported by IPPF with US and British government funding.. Each family is allowed
only one child and often wants a son, so baby girls are aborted.
What is seldom considered is whether it is in the interests of the handicapped child to be
aborted, possible now in Britain even up to birth.This conflicts most poignantly with the love
and dedication of so many who care for the handicapped. The idea that all have "the right to a
perfect child" has become commonplace, so that imperfect babies are rejected and disposed
of.
(vi) Social indications appeal to non-medical criteria: - economics, education, life conditions,
unmarried mothers. It is much cheaper for the State to provide abortion than child welfare. One
Inner London borough closed its hostel for unmarried mothers on the grounds that they should
all have abortions. The financial burden of an extra child is often given as a justification for
abortion, but in fact abortion is more widely practised among the better-off. Severe social
problems, like overcrowding in Moscow's flats, are "solved" at the expense of unborn life?
Abortion becomes a way of avoiding having to face up to urgent social problems.
(
vii) Population control and racist attitudes: Different criteria are used and different amounts
of pressure applied to white, Asian or black mothers to have abortions. U.S. courts have
ordered Norplant (a 5-year contraceptive and abortifacient device) to be implanted in women
who have been found guilty of violence against their children. Sometimes its implantation is
made a condition of receiving welfare benefits. It is alleged that black girls have been a
particular target. (The Independent, 4.8.93). One consultant gynaecologist at an east London
hospital was heard saying as he returned from the operating theatre after doing an abortion "Well, that's one Paki less, at any-rate."
"T
oday, in many people's consciences, the perception of its [abortion's] gravity has become progressively
obscured. The acceptance of abortion in the popular mind, in behaviour and even in law itself, is a telling
sign of an extremely dangerous crisis of the moral sense, which is becoming more and more incapable of
distinguishing between good and evil, even when the fundamental right to life is at stake. . . " (EV58 cf
EV24 also)
--------------------------------------------------------------------------------------------------------------------TO THINK ABOUT:
In 1938 in Germany a Jewish couple were acquitted of attempting to procure an abortion on the
grounds that the relevant section of the National Socialist Criminal Code prohibiting abortion
could not be used for the protection of Jewish embryos.
SELF-CHECK (3.4):
1. Read Basterra, Bioethics pp.132-55 and/or Haring, Medical Ethics pp.89-110.
2. A mother is expecting her fifth child. The family lives in poverty and the father suffers from
syphilis which has caused congenital defects in all the other children: the first son is blind, the
second has only one leg, the third has T.B., the fourth is mentally retarded. The fifth is likely to
suffer handicap, perhaps deafness. if you were one of two doctors advising the mother, would
you be willing to sign the form for abortion? (Answer at end of chapter).
-----------------------------------------------------------------------------------------------------------------------
3.E. Legal and demographic aspects of abortion:
T
he Abortion Act (1967) for Great Britain (excluding Northern Ireland) provides that a pregnancy
may be lawfully terminated "If two registered medical practitioners have formed the opinion in
good faith: (a) that the continuance of the pregnancy would involve risk to the life of the pregnant
woman, or of injury to the physical or mental health of the pregnant woman or any existing
children of her family, greater than if the pregnancy was terminated; or
 (b) that there is a substantial risk that if the child were born it would suffer from such
physical or mental abnormalities as to be seriously handicapped."
I
n weighing up the risk to health under paragraph (a) "Account may be taken of the pregnant
woman's actual or reasonably foreseeable environment." The Act is limited by two
qualifications. The first, in section 5(1) states "Nothing in this act shall affect the provisions of
the Infant Life (Preservation) Act 1929 (protecting the life of the viable foetus)." This legislation
reads in section 1(1): "Any person who, with intent to destroy the life of a child capable of being
born alive, or by wilful act causes a child to die before it has an existence independent of its
mother, shall be guilty of felony, to wit, of child destruction."
T
he second major qualification, in section 4(1), is the conscientious objection clause: "No
person shall be under any duty, whether by contract or by any statutory or other legal
requirement, to participate in any treatment authorised by this Act to which he has a
conscientious objection." However this clause is further qualified by section 4(2), which adds
that nothing in section 4(1) "shall affect any duty to participate in treatment to save the life or to
prevent grave permanent injury to the physical or mental health of a pregnant woman."
T
he Infant Life Preservation Act speaks of a child "capable of being born alive", and this has
been interpreted as 28 weeks. However, with intensive medical care, premature babies have
survived from 22 weeks. In further legal cases "capable of being born alive" has been
construed as "viable" which is a deliberate twisting of language (cf EV58) to ignore an
important distinction. A child may certainly be 'capable of being born alive' quite early on, but
unable to survive beyond a few minutes or hours i.e. not 'viable'.
Repeated Parliamentary attempts (1975-88) to tighten up the Abortion Act, failed for lack of
time or by being filibustered in the House of Commons. There were proposals to qualify the
references to 'risk' or 'injury' as "grave", "serious", or "substantial," to strengthen the
conscience clause, and to reduce the maximum age to 24, 22, 20 or 18 weeks. Finally in
November 1990 a Bill amending the 1967 Act reached the Statute Book. It restricts abortions
to 24 weeks of pregnancy, except in the case of handicapped babies who can now be aborted
up to birth.
T
he statutory grounds for abortions performed on residents of Great Britain and the % of the
total (147,700) to which they apply are as follows (from 1995 statistics in Health and Personal
Social Services Statistics for England, 1997 edition).
A. Risk to life of woman. 0.1%
B. To prevent grave permanent injury to physical or mental health of woman. 1.5%
C. Risk of injury to physical or mental health of woman. 90.2%
D. Risk of injury to physical or mental health of existing children. 7.1%
E. Substantial risk of child born seriously handicapped. 1.1%
F. In emergency - to save life of woman. 0.001%
G. In emergency - to prevent grave permanent injury to the physical or mental health of the
woman. 0.002%
Status of mothers:
Single
63.34%
Married
26.00%
47.0%
Widowed 0.42%
9.5%
Divorced
5.13%
1.2%
Separated 4.04%
Previous births:
42.3%
1 - 13.68%
2 3 -
15.58%
6.97%
Age of aborted child: 1985
/ 1995
0 - 59.62%
<9 weeks : 32.39%
9 - 12 weeks :
13 - 18 weeks :
19 - 24 weeks :
4 2.37%
25+ weeks : 0.02%
5+ - 1.09%
(from 1986 OPCS statistics AB87/3----------------------------------)
51.69%
12.63%
3.27%
}
}
Note the trend towards earlier abortion over the last decade, and the high percentage of
abortions which are performed on single women: 116,300 out of 152,600 in 1995. In 1994
there were approx. 6000 adoption orders made nationwide in England and Wales.
I
n Canada Prof.P.G.Ney (Vancouver) found that the most important factors in the decision to
abort are lack of partner support, young age, marital status and the absence of any strong
moral objection to abortion.
T
he widespread practice of abortion in Great Britain has produced a social cIimate in which an
unplanned pregnancy is regarded as an undesirable entity to be disposed of. The woman can
exercise the right to choose whether to continue or to interrupt the pregnancy without reference
to the wishes of father, grandparents, siblings or the medical profession. Conversely, hesitant
mothers may be pressurised by medical staff to opt for abortion. Mothers of 4 or 5 children
commonly report that abortion was offered in their later pregnancies. Young girls are seldom
fully informed about the true facts of abortion. A Cardiff nurse was disciplined for showing a
pregnant girl pictures of an aborted baby. Often the foetus is described as "just tissue" or "a
piece of jelly" which is anatomically quite untrue.
How does the British limit of 24 weeks (full term for the handicapped) on abortion compare
with European nations? In Denmark, Sweden, Finland and Russia, abortion is available on
demand up to 12 weeks, in France up to 10 weeks. In Italy and Austria where there is risk to
the mother or eugenic reasons, 90 days is the limit, in Spain 12 weeks. Belgian law is quite
restrictive, in Ireland abortion is illegal, and now in Poland tolerated only for very grave
reasons. The German situation is strained at present. West Germany tolerated abortion only
for very serious reasons. East Germany, along with most communist countries, had abortion
on demand up to 12 weeks. Since reunification a restricted form of the GDR law has been
extended to the united Germany, despite heated debate in the Constitutional Court. In general
we can say that Britain allows what is effectively abortion on demand far later than most other
nations.
European Abortion Statistics 1992:
Nation
Abortions per 1000 women
annually
Russia
98.1
225
Romania
90.9
157
Belarus
62.6
153
Abortions per 100 live
births
Ukraine
56.7
164
Bulgaria
64.7
138
---------------------------------------------------------------------------------------------------------------------Latvia
60.2
126
Estonia
63.9
117
Czechoslovakia
46.7
87
Hungary
38.2
72
Lithuania
30.1 (1990)
---------------------------------------------------------------------------------------------------------------------Denmark
36 (1988)
Sweden
19.8
30
I
taly
15.3
29
United Kingdom
14.2
23
France
13.3
21
---------------------------------------------------------------------------------------------------------------------Finland
11.7
20
Austria
16.6
17
Germany
7.0
11
Netherlands
5.0
8
Care is necessary in interpreting these statistics. The Soviet Union under Lenin was the first
nation on earth to legalise abortion, in 1920, under the slogan of the "emancipation of women."
Access to abortion became part of the legal code of all the Soviet republics. Contraceptives
were not available, and abortion was widely used as a form of contraception, the average
Russian woman having between three and eight abortions in the course of her life. Cramped
living conditions in the industrialised cities, where some families had only one living room, and
shared kitchen and bathroom with four other families, made small families the norm. The
birthrate was higher in the villages, where there was more space.
Since the collapse of the USSR, the official abortion rates have been falling: the new private
clinics do not always give accurate returns. Moreover the resurgence of Christianity and Islam
has reduced abortion rates where these religions are strongest: Lithuania and western Ukraine
for the former, central Asia for the latter.
The lower abortion rates in western Europe do not signify more moral societies, but rather the
availability of contraceptives, and a high level of medical rather than surgical abortion. There is
an overall move towards early pharmacological abortion: the morning-after pill, mifepristone,
IUDs and Norplant. Much immunological research is being channelled into the attempt to make
the womb hostile to the fertilised ovum by means of "contraceptive vaccines." In Holland, early
abortions are classified as "menstrual extraction" and therefore do not figure in the abortion
statistics at all.
The demographic effects are ominous: the Slavic republics are already in severe population
decline. Italy and Spain have birthrates below replacement level. Europe is an ageing
continent. Unless governments begin to promote pro-natalist policies, her population will only
be maintained by net immigration.
Many politicians assert: "I personally am against abortion, but I would not vote against it in
Parliament, because I believe people have a right to it if they wish . . " This is the apparently
tolerant route of democratic compromise.
However it contains a massive logical error. Replace the word "abortion" with fox-hunting /
alcohol / tobacco - on the one hand; or slavery / paedophilia / the extermination of Jews - on
the other. This argument presumes that abortion is but a mild evil: after all, nobody is forced to
have an abortion (except the foetus, that is). The legislation is permissive, not mandatory.
Here we have reached the limits of democratic freedom and the privatisation of morality.
Freedom has lost its essential link with the truth, unties itself from all forms of tradition and
authority, and promotes only personal whim. It thus exalts the absolute autonomy of the self.
Society then has to find some compromise between millions of individual self-assertions,
without reference to common values or to any truth which binds absolutely: "Social life
ventures onto the shifting sands of complete relativism. At that point everything is negotiable,
everything is open to bargaining - even the first of the fundamental rights, the right to life." (EV
20)
------------------------------------------------------------------------------------------------------------------SELF-CHECK (3.5):
"
Democracy cannot be idolized to the point of making it a substitute for morality or a panacea
for immorality . . The value of democracy stands or falls with the values it embodies and
promotes." (EV 70). Read Evangelium Vitae 68-74 and make notes on the necessary
conformity of the civil law to the moral law.
FURTHER READING:
Duncan, Dunstan & Welbourn, Dictionary of Medical Ethics, pp.l-8.
BMA, Medical Ethics Today, pp. 103-9
Sutton A., Pre-natal Diagnosis: Confronting the Ethical Issues, pp 62-82.
-------------------------------------------------------------------------------------------------------------------
3. F. The Position of the Catholic Church and other Christian denominations
on abortion.
3.F. 1. Roman Catholic Church
---------------------------------------------------------------------------------------------------------------------SELF-CHECK (3:6):
1. It is essential to read the Declaration on Procured Abortion (Quaestio de Abortu, C.D.F.
18-11-74) in Flannery, Vatican Council II - More Postconciliar Documents, Vol 2, pp.441-453.
Then make notes on the following points: (a) How does this document treat the rights of conscience and freedom in a pluralist society
a propos the abortion issue?
 (b) What light does it shed on the relationship between law and morality?
 (c) What limitations does it suggest on science and technology?
 (d) What does footnote 19 define about the time of ensoulment of the embryo?
2. Read also CCC 2270-3 and C.D.F. Donum Vitae (1987) Section 1 Respect for human
embryos, para.1. What respect is due to the human embryo, taking into account his nature
and identity?
---------------------------------------------------------------------------------------------------------------------FURTHER READING:
Abortion and the Right to Live - Joint Statement of the Catholic Archbishops of Great
Britain. 24-1-80, C.T.S. (London) 5345.
John T. Noonan Jr, The Morality of Abortion: Legal and Historical Perspectives, Cambridge,
Mass. Harvard Press 1970.
---------------------------------------------------------------------------------------------------------------------3.F.2. Church of England
F
rom its foundation in 1559 the Church of England continued the teaching of the Catholic
Church on both contraception and abortion for 371 years. The Lambeth Conference of 1930
made a revolutionary break with the unanimous Christian tradition of 19 centuries and admitted
the licitness of artificial contraception within marriage, contradicting their own solemn
statements of 1920 and 1908.
I
n theory the Anglican Communion remained opposed to abortion, but in 1965 its Board for
Social Responsibility published Abortion. An Ethical Discussion as a contribution to the debate
prior to the 1967 Act. This remains the main official statement on the matter. Its position on the
status of the embryo runs as follows:'The foetus, as potentially a human life, has a significance which must not be overlooked,
minimised or denied. Indeed the problem of abortion is precisely the problem of weighing the claims of
the mother against the claims of the foetus and vice versa, when they conflict; though it is important
that neither be thought of in isolation from the family group of which they are part.
'
The foetus is not held to derive its significance from a theory that ''the soul enters the body'' at some
point in time; nor must the foetus be thought of and talked about as if it were already a person. In
particular, words like "innocent", which are normally matched with other words like "guilty' in a
full-fledged moral discourse, are questionably meaningful when used of the "life" of the foetus. But...it
still remains true that the foetus has a moral significance insofar as it is potentially a human life and is
likely to become a human person in the normal course of events...
Our broad conclusion is that in certain circumstances abortion can be justified. This would be when, at
the request of the mother and after the kind of consultation which we have envisaged in this report, ii
could be reasonably established that there was a threat to the mother's life or well-being, and hence
inescapably to her health, if she were obliged to carry the child to term and give it birth. And our view is
that, in reaching this conclusion, her life and well-being must be seen as integrally connected with the
life and well-being of her family...In our view such a consultative procedure could cover those cases
where justification for abortion would rest upon there being an assessable risk of a defective or
deformed child, as well as cases of incest or rape; though the ground of the decision would be the
prognosis concerning the mother as affected by the pregnancy; not the possibility of deformity itself,
nor simply the fact (if established) of the act of incest or rape.' (pp.61-62)
The actual working of the 1967 Abortion Act and the steep rise in the number of abortions,
however, caused 'widespread anxiety' to the Anglican General Synod. The Board for Social
Responsibility welcomed the Catholic Archbishops' Statement of 1980, and whilst
acknowledging that 'deep differences of judgement concerning abortion exist within the Church
of England', their published statement backtracks a few paces from the liberal 1965 stance:'
First, the central issue. In the light of our conviction that the foetus has a right to live and develop as a
member of the human family, we see abortion, the termination of that life by the act of man, as a great
moral evil. We do not believe that the right to life, as a right pertaining to persons, admits of no
exceptions whatever; but the right of the innocent to life admits surely of few exceptions indeed.
Circumstances exist where the character or location of the pregnancy render the foetus a serious
threat to the life or health of the mother; in such circumstances (and they are extremely few and
well-known) the foetus could be regarded as an 'aggressor' on the mother. The mother would be
entitled to seek protection against the threat to her life and health which the foetal life represented. If in
those circumstances a choice had to be made between the life of the mother and the continuation of
the pregnancy, precedence should be given to the mother's interests; but such a choice would only
arise if no less dramatic remedy for the ill existed. The undoubted evil of abortion would in this
situation represent the lesser of the two evils, only resorted to as the appropriate way of caring for the
mother if the evil of a significant threat to her life or health cannot otherwise be avoided.
I
n a society such as ours, however, with advanced facilities for pre-natal diagnosis and care, such
situations are today highly exceptional. Women today turn to abortion, or are encouraged to seek
abortion' for quite other reasons, reasons which frequently point to seriously unsatisfactory personal or
family circumstances but which cannot on that account morally justify the extreme step of abortion.'
(Abortion: a great moral evil, 1980)
The 1983 General Synod affirmed its belief that human life developing in the womb is created
by God in His own image and therefore is to be "nurtured, supported and protected." It
expressed "serious concern" at the number and consequences of abortions in the U.K., but
"recognises that in situations where the continuance of a pregnancy threatens the life of the
mother termination of pregnancy may be justified and that there must be adequate and safe
provision in our society for such situations."
The 1985 Board for Social Responsibility statement entitled "Personal Origins" (2nd revised
edition 1996), reflected the debate which preceded legislation on embryo experimentation and
involved the Warnock Commission. It revealed the radical division of opinion within
Anglicanism. Some hold that the "continuity of the individual subject" is traced back to
fertilisation: others believe that the basic structures necessary for consciousness must be
developed before we can call the embryo human. This resembles the ancient debates over
the time of ensoulment: can there be a human soul present if the biological substratum
necessary to support it is lacking? Of course, one could reply that the capacity for development
to consciousness is already there in the DNA at conception, so it is not unfitting or impossible
that the soul be there too.
I
n 1993 the same Board for Social Responsibility published Abortion & The Church: What are
the Issues? which summarises the ongoing debate within Anglicanism. While anxious to
reduce the total number of abortions, and to ameliorate those social pressures which
predispose women towards abortion, it nevertheless feels that "there are situations in which
abortion can be justified."
3.F.3. Presbyterian (Church of Scotland)
The 1985 General Assembly of the Church of Scotland adopted a position very close to
that of the Roman Catholic Church: "We cannot assert too strongly that the inviolability of the
foetus is one of the fundamentals and its right to life must be strongly defended." This was
however by a narrow majority and a number of the Church of Scotland's ethical theologians
publicly dissociated themselves from the decision. The 1986 Assembly partly reversed the
statement to reaffirm: "the position held since 1966, that the criteria for abortion should be that
the continuance of the pregnancy would involve serious risk to the life or grave injury to the
health, whether physical or mental, of the pregnant woman."
T
he Kirk's position seems somewhat confused, but its outstanding Professor of Dogmatics at
Edinburgh, Thomas Torrance, is in no doubt '
There is no scientific doubt about the fact that from the movement of conception the human embryo is
genetically complete and must be treated as such, as distinctively human, and not just as a mere
biochemical episode or as equivalent to the fertilised egg of an animal or a bit of animal tissue. After
all if the human embryo were neither human nor alive it would have no place in research on human
beings. If the human embryo is genetically complete and distinctively human from the very beginning,
then arguments allowing for scientific experiment or genetic manipulation after a certain period,
seven, fourteen days or whatever, are scientifically and morally specious. There is also a serious
ambiguity about an argument from the premise that the embryo is "potentially human", for the
potentiality concerned is not of becoming something else but of becoming what it essentially is.
No human being, at any age in his/her existence may be treated in any way that violates his/her
distinctively human nature and status or subjects him or her to being a means to an end...The moral
status of a human embryo and its moral claim on our behaviour toward it do not diminish the further
back we go in the stages of its development, for even in its most minimal state it must never be
treated as a means to an end but be respected in itself in its own independent right. Thus it would
seem to be morally indefensible when the need to alleviate infertility is given a higher right than that
accorded to the gamete or the embryo.' (Test Tube Babies: Morals - Science - the Law, Edinburgh
1984, pp 2-4.)
3.F.4. The Methodist Church
The Methodist Co
mother. It explains the different developmental stages - fertilisation, nidation, quickening',
and viability (no earlier than the 20th week) and questions at what point the foetus becomes
a person:
'The Christian believes that man is a creature of God, made in the divine image, and that human life,
though marred, has eternal as well as physical and material dimensions. All human life should
therefore be reverenced. The foetus is undoubtedly part of the continuum of human existence, but the
Christian will wish to study further the extent to which a foetus is a person....Although the foetus
possesses a degree of individual identity it lacks independence and the ability to respond to
relationships. All persons are always our 'neighbours'; other beings may call forth our loving care. In
considering the matter of abortion, therefore, the Christian asks what persons, or beings who are
properly to be treated wholly or in part as persons, are involved and how they will be affected by a
decision to permit or forbid abortion.'
Later it comes to a tentative conclusion:
'There is never any moment from conception onwards when the foetus totally lacks human
significance - a fact which may be overlooked in the pressure for abortion on demand. However the
degree of this significance manifestly increases. At the very least this suggests that no pregnancy
should be aborted after the point when the aborted foetus would be viable...'
3.F.5. The Baptist Union of Great Britain and Ireland.
Every local Baptist church is free to adopt its own position. However the Baptist Union
submitted evidence to the Warnock committee. They began with a statement about moral
norms "There are no fixed and universal moral rules available which might be simply applied to a situation.
Rather, Christian ethics must seek to find the demand with which God confronts us in any particular
situation. While God has a will for men's life, any set of rules could only be a relative and approximate
reflection of this will...This kind of ethic...recognises that there are intrinsic goods (God's will for
mankind) and conversely evils, but that no human expression of these can ever be absolute...It
confirms the notion of the "lesser of the two evils" in some situations...!
[
One might accuse the authors of 'linguistic agnosticism', a lack of faith in the power of human
language as an adequate vehicle for God's truths. When God speaks in human words, can he
not make His will totally clear on an issue? - "Thou shalt not murder", for instance. It is unclear
why necessarily "There are no fixed and universal rules available which might be simply
applied to a situation." "Thou shalt not commit direct abortion" would be a good candidate for
one such universal rule.]
According to the Baptist submission, life begins at either fertilization or implantation.
"It depends upon a positive interaction with the environment for its sustenance, and until implantation
there is no such interaction. The bundle of cells that make up the embryo has only a small internal
supply of food which is quickly used up...Until a foetus is viable outside the womb it can only be a
potential human personality, but it nevertheless deserves respect on precisely that account....There is
clearly an increasing weight of claim to respect as a "potential personality" as the embryo increases in
that potential...With increasing growth of an embryo the greater would need to be the weight of
argument for altering or terminating that potential personality."
3.F.6. The Eastern Orthodox Churches
The eastern Christian churches do not have a highly developed systematic moral theology as
does the Roman Catholic Church. Nevertheless they would own the pronouncements of the
Greek and Syriac Fathers - starting with the Didache - as their heritage. Their tradition gives us
a window onto eastern Church practice of the first millennium. It is valuable in ecumenical
dialogue because it proves what is apostolical and historic Christian truth, even without a
Roman Magisterium and Petrine ministry.
I
n orthodox thought a General Council is the highest authority. Yet because of the East-West
schism, they have had no such Council for 1200 years. Determinative for the question of
abortion are Canon 21 of the Council of Ancyra (313-4 AD), Canons 2 and 8 of St Basil the
Great', Canon 91 of the Quinisext Council in Trullo, and Canons 21-2 of John the Faster
(C9-10).
These canons reckon abortion to be homicide, and impose a 10 year penance, which is neither
so severe as the penance for murdering an adult (lifelong excommunication), yet more than the
5 years for involuntary killing (manslaughter). According to St Basil, abortion must always be
regarded as murder, whatever the stage of growth of the embryo, be it formed or unformed. St
Basil's refusal to distinguish between a formed or unformed foetus caused the doctrine of
immediate animation of the embryo to prevail in Orthodox theology from the early centuries. In
the west it only became clear in the 18th century. St Gregory of Nyssa, Maximus the Confessor
and St John Damascene used Christological arguments (referring to the conception of Christ at
the Incarnation) to arrive at the teaching of simultaneous creation of body and soul.
The canonical penalty applied to all who provide abortifacient poisons (farmaka), the women
who use them, or who deliberately provoke miscarriage by physical external acts.
This century many Orthodox churches found themselves under communist tyrannies which had
legalised abortion. It would have been extremely dangerous, if not impossible, to publish an
open denunciation of Stalinist laws.
I
n 1987 Pimen, Patriarch of Moscow stated: "All forms of abortion, and every conscious
interruption of newly-conceived life, the Church has always considered equivalent to homicide
and condemned them as such. [From the very beginning] the fertilized cellhas in itself
everything necessary to become man . . . The fact that abortion attacks a life which is unseen
does not change the substance of the act performed.." He referred to Lk 1:39-44 (the Visitation
narrative), to the Didache, Athenagoras and Clement of Alexandria. The condemnation of
abortion, he said, is unchangeable.
The Greek Orthodox Church has had more chance to develop its thinking. In 1978 the bishops
in Greece issued an Encyclical condemning the c.200,000 illegal abortions taking place each
year. The 1985 Synod condemned abortion as "premeditated murder", and strongly opposed
the Left's attempts to legalise it, which came about in May 1986.
However several Greek theologians have moved towards the acceptance of "therapeutic
abortion" as a lesser evil (an "involuntary sin") in order to save the mother's life (S. Harakas,
Meyendorff). Metropolitan Nikodemos of Patras went further towards allowing eugenic
abortions where doctors advise it on account of rhesus incompatibility between parents and
child. This may reflect actual pastoral praxis in some areas.
FURTHER READING:
K.T. Kelly, Life and Love, Collins, London (1987) pp.47-82 for a collation of the various
ecumenical positions. Please note that this text has a faulty ecclesiology when it discusses a
common ecumenical Christian agreement, because the author fails to give due weight to the
role of the Magisterium of the Catholic Church.
3.G. The medical reality of abortion in terms of methods used
----------------------------------------------------------------------------------------------------------------------SELF CHECK (3.7):
C
onsult a medical textbook or other book on abortion and make notes on the commonly used
methods:
(a) Vacuum aspiration
(b) Vaginal dilation and curettage (D & C)
(c) Dilation and evacuation (D & E)
(d) Intra-amniotic injection - prostaglandin induction of labour
(e) Intra-amniotic injection - saline solution
(f) Hysterotomy.
FURTHER READING:
Mary Kenny, Abortion: The Whole Story, Quartet, London (1986) pp.147-176
---------------------------------------------------------------------------------------------------------------------Answer to question (self-check 3.4): If you said 'Yes', you have just killed Ludwig van
Beethoven.
3.H. Appendix - Declaration of Oslo (1970)
STATEMENT ON THERAPEUTIC ABORTION
1. The first moral principle imposed upon the doctor is respect for human life as expressed in a clause of
the Declaration of Geneva: I will maintain the utmost respect for human life from the time of conception.
2. Circumstances which bring the vital interests of a mother into conflict with the vital interests of her
unborn child create a dilemma and raise the question whether or not the pregnancy should be
deliberately terminated.
3. Diversity of response to this situation results from the diversity of attitudes towards the life of the
unborn child. This is a matter of individual conviction and conscience which must be respected.
4. It is not the role of the medical profession to determine the attitudes and rules of any particular state or
community in this matter, but it is our duty to attempt both to ensure the protection of our patients and to
safeguard the rights of the doctor within society.
5. Therefore, where the law allows therapeutic abortion to be performed, or legislation to that effect is
contemplated, and this is not against the policy of the national medical association, and where the
legislature desires or will accept the guidance of the medical profession, the following principles are
approved:
(a) Abortion should be performed only as a therapeutic measure.
(b) A decision to terminate pregnancy should normally be approved in writing by at least two
doctors chosen for their professional competence.
(c) The procedure should be performed by a doctor competent to do so in premises approved by
the appropriate authority.
6. If the doctor considers that his convictions do not allow him to advise or perform an abortion, he may
withdraw while ensuring the continuity of (medical) care by a qualified colleague.
7. This statement, while it is endorsed by the General Assembly of the World Medical Association, is not
to be regarded as binding on any individual member association unless it is adopted by that member
association.
CHAPTER 4
RESPECT FOR HUMAN LIFE IN ITS ORIGINS (continued)
4. A. The Status of the Human Embryo / Foetus
1. The physiological process of fertilisation and embryo growth
2. Is the embryo / foetus an alive, individual, human person?
3. Problems of ensoulment (animation)
4. Objections to the personhood of the embryo or foetus
5. Responses to these objections
4. B. The Effects of Abortion upon Women, Families and Society
1. Post Abortion Syndrome
2 . Abortion and child abuse
3. Effects upon society. Theological Reflection
4. C. Conflict situations
1. Questions of co-operation in abortion procedures
2. Indirect abortion and "therapeutic" abortion
3. Rape protocols
4. D. Medical abortion by abortifacient drugs
-------------------------------------------------------------------------------------------------------------------
OBJECTIVES IN THIS CHAPTER:




1. To examine the wonderful development of the fertilised human ovum, consider its
status and the question of ensoulment.
2. Research some of the hidden consequences of abortion.
3. Consider difficult medical dilemmas when a mother's life is at risk.
4. Realise the abortifacient nature of many pharmacological contraceptives.
--------------------------------------------------------------------------------------------------------------------
4. A The Status of the Human Embryo
4.A. 1. The physiological process of fertilization and embryo growth
Please study the schema showing the various stages in development. The four principal
landmarks in the process are fertilization; implantation (nidation) into the womb-lining
(endometrium) and formation of the placenta; quickening when the mother first feels the baby
move within her; and viability, when a child could survive if born. Viability is variable since it
depends on the state of medical technology available. In theory, if one day a test-tube baby
was reared from fertilisation using an artificial womb and placenta (so called ectogenesis) then
viability would have been assimilated to the moment of fertilisation.
1. The sperm enters the egg, leaving its tail outside. It is one of 300-500 million
a healthy ejaculate, and one of 20, 30 or 40 which may have reached
the ovum. The mechanism by which the egg membrane allows just one sperm
(and which?) to enter is unknown. (divine choice?!)
sperm in
2. Single-celled zygote. The nuclei of egg and sperm with the genetic information have still
not fused. Within 24 hours of the sperm head's entry, the two sets of 23 chromosomes will
pair up to form the new genotype.
3. Mitosis (cell division) begins at about 32 hours after fertilisation (in 98% of zygotes),
producing a two-celled zygote (IVF data).
4. 4-cell zygote (c.46 hours)
5. 8-cell zygote, still moving along the Fallopian tube. Control of genetic events has now
passed entirely from the mother's to the embryo's control.
6. 32 or more cells, referred to as a "morula" (Latin for mulberry).
7. Blastocyst stage - The cells leave a cavity and gravitate towards one side.
8. The blastocyst makes contact with the uterine wall.
9. The trophoblast invades the uterine mucus, burrowing into the wall.
Implantation proper (nidation).
10. Identical twins make up about 0.2% of live births. Twinning is no longer
possible after 14 days. Non-identical twins (0.9%), originate from two separate
ova fertilised independently by different sperm.
11. Possible recombination of twins.
12. Loss of fertilised ova 20-40%
13. Gastrulation (13-14 days). The pre-embryonic mass of cells splits into three welldefined layers, from which placenta,
14. Developing embryo 14-21 days old. 'Primitive streak' visible as foundations
for brain, spinal cord and nervous system are laid down. Blood cell manufacture
begins at 17 days, a primitive heart is forming at 18 days, starting to beat at 21
days, regularly and smoothly at 30 days.
15. 28 days. Central nervous system and brain now present. Cerebral cortex
develops and matures.
16. 35 days. Primitive skeleton complete. Stomach, liver and kidneys all functioning.
Arms, hands and finger outlines all visible. Hearing apparatus complete.
17. 40-42 days. ECG can pick up brain waves. Consciousness possible. Can
probably therefore feel pain.
18. 60 days. Kicking, waving arms, turning somersaults. Some inherited
characteristics visible.
19. 90 days (3 months - 13 weeks) Facial expressions similar to parents. Responsive
to taste. Sex organs visible.
20. 'Quickening' comes at about 14-16 weeks, as the mother starts to feel her
child moving around inside the uterus.
21. 5 months. The child has grown to about 12" and weighs about 1 lb (450 g). It
can recognise its parents' voices, but its heartbeat speeds up at a loud or
strange
sound.
22. The earliest premature baby to survive in Britain (1991) was born at 22 weeks.
15% of those born at 24 weeks survive, rising to 80% born at 28-32 weeks.
23 . Remember: cigarette smoking increases the risk of a premature and under
-sized baby; alcohol can damage babies' health, and the child of a heroin
addict is born an addict too. Radiation and the contraceptive pill also affect
the child adversely in the first 12 weeks (especially boys, whose hormonal
development is upset by Pill oestrogens).
Theological Reflection: The beauty and the dynamism of this whole process fill one with
wonder at the Creator's ingenuity. This alone can change the hearts of some unbelievers.
Dr
Bernard Nathanson was a co-founder of the US National Abortion Rights Action League and
overseer of some 60,000 abortions in the 1970's. He renounced this work to become a pro-life
advocate. More recently he was baptised into the Catholic Church. In his book The Hand of God
he describes his gradual journey away from abortion - his growing conviction that human life
exists within the womb, and the moral tension and duplicity this brought.
Es
pecially effective was the revelation brought by ultrasound pictures of the fetus. Knowledge of
the fetus has expanded explosively: in 1969 there were only five articles in world medical
literature on "fetus, physiology and anatomy of". By 1979 there were 2,800, and by 1994 nearly
5,000. Ultrasound technology has opened up a new world.
To
Nathanson the most compelling factor was what he calls the "vector of life" - the forces and
velocities of embryonic life directed towards a specific end. In those first 17-19 days after
fertilisation the embryo grows (by cell division) faster than at any other time in a human being's
life, in respect to both weight and protein content. If we continued to grow at this same rate
throughout gestation, we would weight 12,700 kg at birth. After 19 days, cell division and overall
growth slow down. Growth subsequently takes place primarily through increase in the size of the
cells themselves - this stage persists throughout adolescence and into adulthood.
Ye
t those first 19 days of "biological tumult" are highly organised. The rapidly dividing armies of
cells - even in the pre-implantation embryo - "know" exactly where to position themselves. They
are directed by genes and enzyme systems. It is at the 4-8 cell stage that control of genetic
events passes from maternal influences to the embryo's exclusive control, preparing for
gastrulation (13-14 days) when the mass of embryonic cells divides into three well-defined
layers, from which all structures, organs, appendages and other assorted anatomical
phenomena will derive.
"Fr
om the seeming chaos of early rapid-fire cell division and unimaginably precise deployment of these cells to their
designated posts there is a vector of life: a direction and velocity of life-forces that is perfectly programmed, irresistibly
logical and immutably fixed in time and space. . . That biologic vector is at its most glorious (and most mysterious)
when we are morphologically very little, not even visible to the naked eye." (op.cit.135-7)
Si
nce we believe that God designed this wonderful process, and that He deliberately calls every
individual into existence - while respecting the parents' free choice whom to marry - does Divine
Providence have an additional role to play in the physiological process we have seen?
Co
nsider, all a woman's ova were already present in her ovaries as oocytes from infancy. Why
does the pituitary hormone stimulate one particular follicle to mature and release its ovum into
the Fallopian tube? Is it one with a particular genetic coding which is released? The ovum lives
for only 24 hours after release and can be fertilised during only 3 hours of this period. Again, is
there any selection or 'predestination' of a particular sperm to reach the egg and to be allowed to
enter? Are we genetic accidents or were we genetically intended by God in some way? Note too
that there are safety devices: as sperm swim through the cervical mucus, they are guided along
microscopic channels which nourish them and aid their motion. Weak, damaged or unhealthy
sperm fall by the wayside and are absorbed into the cervical crypts. The rate of genetic defects
and congenital malformations in man is only 10% of that in other mammals.
Ca
tholics draw much of their conviction about the sanctity of unborn life from Biblical or Church
sources e.g. Jer.1:5 "Before I formed you in the womb I knew you.", Ps.139: 13-16, or the
Annunciation and Visitation narratives (Lk.1:26-45). Such appeals to Scripture, or to the
Magisterium or to Tradition will not necessarily be accepted by non-believers or by those of weak
faith - or even by Christians of other denominations.
Th
erefore we shall now work from a philosophical angle using the medical, physiological,
psychological and sociological evidence. God's truth comes through the Book of Creation
(nature and science) as well as the Books of Revelation. We shall ask:
4.A. 2. Is the embryo an alive, individual, human person?
(I) Is the embryo alive? Certainly. Cellular division and growth proceed at a phenomenal rate
from conception onwards. Separate sperm and ova are also alive, but individually cannot
multiply or survive more than 3 days (sperm) or 48 hours (ovum). At 42 days the foetus can feel
pain, at 12 weeks it can respond to music. Most adult bodily functions (blood circulation,
excretion, nervous impulses, swallowing) are taking place. By birth it has grown from 1 cell to
200 million and weighs 6 billion times more than the fertilised egg.
(ii) Is the embryo individual and distinct from the mother, or is it merely a tissue growth?
Genetically and biologically the embryo is clearly distinct, although joined to mother via the
placenta in a dependent relationship. There is no intermingling of the embryo's and the
mother's blood, and the embryo often has a different blood group. There is an exchange of
carbon dioxide and oxygen, of waste and nutrients, across the placenta membranes.
Immunological research is in progress on the suppression mechanism which prevents the
mother from rejecting the foetus in the way she would reject a transplant organ. The foetus'
fingerprints and heartbeat rate are different from the mother's. Admittedly its ability to survive
independently is severely limited, but then how many adults could survive completely
independently in nature?
(iii) Is the embryo human? Its DNA coding and proteins are human. It can grow only into an
adult member of the species homo sapiens, not any other species. It has the full potential to
do so, unlike the sperm and ovum which alone have limited lifespan. From conception onwards
its life is a continuum without any sharp discontinuity in the development process.
(iv) Is the embryo a human person? This question is one more for the philosopher and
theologian than for the biologist. Psychological notions of what constitutes personhood vary
widely. Some suggest that the formation of meaningful relationships or acceptance by society
are necessary. We hold that personhood is something intrinsic to the human being, which is
recognised by others, not conferred by them. It is not a desired status to be granted at the
discretion of the state or the medical or legal profession. This point was very well put by a
writer in The Month (234 (1973) 163-71):
"
A widespread contemporary view sees personhood as stemming from social interaction, from
relationships. This implies that humanity is an achievement not an endowment. Hence the justification
of abortion has reshaped the definitions of what it means to be human.
"
We should reject the idea that achievement is to be preferred to potentiality. We prize and value
children for their very potential. Moreover, to rate achievement over potentiality affirms the right of the
big battalions over the defenceless
"
To weight the debate a priori in favour of the mother who can then deal with the foetus as though it
were a malignant growth is to sanction a drastic exercise of power. In all other fields we would
recognise this and stop it at once. But here, and for most of us, the victims die unseen, and so
consciences are easily tranquillised."
A
n apt phrase to describe the embryo is "une personne en devenir" who enjoys an inalienable
"droit de naître" (Pope Paul VI). There can be no doubt of the stance of Christian tradition on
this point from the days of the Didache onwards. In the words of Tertullian (160-240 AD), for
example "
For us indeed, homicide having been forbidden once and for all, it is not lawful to destroy what is
conceived in the womb even while the blood is being drawn into a human being. To deny birth is to
hasten homicide; for it makes no difference whether you snatch away the soul after birth or destroy it
while coming to birth. Even the man who is yet to be is a man; just as every fruit is already present in
the seed." (Apologia c.9)
Evangelium Vitae 60 quotes the 1974 C.D.F. Declaration on Abortion:
"From the time that the ovum is fertilised, a life is begun which is neither that of the father nor
the mother; it is rather the life of a new human being with his own growth. It would never be human if it
were not human already. This has always been clear, and . . . . modern genetic science offers clear
confirmation. It has demonstrated that from the first instant there is established the programme of
what this living being will be: a person, this individual person with his characteristic aspects already
well-determined. Right from fertilization the adventure of a human life begins, and each of its
capacities requires time - a rather lengthy time - to find its place and to be in a position to act."
-------------------------------------------------------------------------------------------------------------------------------------
SELF CHECK (4.1):
1. Read Donum Vitae, I. Respect for Human Embryos once more. List the practical
consequences mentioned as a result of recognising that the human embryo must be treated
as a human person.
2. B Häring, Medical Ethics, pp.72-79. What does Haring mean by hominization? When does
the cerebral cortex develop? When is its development thought sufficient to allow full
self-consciousness?
----------------------------------------------------------------------------------------------------------4.A. 3. Problems of ensoulment (animation)
Only in the early eighteenth century did the development of the microscope enable detailed
observation of single sperm and of the follicles of the ovaries. It was realised that both male
and female seed were necessary for procreation. Until then, women had been regarded as
merely receptacles of the male seed. For example, St Augustine held that for the first 6 days
the semen remained thick like milk, then during the next 9 days turned into blood which 12
days later solidified. By 45 days he believed the foetus was formed and in possession of all its
limbs and organs.
St Thomas Aquinas, following Aristotle, considered that the male semen held the dynamic
power of procreation, and that female menstrual blood provided the basic matter from which
the embryo was formed. He believed the male foetus came into being 40 days from conception
whereas the female foetus took 90 days. Given the state of medical knowledge at the time,
neither of these theories was so outlandish as they now seem.
I
n the Septuagint Greek Old Testament, Exod. 21:22-25 prescribed the penalty for causing a
women a miscarriage while engaged in a brawl with a man. The death of an imperfectly formed
foetus was punished with a fine, whereas the death of a perfectly formed foetus calls for the
lex talionis, a life for a life. This distinction in the Greek (although not in the Hebrew text or
Latin Vulgate translations) stimulated discussion about the time of formation and animation of
the foetus.
There were two streams of thought in the early Church on this point. Tertullian represents the
traducianist theory - that is, immediate animation through transmission of the seed. The
alternative was the creationist view, which held that the individual and spiritual soul was
created by God independently of the seed and the beginnings of the body. The soul could then
be infused either at conception or at some later time. Gratian's Decretals, an early C12 codex
of canon law, adopts the latter widely-held view that animation is delayed until formation was
complete. Therefore the penances for early abortion were equal to those for the sin of
sterilisation, while late abortion was equated to homicide. Pope Innocent III confirmed that the
destruction of the unborn child is not to be treated as homicide unless it is animated.
A
quinas drew heavily upon Aristotle's theory of the soul (De Anima) which distinguishes three
types of soul or life principle: vegetative (e.g. plants), sensitive or animal (with powers of sense
perception, desire and motion) and rational (with the capacities of rational thought and
purpose). The higher levels contain the lower. Aristotle believed that foetal development was
accompanied by a succession of souls from the vegetative, through the sensitive, and finally to
the rational. Body and soul are mutually dependent and united so as to form one substance.
On this view, animation is delayed until the body can express the respective powers of the soul.
This theory of delayed animation remained influential for some centuries, but despite this, early
abortion was always considered a grave sin, although not so serious as homicide. Acrimonious
debates ensued throughout the 17th and 18th centuries, but the impact of biological
discoveries caused the delayed animation theory to lose ground. In 1869 Pope Pius IX
overruled any distinction between early and late abortion by attaching the penalty of
excommunication to them both.
Even in this century official Catholic pronouncements refrain from a definition of the precise
moment of animation. They do declare that any interruption of the generative process begun at
conception is a thwarting of God's creative action and hence that human life is inviolable from
conception. This follows the line of St Basil the Great, St Jerome, St Augustine, Reginald of
Prüm, Ivo of Chartres, Raymond of Penyafort who condemned both abortion and sterilising
drugs. See also Casti Connubii 63 (Pius XI, 1930); Mater et Magistra 194 (John XXIII, 1961);
Gaudium et Spes 51 (Vatican II, 1966}; Humanae Vitae 14 (Paul VI, 1968) and the C.D.F.
document already cited.
One may legitimately doubt whether or not the early embryo is animated. But when a human
life is at risk, great prudence is necessary. To give an example:- if you were out driving, and
suddenly saw what you thought was a shadow but might be a man walk out on the road in front
of you, it would be your duty to take avoiding action. If you hit the "shadow" which turned out to
be found a man, you could be found guilty of causing death by dangerous driving. So too the
embryo in the womb must be given the benefit of the doubt.
Donum Vitae (C.D.F. 1987) notes that
"i
n the zygote resulting from fertilisation the biological identity of a new human individual is already
constituted. Certainly no experimental datum can be in itself sufficient to bring us to the recognition of
a spiritual soul; nevertheless the conclusions of science regarding the human embryo provide a
valuable indication for discerning by the use of reason a personal presence at the moment of this first
appearance of human life: how could a human individual not be a human person? The Magisterium
has not expressly committed itself to an affirmation of a spiritual nature, but it constantly reaffirms the
moral condemnation of any kind of procured abortion. This teaching has not been changed and is
unchangeable....
.....from the first moment of its existence...the zygote...demands the unconditional respect that is
morally due to the human being in his bodily and spiritual integrity. The human being is to be
respected and treated as a person from the moment of conception; and therefore from that same
moment his rights as a person must be recognised, among which in the first place is the inviolable
right of every innocent human being to life."
4.A. 4. Objections to the personhood of the embryo or foetus
I
t is widely asserted that the embryo is not a human being in the full sense but becomes a
person at some later stage, after conception and prior to birth but perhaps not precisely
identifiable. The Anglican statements referred to the foetus as "potentially a human life". The
Baptists suggested that "Until a foetus is viable outside the womb it can only be a potential
human personality."
The Roe v Wade 1973 U.S.A. Supreme Court decision which legalised abortion used such
terms as "potential life" as if to imply that human life was not present in the embryo.
The Warnock Report wrongly stated the major argument against embryo experimentation
thus: "The human embryo is seen as having the same status as a child or an adult, by virtue
of its potential for human life" i.e. the embryo is not yet a human life though it may grow into
one - it is a type of pre-human tissue. It may become human life at the point of hominisation when it is capable of sustaining consciousness.
Ova removed by laparoscopy are also in a sense "potential human beings". Their genetic
make-up marks them out as specifically human tissue - United with male sperm and allowed
the right environment to develop, they will become fully fledged persons capable of thinking,
feeling, deliberating and making choices, having emotions, conversing with others and so on.
Here and now the ova can perform none of these typically human activities. It is by this range
of activities that we judge something to be a person or not. The embryo and foetus fail the test
- like sperm and ova they fail to measure up to the criteria of full personhood.
I
ndeed the embryo does not even look specifically human - a roughly spherical collection of
cells with no distinguishable parts for specialised functions. Many of the cells will not form part
of the human body, but the placenta, and will ultimately be discarded as the afterbirth. The
foetus looks more like a human being but it does not perform any of the conscious mental
activities ordinarily regarded as typical of persons.
The high number (20-40%) of fertilised eggs lost at the early stages argues against their
ensoulment. Does God create millions of souls for them to return to Him within a few days
undeveloped? Or does He only give souls to the ones He knows will develop and cause the
others to abort?
An extra problem to the doctrine of ensoulment at fertilisation is posed by cases of twinning
which can occur up to 14 days. Can one soul divide into two? Is a new soul created? Certainly
it would argue against a distinct individual being there from conception. Moreover when
twinned zygotes recombine into a single individual in rare cases, what would happen to any
"soul" then? Ford, Dunstan and others argue that the possibility of monozygote twinning
(0.33% of live births) provides the ultimate proof that there can be no continuous individual
human life until after this stage of development is past.
4.A. 5. Response to these objections
Much of the ecumenical debate hinges on the question: "Is the foetus a 'human being with
potential' or 'a potential human being'?"
The Roman Catholic Archbishops' (E & W) statement emphasises the former. Certainly the
zygote's possession of a unique and unrepeatable genotype, 23 chromosomes from the father,
23 from mother argues to its possession of potential - hair, eye and skin colour, stature and
build, approximate I.Q., musical, linguistic, mathematical and athletic capacities - are all
specified right from fertilization.
I
n the entire process from sperm and ovum to a born child, the single point of discontinuity is
that of fertilization. Two gametes cease to exist, a dynamic new entity appears upon life's
stage, dividing, growing and differentiating itself. The penetration of a different sperm would
lead to quite a different child with up to half its chromosomes different. Fertilization is the
decisive step. Everything on from there is a continuum through birth, infancy, adolescence to
old age and death. All the timing of developments in the womb is after all based on a
zero-point at the point of fertilization. That is the natural beginning of human life.
This continuity has profound implications. A zygote, blastocyst, and embryo - is all that you and
I once were. Had that life been annihilated, you would not be reading now, I would never have
written. The proponent of abortion is in fact asserting that someone else had the right to kill
him at an earlier stage of his existence. This is to saw off the branch on which you are sitting.
The conceptus is a 'human being with potential' because it has already a radical capacity to
learn English or Japanese, to play the trumpet, to form human relationships. It has not the
present ability to do these things, just as you or I may not at present speak Japanese or play
the trumpet, although with teaching and practice we might make a passable attempt at either.
C
ontrast this unactualised potential with that of a budgerigar or frog. They have the radical
capacity to do none of these things. That is one reason why we class them as animals, not
humans. Enlist the frog with the best brass band in Yorkshire but it will do no more than croak.
The budgie may pick up a phrase from a Japanese visitor, but it can never use language in the
same way that a human being does. The foetus' radical capacity to learn English (to cite a
more useful option) is a feature of what he or she already is. The animals lack this. It is a
quality of humanity already present, with much potential and many capacities to be developed.
With respect to the problems of twinning and recombination, Sutton (op.cit. pp.l06-111)
suggests that if the twinning is genetically in-programmed from fertilisation, there are two
individual presences from the start. An alternative is that a second individual comes into being
at the moment of twinning. For recombination one can hypothesise either one 'soul' manifest in
both organisms, or two souls of which one dies upon recombination. Whichever is actually the
case, there is at least one individual presence from fertilisation onwards, if not two. Certainly it
cannot be logically deduced that there is not one soul present.
Our final comment concerns the ban on any interruption of the generative process. We believe
every person enters the world not by mere chance, but by God's design, and that He calls
them to a specific vocation in the world. In that case direct abortion is a rebellious and
deliberate 'No' to God, throwing back a life He has already created and diminishing humanity.
Each individual can reflect God's glory in a unique way, so abortion impoverishes us all.
Moreover it undermines respect for the individual, the essential basis of all civilised and
democratic society.
Nathanson (op.cit.pp 4-5) remarks that he is often asked:
"Isn't abortion at the root of all our problems? Hasn't the abortion mentality infiltrated our culture so
extensively that it has contaminated every social institution touching upon our lives: education, family,
sex, politics, economics? And if abortion were to be recriminalized, would not our moribund society
come bounding off its ventilator in robust good health?
"The answers are no, yes and no. The abortion mentality . . . . . has metastasized throughout our
society so subtly and so aggressively that even if it were miraculously recriminalised, it is extremely
doubtful that such allied plagues as child abuse, pornography, violence against women and genocide would all magically vanish. We live in an age of fulsome nihilism . . . in which 'compassion leads to the
gas chamber' or the abortion clinic or the euthanasiast's office. We live in an age of defining
personhood upwards, so that fewer and fewer of us make the cut, an age of virtual abjuring of moral
values, so that we can treat people like objects - and yes, abortion has helped us learn to do that."
-------------------------------------------------------------------------------------------------------------------------------------
SELF CHECK (4:2):
1. Read EV 78-101. List the ways in which the Gospel of Life is to be promoted, as a remedy
to the nihilism which Nathanson diagnoses.
2. Draft a response to the following letter which appeared in the Catholic Times:
"I
regard abortion as an evil, but a lesser one than having a child with Down's syndrome or cystic
fibrosis. We tend to forget that in former days, before the advent of antibiotics, such children
rarely survived into adulthood, and nature merely took its course when they succumbed to the
first childhood infection. . . The only reason a mother with one child afflicted with such an
illness will take the risk of embrarking upon another pregnancy is if she knows pre-natal
screening is available and, if the second child is similarly affected, she will be given the
opportunity of termination. I think the mother's right to choose is paramount - after all, she is
the one who has to watch the suffering of a child with, say, sickle cell anaemia or cystic
fibrosis, and to expect anyone to go through that sort of ordeal twice is to me totally
unacceptable." (Dr Kay Moss, 11/5/97)
FURTHER READING:
DeMarco D., In My Mother's Womb, The Catholic Church's Defense of Natural Life, p.7-99,
Trinity Communications, Manassas, Virginia, 1987.
McCullagh P., Fetal Sentience, All-Party Parliamentary Pro-Life Group, London, 1995.
----------------------------------------------------------------------------------------------------------
4. B. The effects of abortion upon women, families and society
4.B. 1. Effects of Abortion - Post Abortion Syndrome
"
As experience of liberal abortion has spread, there has been an awareness that for many
women termination brings genuine relief...For the healthy women with a happy marriage,
abortion is most often truly therapeutic." (Potts, Diggory & Peel, Abortion, Cambridge (l977)
p.227).
I
s the aftermath of abortion really so trouble-free? An immediate sense of relief that the
problem pregnancy is finished with is quite understandable. But what of longer term effects?
There are small increases in the % rate of complications in subsequent pregnancies (bleeding,
low birth weight, premature births) to be reckoned with, and a miscarriage rate doubled if the
first pregnancy was aborted (21% compared to 9%, P.G.Ney) . Pelvic and upper genital
infections, caused by transfer of chlamydia or other bacteria from the cervix into the womb,
afflicted 20% of patients at a Liverpool day-centre abortion clinic. Such statistics do not include
those who later are completely unable to conceive. (Genitourinary Medicine 63 (1987) 182-7).
I
n Ney's North American study of 44 factors impacting women's assessment of their own health,
the most important were the quality of family life, and the loss of a pregnancy (especially the
first). Abortion showed a more deleterious impact than a simple miscarriage. All pregnancy
losses tend to cause depression, which interferes with the immune system, making the person
more vulnerable to cancer and infections.
U
ntil recently the literature on the psychological consequences of abortion was scanty and often
self-contradictory. In the last decade many more studies have been completed. The traditional
expectation is that abortion must be mentally injurious. This may be more than an old wives'
tale. Even Calderone, a writer who campaigned for liberalised abortion in the U.S.A. reported
that "in almost every case, abortion, whether legal or illegal is a traumatic experience, which
may have severe consequences later on."
R
ecent studies have unearthed a growing body of evidence to support the contention that
abortion often has a painful aftermath. The medical and counselling professions have been
slow to recognise this Post Abortion Syndrome, which shows many of the features of a major
post-traumatic stress disorder.
Alt
hough abortion is now the most common surgical procedure in the USA (1.6 million p.a.) and
46% of all American women will have at least one termination, the prevailing opinion about the
psychological aftermath of abortion is based on methodologically flawed and substandard
studies. Most national mental health professional associations maintain that abortion causes no
lasting or significant emotional health risks. The vast majority of US publications assert that:
 abortion primarily causes relief
 abortion is psychologically safe short-term
 the emotional harm some women experience post-abortion is not attributable to the abortion
but to their pre-abortion fragility.
 abortion is a maturing experience for women.
 abortion is a coping mechanism and is associated with higher levels of self-esteem.
Th
e evidence for these conclusions is very weak. The timing and detail of interviews is very
important. Many women are reticent and do not want to speak about their abortion experience.
Some follow-up studies, allegedly showing that abortion rarely had harmful psychological
consequences, were invalidated by 60-80% drop-out rates. And in US health surveys only 50%
of the statistically expected number of women will admit to having had an abortion.
So
me statistics refer only to psychiatric hospital admissions where abortion is cited as the primary
factor, but this catches only extreme cases of depression and psychosis. In psychiatric inpatient
or outpatient care a woman's reproductive history is often overlooked or not reported anyway.
Many other women might suffer silently without being committed for psychiatric care. Many
studies were short-term, up to three months after the abortion, but a different picture emerges
when one looks at the effect of abortion within the whole of a woman's life. In the the first few
months ego-defensive attitudes and emotional repression of maternal grief feelings may be
securely in place.
"I
f you study abortion the way many people have, and see how well women feel about their
decision three months after the actual procedure, you can be very badly misled." (U.S.Surgeon
General Koop)
Often women themselves deny their hurt after an abortion. When they express their feelings to
friends or family or therapists, they are told they have no legitimate reason to feel that way. Our
society does not acknowledge the validity of grieving for an abortion.
R
esearch concentrating on women whose abortions were months or years earlier, unearths a
much higher % negatively affected by guilt. Abortion is probably not the immediate reason they
come to consult a therapist. It may be marital confIict, depression or chemical dependency.
Reports in counselling circles and psychotherapy journals in the 1980's gradually revealed a
swelling wave of post-abortion problems - the symptoms of many women were remarkably
similar. The "simple termination of pregnancy" was showing itself as a major death experience,
typically denied. Yet it is an unsanctioned death event. Public mourning is not permitted.
Post-abortion grief is "disenfranchised."
P.A.S. displays the hallmarks of repressed mourning, guilt, pain and impacted grief. Its
common symptoms include guilt, depression, grief, anxiety, sadness, shame, helplessness,
hopelessness, lowered self-esteem, distrust, hostility towards self and others, regret, insomnia,
recurring dreams, nightmares, psycho-physiological symptoms, suicidal thoughts and attempts,
alcohol and/or chemical dependencies, sexual dysfunction, insecurity, emotional numbness,
flashbacks of the abortion, relationship disruption, communication impairment and/or restriction,
isolation, foetal fantasies, self-condemnation, uncontrollable weeping, eating disorders,
preoccupation with abortion, confused and/or distorted thinking (cf V M. Rue, A.P.A. (1987)
Diagnostic & Statistical Manual of Mental Disorders p.250).
Reactions on the anniversary of the abortion or on the expected birthdate of the child are
particularly intense. Women who have undergone abortion may be grouped into (1) those
suffering post-traumatic disorder on an acute or clinic basis (2) those with no identifiable
symptoms, but who are at risk at some future stress point (often a new pregnancy or the
inability to conceive or complete a pregnancy). "Unresolved feelings of guilt, grief and loss may
remain dormant long after an abortion until they are apparently reawakened by another
pregnancy." (Kumar & Robson, UK study of 119 pregnant women with previous abortions).
Studies documenting post-abortion emotional harm:
Miller (San Francisco) in 1992 interviewed 967 women at least 60 days after their abortion. 22%
reported feeling much worse, detachment from their body or "sexlessness". 38% reported both
relief and distress. 18% distress only, and 22% some degree of emotional upset. (J. Soc.
Issues 48:67-94)
David, Rasmussen and Holst in Denmark, 1981 followed up 27,000 women within three months
of childbirth or abortion. 18.4 per 10,000 of the aborters were admitted to psychiatric hospital
compared to 12.0 per 10,000 of those who gave birth. It was much worse for divorced, widowed
or single aborters (63.8 per 10,000) compared to 16.9 of single mothers. (Fam. Plann
Perspectives 13:88-91)
Reardon lists the problems of 252 high-stress post-abortion women. Flashbacks (61%),
sexual difficulties (59%), anniversary reactions (54%), difficulty in maintaining relationships
(52%), use of drugs (49%), suicidal ideation (33%). 62% reported that their worst reactions
came more than one year after the abortion. 53% felt "forced" into abortion by others and only
33% felt "free" to make their own decision. 83% stated they would have kept the baby had they
been encouraged to do so by one or more significant persons in their lives - parents, boyfriends
or husbands. (Kevin Reardon: Aborted Women, Silent No More, Chicago, Crossway, 1987.
p.11)
I
n 1993 the Open Arms AIS Project of Colombia, Missouri, published a study of 828 women with
prior abortions who came seeking crisis counselling during another pregnancy. 27% reported
suicidal moods, 81% lowered self-esteem, 32% drug or alcohol abuse, 32% nightmares, 11%
attempted suicide and 46% feelings of despair and helplessness.
I
n Britain the King's Termination Study (1977) by Belsey interviewed women three months after
abortion. 64% reported guilt feelings, and 61% were ambivalent about the operation. Most likely
to be disturbed were those with a history of instability, poor or no family ties, few friends, poor
work pattern. It goes to show that abortion only worsens a psychologically unstable situation.
(Soc.Sci. & Medicine 11:71-82)
A
major long-term study is that of Vaughan, Portsmouth, New Hampshire. 232 women averaging
11 years since their abortion reported the following: 94% of the unmarried relationships giving
rise to the pregnancy had failed. 45% experienced negative feelings and bonding problems in a
subsequent pregnancy, or obsessive thoughts of a replacement child. 24% had medical
problems which were perceived as caused by the abortion. 28% had fears of infertility and
miscarriages. 36% had experienced suicidal thoughts.
It
is difficult to assess accurately what percentage of women suffer post-abortion syndrome.
Conservative estimates go as low as <10%. Dagg (in Amer. Jour. Psychiatry 148/5:578-85)
reports 6-32% (average 15%). Others give a 10-50% range or even higher. The following risk
factors predispose towards the likelihood of PAS:
1. Prior history of mental illness. 2. Immature personal relationships. 3. Unstable conflicted
relationship with sexual partner. 4. History of negative relationship with one's mother. 5.
Ambivalence regarding the abortion. 6. Religious or cultural background hostile to abortion.
7. Single status with no previous births. 8. Age: adolescents rather than adult women.
9.
2nd trimester more than 1st trimester abortions 10. Abortion for genetic reasons (foetal
abnormality). 11. External pressure or coercion to abort
12. Prior abortion 13. Maternal orientation 14. Biased pro-abortion counselling.
T
. Strahan recently published a major review of 26 studies relating to abortion's impact on
women's socio-economic status ("Women Increasingly Receive Public Assistance as Abortion
is Repeated," Association for Interdisciplinary Research in Values and Social Change, 4/2
(1991).)
 (a) Women who have had abortions are at greater risk of emotional and psychological
problems which interfere with employment opportunities.
 (b) Drug and alcohol abuse, a means of numbing negative feelings stemming from
abortion, also affect women in the work place and their ability to enter into meaningful
relationships.
 (c) After abortion women are more likely to become pregnant again and undergo additional
abortions. In the U.S. nearly 50% of abortions are 'repeat abortions'. Is this seeking a
replacement pregnancy and then being faced with the same social pressures as before?
Do some women undergo repeated abortions as an act of self-punishment?




(d) Compared to their peers, teenagers who have had one abortion are 4 times more likely
to have another, 20% of teen aborters repeat within a year, 38% within 5 years.
(e) The odds of requiring welfare assistance increases with each subsequent abortion.
Women with repeat abortions tend to have more health problems and greater personality
disintegration.
(f) Post-abortion women have greater difficulty establishing permanent relationships with a
male partner. They are more likely never to marry, more likely to divorce, more likely to go
through a long string of ''unsuccessful relationships." This inability to form a stable family
reduces household income and increases the probable need of welfare assistance.
(g) Repeat aborters strangely are more likely to desire children and are likely to carry one
or more subsequent "replacement" pregnancies to term. Thus many become unmarried
mothers which is what they were trying to avoid at the beginning.
I
n the light of this evidence it is hard to see how abortion "empowers" women. It has not in
practice made them richer, happier or more successful. Instead it leads to not social well-being,
but "an increased feminisation of poverty."
Many women who suffer P.A.S. underwent unwanted abortions. Researchers report that
30-60% of women seeking abortion express some desire to keep the child. Many of these abort
primarily to satisfy others. They may feel they have to choose between love for their unborn
child and love of boyfriend or parents. To what extent are women seduced, pressured or
coerced into accepting unwanted abortions?
---------------------------------------------------------------------------------------------------------------------FURTHER READING:
M.T.Mannion (ed.) Post-Abortion Aftermath, Sheed and Ward, Kansas City MO, 1994.
M. Mannion, Abortion and Healing - A Cry to
be Whole, Sheed and Ward, Kansas City, 1986.
TO THINK ABOUT:
Do you know anyone who has had an abortion? Have they ever spoken about it with you? What
effect has it had upon their lives? Does anything you have learnt about P.A.S. in this section
correlate with their experiences?
----------------------------------------------------------------------------------------------------------------------4.B. 2. The effects of abortion on other children and the family
In
the U.K., Canada and U.S.A. the increase in abortions has been followed by an increase in child
battering and children in care. For example rates of illegitimacy and children taken into care are
far lower in Northern Ireland (where abortion is illegal) than in Great Britain. Yet Northern Ireland
is ostensibly a society torn apart by violence. Deaths among Canadian children from social
causes increased rapidly after 1969 when early abortion became available on demand. British
Columbia and Ontario now have the highest abortion rates and also the highest child abuse
rates. Newfoundland, Prince Edward Island and New Brunswick have the Iowest abortion rates,
and much lower child abuse. These are not proofs but pointers. As Newman said, "a proof is the
convergence of probabilities." Frighteningly the most common cause of death in American
infants (6-12 months) is murder by their own parents (Schmidt & Kempre, Child Abuse, Basle,
Ciba-Geigy 1975).
P
entecostal circles speak of a spirit of abortion or murder that afflicts those who have had
abortions, demons who hate children and encourage parents to murder them. Abortion, they
say, expresses Satan's hatred of children. Consider this Christian doctor's description of his wife
"O
n the one hand she could be a fine functioning Christian - happy, joyful and normaI...then suddenly she
would reveal a side of her nature that seemed totally out of character and she would manifest...hatred
towards our kids...That look on her face as she would sometimes turn and lash out with such hatred
towards the kids and even towards me! She unleashed such anger, such vehemence, such hatred and
such violence as she would scream at them - I can almost believe she wanted to murder them." "My wife
had an abortion years ago - and I think that is the key to all our problems.'' (B. & S. Banks, Ministering to
Abortion's Aftermath, 1982, Kirkwood, Missouri).
Th
e solution proposed is prayer for deliverance and exorcism in the name of Jesus.
O
n a less supernatural level Professor P. Ney (Psychiatry, Vancouver) has done extensive
research on the link between abortion and child abuse. He suggests that the following
mechanisms may explain the connection  (1) Having an abortion may decrease the individual's instinctive restraint against the
occasional rage felt towards those dependent on her care.
 (2) Allowing infants to die by permissive abortion may diminish the social taboo against
attacking the defenceless.
 (3) By discarding unborn children wholesale, abortion may devaIue children thus
diminishing the importance of caring for children.
 (4) When abortion increases guilt and self-hatred, the parent may displace it onto a child.
 (5) A woman' choice for abortion increases the hostile frustration of some men, intensifying
the battle of the sexes, for which children have become the scapegoats.
 (6) Abortion of the first pregnancy may truncate the initial developing mother/infant bond in
later pregnancies, thus reducing mothering capacity.
 (7) A previous abortion may result in depression which interferes with the mother's capacity
to bond to her newborn. (Human Concern 36, 5 (1993) S.P.U.C. London).
Other researchers (Rent, Greenwood, Loekers & Nichols, Brit. Columbia, Med.J.
20:118-119 (1978)) note that a major result of abortion is lack of self-esteem in the mother.
Accompanied by guilt feelings, this contributes to child battery. Detailed interviews reveal that
"without exception there are feelings of guilt and profound regret." "All the women felt that they
had lost an important part of themselves." "They had a feeling that they had been symbolically
killing themselves."
Ney is now collecting data on what he calls Post-Abortion Survivor Syndrome (PASS): the
impact on the survivors. He lists the following:








1. Children who had a statistically low chance of surviving a pregnancy (as low as 10% in some parts of
eastern Europe).
2. Children whose parents carefully considered terminating them in utero.
3. Children who have had one or more younger or older sibling(s) aborted.
4. Children whose parents have threatened them: "You wretched child. I should have aborted you!" or words
to that effect.
5. Children who realise they might have been aborted because they are handicapped, suffer developmental
defects, are of the "wrong" sex or mixed-race.
6. Those children whose parents would have aborted them had they been able to.
7. Children whose parents could not make up their mind and delayed until it was too late for an abortion.
8. Children whose twin was aborted. Twins have an intimate relationship in the womb. If one is aborted, the
other feels terrible and is often suicidal.


9. Children who survived a deliberate to terminate their lives by saline, suction curettage or hysterotomy. They
suffer difficult psychological struggles, nightmares, confused identities and a fear of doctors.
10. Those tiny children who survived an abortion for a short while but were abandoned to die on a draining
board or were smothered by hospital staff.
(
see pp 69-87 in M.T.Mannion, Post-Abortion Aftermath (1994))
L
ittle information is available on the psychological effect of abortion on fathers, grandparents
and other family members. Abortion policies tend to exclude the father from his proper
responsibility for pregnancy and for the child - or allow him to shirk it. They exclude him from
his duty to support his wife and share her burdens. Thus he too is degraded as a person and
burdened with deep conflicts. See V.M.Rue in Mannion, op.cit. (1994) pp.24-28.
4.B. 3. Effects of abortion upon society
What has been the effect of abortion on the medical profession itself? The Hippocratic Oath
and Geneva Declaration are now almost abandoned. There is increasing pressure for
euthanasia and often a refusal to treat handicapped infants. One anecdote reveals the
hypocrisy of the present situation. A nurse was accompanying a gynaecologist around the
ward. In one bed was a woman 20 weeks into pregnancy with a threatened miscarriage, whom
he assured "Don't worry, we are doing everything we can to save your baby and I'm sure it's
going to be all right." At the very next bed was a woman at the same stage of pregnancy
unsure whether she wished to keep her child and in for tests. "Well, you decide," he said, "but
remember, if you don't want to keep it, it's no problem getting rid of it for you."
Nathanson (op.cit.) notes that it is the dregs of the medical profession who gravitate towards
the abortion clinics. Most good surgeons and doctors would find the work boringly repetitive
and unchallenging, if lucrative. Morality apart, they prefer to develop their skills doing
something constructive. Many abortionists have been disciplined for malpractice in other
sections of the health service, and for financial frauds in civil life. They bring that degree of
professionalism with them to the abortion clinic.
I
n socio-political terms abortion is profoundly anti-democratic and belongs in the Fascist
totalitarian camp. It exhibits the essence of Fascism whereby one class or group in society
(Aryan, blackshirt, born, healthy), in effect say to another group (Jewish, left-wing, unborn,
handicapped), "There is no place for you in our society. You are not truly human. You shall not
live among us. You shall not live." Abortion brutalises society by a subtle corrosion of respect
for the individual, especially the weak and helpless.
O
n an anthropological level, abortion is an enemy of womanhood and femininity. The female
psyche finds deep fulfilment in bonding with and caring for a new life. Abortion strikes at the
roots of a woman's femininity and capacity to mother. It is a severe blow to her created nature
and damages her ability to ''vivre au feminin" - to love being a woman. One suspects that we
see only the tip of the iceberg, and that most of the damage caused by abortion, the break-up of
relationships, P.A.S., goes undocumented When we violate nature, she exacts her revenge:
"God will always forgive, man sometimes forgives, Nature never forgives."
M
ovements like Operation Rachel and American Victims of Abortion are now working to bring help
and counselling and Cod's forgiveness to women who suffer the effects of abortion. Only the
Author of life can heal the loss of life, in the final analysis.
"The glory of God is a person fully alive, but aborted women often lead half-lives, imprisoned in
silent pain. The Lord comforts those who mourn and proclaims liberty to captives. Will Church leaders
consistently proclaim the same to sorrowful women in bondage to post-abortion pain?"
(Kathleen
Kelly in H.L.I.2.2 (1990) 3)
F
rom an ecclesiastical viewpoint we have the forceful words of Karl Lehmann, President of the
German Episcopal Conference: "Anyone who accepts abortion cannot claim to be a Christian."
The Code of Canon Law emphasises the seriousness of abortion. Canon 1398 reads: "A
person who procures a completed abortion incurs an automatic (latae sententiae)
excommunication." This covers all those directly involved in the abortion, including those who
pressurise the woman into it. They are therefore deprived of the Sacraments.
T
he penalty of excommunication is not inflicted in order to damn the sinner, but as a salutary
warning of the seriousness of the matter (cf EV 62). The Church hopes that in this way genuine
repentance and reconciliation with God may come about, and that it will be a deterrent to
others. The trivialisation of abortion as a sin does no favours to the penitent and fails to take
seriously the trauma they often are suffering.
T
he local Ordinary or priests delegated by him (e.g. Canons Penitentiary, but in some dioceses
all priests) can remit the penalty of excommunication. In danger of death - or in certain other
cases, provided an appropriate penance is imposed - any confessor can remit it (cf Canon
1357.2).
A
man who has procured or positively co-operated in an effective abortion incurs an irregularity
(perpetual impediment) preventing his reception of Holy Orders at any future date (Canon
1041.4) unless dispensed by the Holy See (1047.2). Similarly a cleric who procures or actively
co-operates in an abortion is henceforth prevented from exercising Holy Orders.
4.C. Cooperation and conflict situations
4.C. 1. Questions of co-operation in abortion procedures
When the ethical standards of superior members of the staff are deficient, assistant
surgeons and nurses can encounter serious moral dilemmas. The nurse is professionally trained
and expected to carry out a doctor's orders promptly. Nevertheless she remains a moral person
in her own right. She is quite justified in refusing to participate in illegal or unethical procedures:
abortion, euthanasia of the handicapped or elderly, unlawful experimentation. Sometimes a
nurse is pressurised against her will to assist. What are the limits of moral co-operation in
another's sinful acts?
The traditional distinction is made between:
 Formal co-operation - When the one who is aiding the principal agent freely agrees with the
latter's intention and possibly performs an essential part of the operation him/herself.
 Material co-operation - When one externally concurs in the sinful deed of another without
internally consenting to it. The co-operator carries out merely good or neutral actions,
although they facilitate the agent in his immoral purposes. Material co-operation is described
as proximate or remote according to whether it is more or less closely connected with the act
of the principal agent.
F
ormal co-operation in an evil act is never licit. It shares the malice of the act itself. For instance,
an assistant surgeon could never morally join in performing the act of abortion, when his action
amounts to the direct killing of the unborn child. It does not matter how small one's share of the
actual physical execution of the evil is. Advising, counselling, promoting or condoning an evil
action, merely by remaining silent when one has a duty to speak up or express an opinion, is
formal co-operation because such actions signify agreement with eviI. Think of management
meetings!
A nurse is rareIy confronted with the question of formal co-operation, but more usually with
material co-operation, which may be permissible if there is proportionate reason for rendering it.
Consider the factors (i) How bad is the operation? Is it abortion or merely a sterilisation or an
indirect 'therapeutic' abortion? (ii) How frequently does she have to co-operate? (iii) How
proximate is her co-operation? (iv) How necessary is it? Would her non-co-operation dissuade
the surgeon from going ahead? (v) Is any scandal involved? Will others presume that she
agrees with what is being done? She may be morally obliged to register a protest or request to
be excused, even if she knows it will not be accepted.
On the other hand a nurse has to weigh up (i) financial loss, especially if she has dependants to
support (ii) professional disability - loss of promotion etc. (iii) the interests of the patient (e.g. if
after a Caesarean the surgeon goes on to perform an unnecessary and unconsented tubal
ligation) (iv) loss of opportunity to do good by leaving the institution. A conscientious and
exemplary nurse can do much spiritual good, summoning the priest for Catholic patients,
baptising dying babies, helping the dying to make their peace with God. This would
compensate for occasional and unavoidable material co-operation in eviI.
----------------------------------------------------------------------------------------------------------------------SELF-CHECK (4.3):
 The old Catechism of Christian Doctrine Qu.329 asked "In how many ways may we either
cause or share the guilt of another's sin?" Nine was the answer:- (1) By counsel (2) By
command (3) By consent (4) By provocation (5) By praise or flattery (6) By concealment (7)
By being a partner in the sin (8) By silence (9) By defending the ill done. Consider someone
undergoing sterilisation or abortion and imagine how others might be 'co-operators' in the
sin in each of these nine ways.
 Please read Basterra, Bioethics, 146-8 or Peschke, Christian Ethics Vol I, pp 320-324. or
Fitzpatrick, Ethics in Nursing Practice, pp.128-133.
----------------------------------------------------------------------------------------------------------------------4.C. 2. Indirect abortion and "therapeutic" abortion
In
rare cases abortion is performed to save the mother's life (2 out of the 172,286 British abortions
in 1986). Given modern medical progress the choice between the life of the mother and that of
the child hardly ever arises. The direct killing of either is never permissibIe. We cannot grant an
automatically higher value to the mother's life. Each has an equal right to live.
Had there been regular recourse to abortion in such difficult cases, no medical progress would
have resulted. The challenge of the situation stimulated new techniques and saved lives. Early
this century medical textbooks listed many indications for 'therapeutic abortion' hydrocephalus, breast cancer, rectal cancer, cardiac disease, hyperemesis gravidarum,
epilepsy, Hodgkin's disease, leukaemia, muscular sclerosis, tuberculosis, rubella etc. However
in none of these does termination actually improve the mother's chance of survival. Renal
disease, eclampsia, ectopic pregnancy and cervical cancer can lead to conflict situations, often
resolved by obstetric skill and great patience.
Case Study: A Fallopian tube is in danger of rupture on account of an ectopic pregnancy. May
the tube be opened and the foetus shelled out in order to save the mother from tubal rupture,
serious haemorrhage and often rapid death? We apply the principle of double effect.
 (1) We cannot directly kill the foetus as the directly attended object of the act.
 (2) The intention is to save life, both mother's and child's if possible.
 (3) The foreseen beneficial effects must be equaI to or greater than foreseen harmful
effects. Bear in mind that a very few ectopic pregnancies have successfully come to term.
 (4) The beneficial effects must follow the action at least as immediately as the negative
results.
T
he traditional answer that if there is a very high likelihood of tubal rupture, the diseased tubal
section with the ectopic foetus may be excised. The primary action is to remove the
pathological tube section. The death of the foetus is an unintended and unwelcome side-effect,
which would anyway have happened later on tubal rupture.
P
roblems: (i) the blood vessels are clamped before the tube is cut out, so the foetus may welI
die first. (ii) Why not just shell out the foetus and leave the woman's tube intact and able to
transport an ovum again, instead of half sterilised? The moral solution, if possible, would be to
work on ways of transplanting a tubal pregnancy into the uterine cavity, securing some real
hope for its survival. Obstetricians do not seem to look on this with any great optimism at
present.
----------------------------------------------------------------------------------------------------------------------SELF-CHECK (4.4):

Revise Module 1. Ch.5. pp.34-35 on the Principle of Double Effect

Read either Peschke Vol 1, pp.273-81 or

Ashley & O'Rourke, Healthcare Ethics (3rd ed) pp.184-188; (4th ed) pp.191-3
FURTHER READING:
T.J. O'Donnell, Medicine and Christian Morality, pp.159-61, Alba House, N.Y., (1975).
---------------------------------------------------------------------------------------------------------------------4.C. 3. Rape Protocols
When a woman is raped, what is she to do? A vaginal douche is recommended to prevent
VD, but is unlikely to remove all the sperm, which can reach the fallopian tubes within 5-30
minutes of intercourse. There are only 3-4 days per month when intercourse could lead to
conception. Moreover the trauma of rape itself has an anti-ovulatory effect. If she conceives,
may the embryo be considered an unjust aggressor whom she has the right to repel from her
body?
Most hospital rape protocoIs recommend a high (100 µg) dose of ethinyl estradiol within 72
hours of the attack and repeated 12 hours later. The GBI Bishops' Committee of Bioethical
Issues has stated:
"
The effect of administering hormones - large doses of oestrogen or oestrogen-progestogen combinations - will differ
according to the stage of the menstrual cycle when they are given. If administered early in the cycle they should
prevent ovulation and therefore conception. If given about the time of ovulation they could immobilise the sperm in
the genital tract and thereby inhibit fertilisation. If given after ovulation, their effects upon the female reproductive
tract are such that the survival of any embryo will be put at risk, whether directly or by prevention of implantation or
by inducing early menstruation as a resuIt of a sudden fall in the steroid level."
They concluded that
"
A woman who is the victim of rape is entitled to defend herself against the continuing effects of such an attack, and
to seek immediate medical assistance with a view to preventing conception. Catholics may seek and administer
hormonal postcoital contraception after insemination by sexual assault, provided (i) that there are no grounds for
judging that ovulation preceded or will coincide with the administration of postcoital contraception, and (ii) that the
post-coital contraception is administered urgently, within about a day, of the assault." (Use of the Morning-After PiIl
in cases of Rape, Origins 15 (39), 633-8)
Medical tests are therefore necessary to determine whether or not the woman is pregnant. If
she is, nothing should be done to harm the embryo. If a child has been conceived the mother
undoubtedly needs God's grace and the loving support of her family and the Christian
community to help her to overcome her natural feelings of revulsion and to do what is right. It is
wrong to abort the innocent child, who is not an unjust aggressor.
The mother is in the position of being the only person who can save the life of another. Such
a person is obliged to make considerable sacrifices to save life, even that of a stranger (e.g. if
you find a climber with a broken leg high on the mountains, or see a person drowning in the
canal, you must try to save them or fetch help). The mother has nine months of undeserved
inconvenience ahead of her: then she can decide whether or not to give the child for adoption.
Abortion will only add worse trauma onto an already dreadful ordeal.
Many women may instinctively disagree with this teaching. It is important to go by reason and
not by emotion. The new embryo is an innocent child, and the principle of his/her entitlement to
life must prevail. This is perhaps the hardest test case of the Church's teaching to put across in
today's world.
FURTHER READING:
Ashley & O'Rourke, Healthcare Ethics (3rd ed) pp.286-90; (4th ed.) pp.302-7
4. D. Medical abortion by abortifacient drugs
M
any oral contraceptives are now partly or totally abortifacient in their mode of action. When the
contraceptive PiIl was developed in the 1950's it typically contained doses of l00-l50µg.
oestrogen. This hormone is usually released during pregnancy. Its artificial presence in the
bloodstream deceives the pituitary gland into 'thinking' the body is already pregnant. Thus the
pituitary fails to produce the follicle stimulating hormone (FSH) and luteinizing hormone (LH)
which normally each month cause several follicles in the ovaries to mature and one to be
released. Hence ovulation is suppressed in what is effectively a form of chemical sterilisation.
It
soon emerged that high oestrogen doses produce many unpleasant side-effects - headaches,
weight increases, raised blood-pressure, cardiovascular problems leading to blood clots, and
hence increased chances of heart attacks and strokes. Medium dosage (combined) pills
containing typically 30-40 µg. oestrogen and 1 mg. progestogen were therefore developed.
From October 1988 the high dose pills (with more than 50 µg. oestrogen) were banned in the
U.S.A. and subsequently exported to Third World countries instead.
Lower oestrogen doses, however, allow more "breakthrough ovulations" even with
conscientious use but especially if a tablet is missed. The medium and low oestrogen pills
therefore rely on three back-up effects:
 Barrier contraceptive action - progestogen thickens the cervical mucus into a thick tacky
barrier which hinders sperm penetration into the uterus.
 Abortifacient action - progestogen renders the womb lining (endometrium) less suitable for
implantation (nidation) of the fertilized ovum.
 Some impedance of the peristalsis (wave motion) of the fallopian tubes which gently moves
the fertilised or unfertilised ovum towards the uterus.
All the combined Pills now commonly prescribed are anti-nidatives. They rely in part upon
these early silent abortions. Only the high oestrogen Pill is effectively anti-ovulatory.
T
he so-called mini-Pill contains 0.075-0.35 mg. progestogen only. A woman on this Pill ovulates
normally because it contains no oestrogen. It relies entirely upon thickening the cervical mucus
and rendering the endometrium hostile to any fertilised eggs. It also influences the transport of
the ovum along the Fallopian tube, and carries an increased risk of ectopic pregnancy.
T
he post-coital ('morning after') Pill is a high dose of 2-4 normal progestogen or combined pills
each containing 1 mg. progestogen and 20-30 µ. oestrogen. It is given in order to prevent
implantation if an ovum has already been fertilised after intercourse.
D
epo-Provera injection contains 150 mg. progestogen and lasts 3 months. It works as a
anti-nidative, but is not permitted by the U.S.A. Food and Drugs Administration. Nevertheless it
is a favourite of those who encourage Third World women to use contraceptive measures.
N
orplant consists of 6 rods inserted into the upper arm. Its effect as a progestogen based
anti-nidative lasts 5 years.
R
U486 (mifepristone), the French abortion pill, used up to 12 weeks into pregnancy. It prevents
the uterus receiving progesterone, needed to maintain the pregnancy. The womb lining
subsequently breaks down and the embryo is lost. Bleeding occurs. 48 hours later a
prostaglandin injection or pessary is applied to stimulate contractions of the uterus, ensuring
that the contents have been completely expelled.
I
ntra-uterine devices (IUDs): the Lippes loop, CU-7, Progestasert-T etc. The presence of a
foreign body in the uterus is thought to cause inflammation of the endometrium and hence
prevent implantation of a fertilized ovum. The concentration of metal ions interferes with sperm
motility and with the enzymatic processes necessary for regulating implantation.
The death rate in women who have taken oral contraceptives (OC's) continuously for 5 years is
ten times that of control groups. Deaths from circulatory diseases are five times the level for
women who have never taken OCs (Royal College of General Practitioners' Study l977). The
history of contraception has long been the pursuit of male pleasure at the expense of women's
health.
Future developments will see a continuing shift towards early chemical abortion and away from
later surgical abortions. At the same time, such abortifacient methods will be classified as
contraception. The search is on for simple inducers of early abortion: for example, a ten-dollar
combination of an anti-cancer drug methotrexate and an ulcer drug (misoprostol), easily
available in the US, causes abortion very effectively, while RU 486 has been ridden with
problems and controversy.
"
In order to facilitate the spread of abortion, enormous sums of money have been invested and continue to be
invested in the production of pharmaceutical products which make it possible to kill the fetus in the mother's womb
without recourse to medical assistance . . . Scientific research seems to be almost exclusively preoccupied with
developing products which are ever more simple and effective in suppressing life, and which at the same time are
capable of removing abortion from any kind of control or social responsibility." (EV 13)
-----------------------------------------------------------------------------------------------------------------SELF-C
HECK (4.5):
1. Can a Catholic physician morally prescribe contraceptive pills, even to non-Catholic
patients? (cf. G. Grisez, The Way of the Lord Jesus, Vol.3, Difficult Moral Questions, pp.
308-14)
2. Must a nurse give up her hospital job to avoid assisting in abortions? (idem pp. 355-9)
3. "I am a pharmacist employed in a large chain pharmacy. Part of my job is to watch for
errors in prescriptions, but otherwise I am expected to dispense whatever is prescribed. That
includes birth control pills, though I reject contraception. Knowing that the pills have an
abortifacient dimension, I have not liked doing this. But theologians usually faithful to the
Church's teaching have said that it is acceptable material cooperation, so I have done it. . . .
However, I know that some prescriptions for birth-control pills are being written with instructions
regarding dosage and timing that make it clear they are being used as morning-after pills . .
.What should I do if this happens?"
(see Grisez, idem pp. 374-80)
4. The number of pharmacological abortions worldwide vastly exceeds the number of surgical
abortions, and is likely to increase still further. Discuss.
FURTHER READING:
Basterra, Medical Ethics, pp.92-111 on "Contraception"
Wilks J., A Consumer's Guide to the Pill and Other Drugs, Freedom Publ., North Melbourne,
Australia, 1996.
For a thorough study of the harmful side-effects of OCs by a one-time advocate see
Dr Ellen Grant, The Bitter Pill, London, 1985
------------------------------------------------------------------------------------------------------------------
CHAPTER 7
EUTHANASIA - BENEMORTASIA (ORTHOTHANASIA) - DISTHANASIA
7.A. Explanation and discussion of terms
1. Euthanasia: by act or omission, voluntary or involuntary.
2. Disthanasia - prolonging the process of dying.
3. Ordinary and extraordinary treatments
4. Benemortasia (orthothanasia)
7.B. Analysis of the euthanasiast position.
7.C. Dangers of euthanasia in clinical practice:
1. Care of newborn infants
2. Care of the handicapped
3. Terminal care - the hospice alternative
4. Geriatric medicine
5. Intensive therapy units.
7. D. "Living wills" and advance directives.
7.E.
Experiences and effects of euthanasia in society
1. The Dutch and other experiences of euthanasia.
2. Likely effects of legalised euthanasia on medicine and society in Britain.
----------------------------------------------------------------------------------------------------------------------
OBJECTIVES OF THIS CHAPTER:



1. To understand the moves towards euthanasia in modern society and the arguments
which are used to promote it.
2. To develop a Christian alternative which avoids undue prolongation of dying, and
preserves true respect for human life.
3. To learn from the experience of countries where euthanasia has been introduced.
----------------------------------------------------------------------------------------------------------------------
7.A. Explanation and Discussion of Terms
7.A. 1. Euthanasia: by act or omission, voluntary or involuntary.
Euthanasia refers to an action by which a person is put to death, painlessly if possible,
in order to forestall further suffering from an incurable disease or to end an irreversible
comatose condition. The death of a human being is brought about on purpose as part of the
medical care being administered. Euthanasia is supposedly intended to benefit or at least bring
no harm to the patient and possibly to benefit others.
The word euthanasia comes from the Greek eu - good, and thanatos - death. Death is
procured for the patient as a benefit because it is believed that his quality of life is so wretched
and/or his mental faculties: so confused and impaired, that he would be better off dead. This is
often called mercy-killing. Opponents of euthanasia argue that a first ingredient of mercy is a
pledge not to kill one's neighbour, and question 'Who, in euthanasia, is showing mercy to
whom?' Proponents of euthanasia claim that their principal motive is compassion, compassion
of the suffering of the terminally ill.
The word 'euthanasia' began life quite innocently. In Cicero it signifies a worthy honest
and glorious death, in Suetonius a rapid death without great suffering. Francis Bacon (d.1626)
wrote of an internal euthanasia whose object was to prepare spiritually the dying person's soul
and an external euthanasia which tried to make the dying person comfortable, and did not
simply abandon him when medical treatment was of no more avail, as was then the practice of
many doctors.
In Britain euthanasia now has a new meaning, that of "mercy-killing'. Killing the sick has
a long tradition behind it. Sickly infants were exposed to die in ancient Sparta. In the Middle
Ages cholera victims were burned in their homes to prevent the spread of the plague. Those
with rabies were suffocated. The Wards of Poor Law hospitals usually had available a bottle
containing a mixture of choral and bromide, liberally used by nursing staff to sedate demented
old people so that they ceased to take proper nourishment.
However, as we have already seen, Judaeo-Christian Revelation emphatically forbids
the taking of innocent life. In ch.6.C we saw that suicide is morally illicit. Helping a sick person
to commit suicide is therefore cooperation in an evil act and is also illicit. Killing a sick person at
their request, or with their consent, still ranks as murder or being an accomplice to murder
(assisting suicide).
Euthanasia can be performed by deed or by omission. Where death results from a
positive action e.g. administering a lethal injection to a seriously ill patient, it is called active
euthanasia. Where it results from the omission of medical care e.g. the refusal to operate on a
Down's Syndrome child with duodenal atresia (an intestinal obstruction which can be easily
rectified by simple surgery), it is called passive euthanasia. This terminology of passive
euthanasia sometimes leads to difficulties and misunderstandings After all, there is no moral
obligation to carry out extraordinary treatment (v.i.), such as extensive surgery or very
burdensome treatments on terminally ill patients, causing them acute suffering with minimal
chance of success beyond a very slight extension of lifespan. The description passive
euthanasia, although widely used, is strictly inappropriate for such cases.
Voluntary euthanasia applies to cases when a person asks to be put to death.
Involuntary euthanasia is putting people to death against their will or without their consent. Even
with voluntary euthanasia, how can one be sure that consent has been given freely? Family or
doctors may pressure an elderly person into agreeing to euthanasia. A person who is in a
confused state, unconsciousness or suffering senile dementia, would be unable to give
consent. Even if at some time past they had signed a document requesting euthanasia, how
can one be certain that is still their intention? People can change their minds but might be
unable to communicate the fact. The distinction between voluntary and involuntary euthanasia
cannot be so clearly drawn as the advocates of euthanasia suppose.
Concerning new-born children or other incompetents, the Helsinki Declaration on
Biomedical Research involving human beings states that non-therapeutic research may be
done only on informed volunteers. The same would obviously be necessary for any form of
legalised voluntary euthanasia. Just as parents or guardians cannot morally give consent for
non-therapeutic research upon their child or ward, neither have they any moral right to give
consent for the euthanasia of their child, either passive or active. The adults are guardians and
stewards of the child's life, not owners. The euthanasia of newborn children or incompetents is
ipso facto involuntary euthanasia, because the subject has never requested death and consent
cannot be presumed.
---------------------------------------------------------------------------------------SELF-CHECK (7.1):
1. Read CCC 2276-9 and then either Haring, Medical Ethics, pp.133-140 and/or
Basterra, Bioethics, pp.181-93 and 197-203
2. Do you think that there is a radical difference between voluntary and involuntary
euthanasia?
3. Can the phrase "passive euthanasia" be used to refer to something that is morally
permissible?
4. Do you think that administering pain-killing drugs, as a result of which a patient dies,
can be done by two different people - or by the same person on two different occasions - justly
in one case and immorally in another? Why?
5. Read Evangelium Vitae 64-7 and summarize the principal points in the Pope John
Paul II's reasoned condemnation of euthanasia.
FURTHER READING:
Duncan, Dunstan & Welbourn, Dict. Med. Ethics, pp.164-6 on 'Euthanasia'.
B.M.A., Medical Ethics Today, pp.147-79 "Cessation of treatment, non-resuscitation,
aiding suicide and euthanasia"
----------------------------------------------------------------------------------------------------------------7.A. 2. Disthanasia
This term describes the practice of artificial prolongation of life as far as is physically
possible, taking no account of the patient's suffering or the burdensome nature of the
treatment. It is staving off the moment of death, refusing to let nature take ifs course in a
patient whose death is imminent and inevitable. Indicative of an excessive 'therapeutic zeal', it
represents a prolongation of the process of dying rather than a proIongation of life. The Greek
prefix dys implies imperfection and malfunction in the dying process (thanatos).
Sometimes a famous celebrity or politician has been repeatedly resuscitated at the brink
of death and maintained alive in a state of irreversible vegetative coma. Tito, President of
Yugoslavia, was kept alive for several months in this manner while his subordinates doubtless
manoeuvred to secure the nation's levers of power.
Resuscitation and life-sustaining procedures are generally a great blessing. They save
many lives every day. Even if - after a sudden cardiac arrest or stroke - it later emerges that the
patient will not regain consciousness, the life-support equipment has at least allowed a
thorough diagnosis and prognosis to be made. If no recovery is possible and brain death has
already occurred, once this is clearly ascertained the life-support systems may be switched off.
Various factors influence medical decisions as to whether a particular patient should be
resuscitated and their life artificially prolonged -
(1) The nature of the ordinary or extraordinary medical means necessary to maintain
life.
(2) Possible discrimination in favour of the young rather than the old; someone highly
qualified and economically productive rather than unemployed and unschooled, someone with a
family to support rather than a person with no dependants, rich rather than poor, someone with
a doctor, barrister or M.P. in the family rather than dockers and factory workers.
(3) The chances of genuine recuperation following resuscitation and re-animation and
longer-term medical prospects. Hospital files regularly state 'Not for 2.2.2.2,' or some similar
agreed code to signify patients who are terminally ill or in very poor health, and who will not be
resuscitated in case of sudden cardiac failure.
A moral evaluation of these criteria leads to the following conclusions:
(1) that ordinary medical treatment is obligatory, but extraordinary means may be
optional. Criterion (2) lays us open to all manner of social engineering, racist, class or age
discrimination. The major determinant should be (3), genuine medical reasons and long-term
survival prospects. Nevertheless if a consultant has more seriously ill patients than intensive
care beds and respirators, he is in a conflict situation. Given two candidates with equal chances
of survival and only one life-support machine he ought to both (i) seek guidance in prayer if he
is a believer (ii) take into account family circumstances, dependants etc.
The undue artificial prolongation of life is a problem created by medical advances. It was
not so in our grandparents' day. Heart-rending experiences of prolonged dying have created a
degree of public support for euthanasia. As so often happens in society, abuses in one
direction provoke an over-reaction in the opposite direction. Fear of burdensome and pointless
extension of life starts people claiming a "right to die.""Hard cases make bad laws" runs an old
legal maxim. As Christians we can however speak of the ''right to die humanly when God calls
us" - according to his timing, not human decision. By "die humanly" we mean that the dying
person is loved and cared for with their family and friends around; the Sacraments of the
Church and Spiritual support are made available. This is far preferable to a lonely demise in a
technological purgatory, encircled by electronic machines and strangers, every orifice filled with
tubes and every artery with a needle drip injected into it.
In 1957 Pope Pius XII expressed his thoughts on this subject: "If it is evident that the
attempt at re-animation constitutes actually such a burden for the family that cannot in
conscience be imposed, they may licitly insist that the doctor discontinues his efforts, and the
doctor can licitly accede to their requests. There is in this case no direct disposal of the
patient's life, nor euthanasia, which would not be permitted." (ASS 49 (1957), 1030).
Alternatively, in the words of Cardinal Villot to the International Federation of Catholic
Healthcare Workers (1970): "In many cases would it not be useless torture to impose
vegetative re-animation in the last phase of an incurable illness? The doctor's duty consists
rather in soothing pain than in prolonging life to the utmost using whatever means and in
whatever condition, a life which is already not completely human and is naturally drawing to a
close.''
The German Bishops' Conference (1974) spoke of similar cases where the only result is
to delay artificially the moment of death: Life is prolonged slightly but with severe pain. The
patient "finds himself submitted, on account of the operation or as a result of it, to serious
physical or psychological trauma...If the patient, his relatives, and the doctor, after weighing up
all the circumstances, decline the use of medicines and exceptional means, one cannot accuse
them of arrogating to themselves an illicit right to dispose of human life."
7.A. 3. Ordinary and Extraordinary Means
To proceed further, let us clarify the traditional distinction between ordinary and
extraordinary medical treatment, as stated by Kelly (1958):
Ordinary means of preserving life are all medicines, treatments and operations which
offer a reasonable hope of benefit for the patient and which can be obtained and used without
excessive expense, pain or other inconvenience.
Extraordinary means of preserving life are all medicines, treatments and operations
which cannot be obtained or used without excessive expense, pain or inconvenience, or which,
if used, would not offer a reasonable hope of benefit.
One area of difficulty is that the classifications are relative to a particular society and
time e.g. blood transfusions which were extraordinary in the 1930's had become routine
ordinary means by the 1960's. Haemodialysis for patients with kidney failure was extraordinary
in the 1960's but is routine today.
Moreover the ordinary / extraordinary terminology can be misunderstood. Doctors
understand 'ordinary means' to mean all techniques routinely available in a standard hospital.
'Extraordinary means' suggests unusual treatments in a specialised unit, or experimental and
newly-discovered procedures not yet widely accepted.
These are not the precise meanings of the terms in Catholic moral theology. In order to
avoid confusion, some writers have suggested using 'proportionate / disproportionate means'
instead. Others warn that these too are susceptible to misinterpretation - the operation on a
Down's syndrome baby to unblock the intestine has been labelled 'disproportionate' by
paediatricians. In fact it ranks as 'ordinary' surgery for normal children and so should it also for
the handicapped, given that they have a forty year lifespan. Proportionate / disproportionate
can be used to discriminate against certain groups of individuals. On strategic grounds we may
be better advised to stick with the ordinary / extraordinary nomenclature, while recognising that
this does contain a valuation of the proportionate benefits of the treatment to the patient.
It is therefore impossible to draw up watertight lists classifying every medical procedure
as either ordinary or extraordinary. Means which are ordinary for a young person with good
recovery prospects might be extraordinary for a terminally ill person or an elderly individual with
severely deteriorating health. Means which are ordinary in U.K. hospitals will be extraordinary
(or just not available at any price) in Congo or North Korea.
When the means of prolonging life are (1) ineffective and (2) constitute a grave burden,
then the removal or with-holding of life-support treatment, allowing a person to die, is legitimate.
(Nat. Conf. Cath. Bishops, U.S.A., 1986). They use the terms "ineffective'' and "grave burden"
primarily with respect to the spiritual purpose of life. ''Life, health and all temporal activities are
in fact subordinate to spiritual ends.'' (Pius XII, 1957).
Some ethicists argue that if cognitive-affective function can never be regained, if the
patient is in an irreversible coma, then life-support machinery can be switched off. How can we
be sure the person is never going to recover? Miracles do happen, and not necessarily
supernaturaI miracles. A patient may retain his mental functioning but be unable to
communicate this to the outside world. Patients should enjoy the benefit of the doubt. There are
many recorded cases of handicapped or severely injured persons who, once able to
communicate again, revealed that they had been conscious and intelligent when everyone had
assumed they were inert and incompetent.
--------------------------------------------------------------------------------------------------------------------SELF-CHECK (7.2):
1. Read: Haring, Medical Ethics, pp. 129-133 and/or Ashley & O'Rourke, Healthcare
Ethics, pp. 380-387.
2. Would one ever be justified in withdrawing artificial hydration and nutrition from an
unconscious patient?
-------------------------------------------------------------------------------------------------------------------7.A. 4. Benemortasia (Orthothanasia)
The above considerations encourage us to develop a truly Christian ethic for care for
the dying, which balances the right to a worthy human death in God's time with respect for
human life. Dyck, Professor of Ethics at Harvard, coined a term from the Latin, benemortasia dying well. Boskan of Liege (1950) had devised the word orthothanasia, preserving the Greek
root for 'death' with the prefix 'ortho' - right or proper. The German Episcopal Conference
formulated well the content of the benemortasia ethic in these words:
"Death is the final important act of life, and none can deprive a person of it, but rather
should help him at that moment. This means above all alleviating the sufferings of the sick
person, eventually including also the administration of analgesics, in such a way that he may in
a human manner cope with this last stage of his life.: It means that it is necessary to give him
the best assistance possible. And this does not only consist in medical treatment but above all
in paying attention to the human aspects of help, in order to create around the dying person an
atmosphere of confidence and of human warmth in which he may sense the recognition and
high value placed upon his human existence. It is also a necessary part of this assistance, that
or does not abandon the sick person in his need when he asks for an answer to the problem of
the origin and purpose of life, for these are the final religious problems which can be neither
eliminated nor driven away. In such moments faith is an effective help for resisting and then
overcoming the fear of death, and indeed gives to the dying person a solid hope."
(Ecclesia, 25 (1975), 1239)
In order to promote good practice in care for the dying, society needs to commit itself in
the following ways:
(i) To provide care for the dying with all the means at present possessed by medical
science, both to alleviate pain and prolong life.
(ii) The dying person should not be rendered unnecessarily unconscious and in this way
"deprived of their own death". Dying is a personal experience of immense - eternal - important
(iii) Society should free itself from the taboo on speaking about death. It is better to see
and accept death as normal and natural, rather than suppress it and hide it away, or pretend it
will never happen.
(iv) Hospital services and nursing homes should enable a patient to face death
knowingly and be supported by family and friends.
(v) Religious support has a very important role to play near the time of death. The
human and religious mystery of death must be respected.
(vi) The right to die in a human manner must be maintained. Suitable remedies for pain
control should carefully be administered to the dying patient, even if this therapy shortens
lifespan slightly as a side-effect and induces some degree of sedation. A patient has every right
to refuse pain-killers if he wishes (as did Christ on the cross). Questions about the afterlife
should be answered honestly and not side-stepped.
In the words of the German moralist Bockle, we must aim at "helping the dying person
discover the meaning of the last phase of life, so that he can believe it is worth living it." The
German episcopate, alarmed that euthanasia was being presented as a form of care for the
dying (Sterbehilfe), clarified the distinction between helping someone to die (Hilfe zum Sterben)
- euthanasia, and help in dying (Hilfe im Sterben), which is what we genuinely owe to the
terminally ill.
Our Western society is inclined to regard death as a problem to be solved, a technical
failure one day to be overcome. The Christian approaches death as a mysterium, a mystery to
be entered into, a point of unity with Christ in his death and resurrection. It is true that death
involves corruption and decay of the body. It exhibits the incomprehensibility of evil in its
starkest form here on earth - especially when it strikes at those in the prime of life.
We use the word 'victim' often in a passive sense, when we talk about victims of
accidents, violence, hunger and disease. However in classical thought victima has also an
active ring to it. The victima is not totally passive. He offers himself and his own life. We are
invited to join Christ in his victimhood, actively offering ourselves in union with Him. Every
anguish and sorrow in our lives can be part of that process. Each small daily death prepares for
the final self-offering to Christ in our physical death.
There is a story about a Benedictine monk of Ampleforth at the Headmasters'
Conference, speaking with the Head of a famous public school. The secular Head was anxious
to assure the monk, "We do try to teach our boys Christian standards, to live well, you know."
The Benedictine responded: "We teach our boys to live so that they may die well.''
Deep in the Catholic heritage lies this tradition of the bona mors, the holy death
crowning a good and faithful life. In contrast secular society seeks the bella mors, the "nice
death", rapid, easy and gentle on the survivors. SecuIar culture hides death away. Itis not
integrated into life, but taboo and separate. Death is not the culmination of life but an
afterthought. At the end of it all, you kick the bucket, and go six foot under. Someone retires
from public life into hospital or a home. Years later, like a P.S., obituary notices appear in the
newspapers. Death is the full stop when the sentence of life has muttered its way to an
inaudible close.
The funeral becomes an exercise in the "theology of niceness." The departed must look
nice in the coffin. Cosmetics create an appearance which denies death. The priest must say
complimentary things about the deceased and sing cheerful hymns. I recall one middle-aged
football supporter being buried in full Liverpool strip with next year's fixture programme in his
hands. It becomes difficult to celebrate death in a Christian way, when society distances itself
from death and wants only the bella mors, the nice crematorium service with "You'll never walk
alone" on the way out!
7.B.
Analysis of the euthanasiast position
The pressure towards the legalization of voluntary euthanasia in Britain, within and
outside Parliament, requires us to analyse and respond to this campaign. Much of the
momentum towards euthanasia is demographic and economic. From the l960s onwards the
birthrate dropped, due to widespread use of abortion and contraception. The proportion of the
population in work relative to those retired is decreasing. Britain is becoming an elderly society.
By 2030 there will be double the number of pensioners there are now. The cost of social
services and hospital care place an increasing burden on fewer and fewer taxpayers. Keeping
so many elderly people alive becomes an unattractive proposition in economic terms.
Abstracted from Kohl, Fletcher and others, the philosophical postulates of the
euthanasiast position are as follows:
(1) The sanctity of life is not always to be upheld, since it is a relative and not an
absolute value.
(2) There are times when it is kinder to kill.
(3) Such killing is inspired by benevolent love, compassion, which wants to spare the
sick person suffering.
(4) There is no purpose in much human suffering.
(5) Only a certain sort of life, one with dignity, has value.
(6) A minimum "quality of life'' is necessary for life to be regarded as truly human.
(7) An individual's life belongs to that person to dispose of as he or she wishes.
(8) There is little difference between permitting someone to die and causing their death.
(9) If an individual chooses to die rather than live, he is entitled to be assisted by the
medical profession.
Three human values are involved in the euthanasia debate: (a) prolonging life,
(b) lessening suffering,
(c) preserving freedom and consciousness.
The euthanasia lobby implicitly regards (b) as all important and sacrifices (a) and (c).
Disthanasia prizes (a) excessively above (b) and (c). Benemortasia aims to strike a
correct balance between (a), (b) and (c). It acts in accord with fundamental moral laws and
respects the sanctity of life.
The strongest popular appeal in the euthanasiast case is the plea for compassion.
However much this word is misused, it will prove persuasive with the general public. The
Anglican report On Dying Well (l975) emphasises the great strides made in the treatment of
pain and depression in seriously ill patients. In the following almost lyrical passage, it portrays
how suffering can ennoble the human character:
"The value of human life does not consist simply of a scale of pleasure and pain. Such
may be the value of an animal's life. A dog's life. for example, may be valuable in so far as it is
filled with doggy pleasure and devoid of doggy pains. But the value of human life consists in a
variety of virtues and graces as well as in pleasure. These together constitute man's full
humanity. They grow in soil in which action and passion, doing and suffering, pleasure and pain
are intermixed. What a man is consists not only of what he does, but also of how he endures. A
fully human life is inescapably vulnerable, as every lover knows, and even suffering may by
grace be woven into the texture of a larger humanity. It is not that Christians believe that
suffering is in itself a good, or that it necessarily ennobles. It may indeed destroy, and the
alleviation of pain is a Christian as well as human duty. But suffering as exposure to what is
beyond one's voluntary control, suffering as undergoing, even as diminishment, is part of the
pattern of becoming human. Even dying need not be simply the ebbing away of life; it may be
integrated into life and so made instrumental to a fuller life in God."
We perfect our humanity by interdependence. There is a time for giving, a time for
receiving, when we give to others the chance to give, and evoke their generosity and
unselfishness. "There is a movement of giving and receiving. At the beginning and at the end of
life receiving predominates over and even excludes giving. But the value of human life does not
depend only on its capacity to give. Love, agape, is the equal an unalterable regard for the
value of other human beings independent of their particular characteristics. It extends
especially to the helpless and hopeless, to those who have no value in their own eyes and
seemingly none for society. Such neighbour-love is costly and sacrificial. It is easily destroyed.
In the giver it demands unlimited caring, in the recipient absolute trust. The question must be
asked whether the practice of voluntary euthanasia is consistent with the fostering of such
caring and trust."
-------------------------------------------------------------------------------------------------------------------SELF-C
HECK (7.3):
1. Necessary reading: C.D.F., Declaration on Euthanasia (Jura et Bona) (1980) in
Flannery, op.cit. Vol II, pp. 510-517.
2. When does a patient have the right to refuse medical treatment?
3. The legalization of euthanasia would involve a radical change to the conception of
human life underlying our homicide laws. Discuss, with reasons.
-----------------------------------------------------------------------------------------------------------------------
7.C. Dangers of euthanasia in clinical practice
We shall examine five areas of healthcare where euthanasia is a discussed possibility,
and is sometimes practised under other names: (i) Care of the newborn
(ii) care of the handicapped (iii) terminal care (iv) care of the elderly (v) intensive care.
7.C. 1. Care of newborn infants
In the neonatal period death can be readily brought about by omission. The child needs
nutrition, warmth and nursing care and is totally dependent on others. Any euthanasia is
necessarily involuntary because the child is unable to give assent.
The case of Down's Syndrome babies with duodenal atresia has already been
mentioned. In 1975, 457 members of the American Academy completed a questionnaire
surveying attitudes to such cases.
Surgeons
24%
on their baby.
52%
decision.
77%
17%
3.5%
Physicians
13%
Policy acceptable
WouId try to persuade parents not to have surgery
38%
Would give parents all facts and accept their
50%
28%
16%
Would acquiesce in parental decision to
refuse consent for surgery.
Would try to persuade indecisive parents
to allow surgery.
Would be willing to seek court order
allowing surgery if parents refused.
Parents of spina bifida children are sometimes informed that without an operation the
child will die. This is untrue. But instead of surgery there has been a tendency ''to seek early
death as a management option". Administering sedatives (60 mg. chloral hydrate four times a
day, 8 times the sedative dose recommended in paediatrics textbooks) makes She child
continuously sleepy. It takes little or no food and usually dies at between 2 and 6 weeks. Death
is caused not by spine bifida but by lack of nutrition.
A paediatrician wrote in The Lancet that for congenital handicap he can offer "Some
help in hastening the end of a life which I now have to advise the parents would otherwise be
one which is not a life in any full sense."
The usual considerations advanced in favour of such practices are The problems created for families looking after a severely affected child.
The cost to society of caring for such a child.
The absorption of resources which could otherwise be devoted to the more
adequate care of the moderately handicapped.
These considerations betray the euthanasiast spirit. Heed the warning of the physician
Dr. Christopher Haufland (1762-1836): "If the physician presumes to take into consideration in
his work whether a life has value or not, the consequences are boundless, and the physician
becomes the most dangerous man in the State."
7.C. 2. Care of the handicapped
The handicapped person who has survived (or evaded) prenatal diagnosis and
"custodial management" in infancy is reasonably safe. Few would risk prosecution by
committing obviously illegal acts against the lives of the handicapped.
More insidious will be the quality of life arguments used against the newborn
handicapped. If their lives are declared worthless, it is but a short step to eugenic euthanasia,
portrayed as in the best interests of the handicapped person.
The severely handicapped and comatose patients are at more risk since the Tony Bland
case, that of the young man injured at Hillsborough who was in a coma for 3 years, fed by a
nasogastric tube. If there was absolutely no chance of his recovery and he was genuinely
incapable of feeling and thought (and who knows?), could he have been allowed to succumb to
the recurrent infections which threatened his life, instead of continually administering courses of
antibiotics? That would have been a natural death. However a court order was obtained for the
removal of the nasogatric tube. He then died by starvation and dehydration.
It now appears that besides ordinary and extraordinary means, we must specify a third
category of minimum human care, comprising food, shelter, water, warmth, a bed. To deprive
someone deliberately of food and water, when it can be easily and routinely delivered, is to
murder them. To deprive an aged person of warmth - leaving windows wide open on a cold
winter's day in the room of a pneumonia patient - is to attempted murder.
The fact that Tony Bland was kept alive artificially for so long and then a Court Order
was obtained to withdraw food and water, makes one wonder whether or not the case was
managed so as to furnish a legal precedent for similar treatment of 1,500 other "persistent
vegetative state' U.K. patients. Was it the beginning of "a licence to clear the long stay wards",
as one commentator suggested?
7.C. 3. Terminal care - the hospice alternative
Euthanasia cases occasionally hit the headlines. Dr. Cox gave an old lady crippled with
arthritic pain a lethal injection of potassium chloride in the heart. He was neither gaoled nor
struck off the B.M.A. register. One suspects that certain hospitals practise 'euthanasia by
instalments', where the dose of diamorphine delivered by syringe driver to a terminally ill patient
is automatically increased at regular intervals, not because the patient remains in pain or
distress, but to hasten their exit. While it is true that pharmacological tolerance gradually
increases, so that more of the drug is required to have the same analgesic effect, here it is the
intention which is paramount. Is it to soothe and relieve, or to kill because the hospital has a
beds shortage?
Fortunately the hospice movement has brought a far more positive approach to the care
of the terminally ill. Those who work in hospices are among the most vocal opponents of
euthanasia. The great value of hospice care is seen in this extract from a patient's letter to a TV
producer following a programme on euthanasia:
'My cancer was diagnosed in November 1979 and my health deteriorated rapidly
thereafter. By January of this year I was bedbound by pain and weakness, having been able
to drink only water for six weeks. My wife had been told by our family doctor that "I would die a
painful death within three months." I felt desperate, isolated and frightened and at that time I
truly wished that euthanasia could have been administered. I know now that only my death is
inevitable and since coming under the care of the Macmillan Service my pain has been relieved
completely, my ability to enjoy life restored and my fears of an agonising end allayed. As you
can see, I'm still alive today. My weight and strength have increased since treatment made it
possible to eat normally and I feel that I'm living a full life, worth living. My wife and I have come
to accept that I'm dying and we can now discuss it openly between ourselves and with the staff
of the Macmillan Service, which does much to ease our anxieties. My experiences have served
to convince me that euthanasia, even if voluntary, is fundamentally wrong and I'm now
staunchly against it on religious, moral, intellectual and spiritual grounds. My wife's views have
changed similarly. I'm no longer in such misery that her love for me would make her want me to
be dead. And after I've gone she will not have to fear the burden of guilt which would have been
upon her had she wished for my early death'. (Cohen in Macmillan Service 5th Report, London,
1980).
7.C. 4. Geriatric Medicine
There is not strong evidence in the published thinking of geriatricians for a negative view
of the lives of their patients. Age discrimination is present when pacemakers or heart-surgery
are refused to 70-year olds on the grounds of age alone. Other medical indications might
advise against it in many cases, but to automatically refuse treatment on the grounds of age
alone is unjust - a symptom of society's loss of respect for the elderly and their accumulated
wisdom. Some people are more physically and mentally capable at 85 than are others at 55.
There are euthanasiasts who advocate the withdrawal of the tube-feeding from elderly
patients. Once that is permitted, they hope people will see what a painful way it is to die, and
vote for the provision of a quick lethal injection instead. There is the gradual move from
euthanasia by omission to euthanasia by commission.
7.C. 5. Intensive Therapy Units
Provided the criteria for brain death are properly observed there would seem to be no
problem. The risk is more one of disthanasia. However the situation ethicist Fletcher, for cases
of organ donation, has written: " Speeding up a donor's death, when death is positively
inevitable, may be justified if the transplant provides another human with valuable life." It is a
tempting and hence a dangerous argument.
---------------------------------------------------------------------------------------------------------------------SELF-CHECK (7.4):
Consider and respond to the following case studies:
1. An infant is deIivered with a hydrocephalic condition and requires artificial
respiration at once. If he survives, he is very likely to be mentally defective and to be a grave
burden upon the parents. Is it obligatory to use artificial respiration to bring about normal
breathing or may the infant be left to die?
2. A patient is in terminal coma and is being kept alive by oxygen. As the dying process
has set in beyond all doubt, the doctor sees no point in prolonging a meaningless existence.
May he cut off the oxygen to allow the patient to 'die with dignity' or to make the limited oxygen
equipment available to another patient whose life may thereby be saved?
3. A certain stimulating drug may prolong the life of a dying patient for a few more
hours. The family request the doctor not to give it because "he's already suffered enough."
Should he accede to their request?
4. An elderly lady has been on dialysis for 10 years. Now she has had to come into
hospital and her health is gradually failing. She is tired and worn out. She wonders about asking
to discontinue the dialysis which would mean death within a week or two. She is at peace with
God and ready to die, but worries whether stopping dialysis would be like committing suicide?
How would you advise her?
5. A 90-year old lady in a psycho-geriatric ward is suffering senile dementia, diabetes,
circulatory problems, a recent stroke and urinary tract infection. She is bedridden but not
classed as terminally ilI. She is fed by an intravenous drip and a nasogastric tube, but she
keeps pulling out the feeding tubes because they annoy her. Must the nurses keep trying to
feed her?
6. When Barney Clark became the first human to receive an artificial heart, he was
given a key that he could use to turn off the compressor if he wanted to die. As Dr Wilhelm Kolff
noted, if the patient "suffers and feels it isn't worth it any more, he has a key that he can apply .
. . I think it is entirely legitimate that this man whose life has been extended should have the
right to cut it off if he doesn't want it, if life ceases to be enjoyable."
--------------------------------------------------------------------------------------------------------------------7. D. "Living wills" and advance directives
The term "living will" was coined by Kutner, a Chicago lawyer, in 1967, and the first draft
of such a document submitted to the U.S.Euthanasia Education Council in 1969. To date some
20 million Americans have signed such declarations.
We are familiar with the Last Will and Testament, whereby an individual directs how his
assests are to be disposed of after his death. The "living will" or advance directive is drawn up
specifying what kind of medical treatment the individual wants or does not want used upon him,
should he become incompetent and no longer able to decide rationally for himself. It is an
expression of the demand for autonomy and freedom so prevalent in western society. In
particular a living will may reject futile life-prolonging treatments, and - this is where it becomes
morally problematic - request euthanasia in certain circumstances.
There is a positive aspect to advance directives. It may be better that, if we become
incompetent, some indication of our wishes has been recorded. The advance directive affirms
three fundamental points of sound medical ethics: the doctrine of informed consent; the right to
refuse extraordinary or burdensome treatment; the legal right of all competent patients to
refuse treatment. Furthermore, the drawing up of an advance directive turns a person's mind to
pondering the end of earthly life and questions of ultimate value.
However, while an individual wishes to avoid disthanasia and extraordinary treatments, it
is hardly possible to specify in advance to suit all possible eventualities. Therefore a second
type of "living will" was devised. The individual designates a proxy, a representative, to whom
he delegates effective power of attorney, authorized to take medical decisions on his behalf
should he become incompetent. Obviously the proxy should understand and respect the
person's attitudes and beliefs, know which therapies he wishes or does not want, and is
trustworthy enough to carry out these previously expressed wishes. If the nation's legislature
recognises living wills as legally binding, the proxy has right of decision over next-of-kin and
over the attendant medical staff. Herein lies a possible area of conflict.
The living will is usually addressed to family, doctors or priests. There are several
models available:
The religious model e.g. the American Association of Catholic Hospitals, the U.S. and
Spanish bishops' conferences, various groups of Protestant hospitals. The Spanish text (1989),
for instance, speaks of life as a gift and blessing of God, without being the supreme and
absolute value. Death is accepted as an inevitable reality, the end of life upon earth and the
gateway to eternal life. The text then asks that the appropriate treatment be used to relieve
pain. It rejects disproportionate or extraordinary treatments. It rejects any type of active
euthanasia. It specifies that there shall be no prainful or unreasonable prolongation of the
process of dying, and requests help for dying in a Christian and humane way. There would
obviously be no ethical problem about signing such a document.
The professional model e.g.American Public Health Association. These documents are
often highly technical. they list many kinds of treatment which must be started or stopped, and
types of pain which must be avoided.
The euthanasiast model e.g. Exit, Society for the Right to Die with Dignity. These
request active euthanasia under certain circumstances. Some US state laws are ambiguous
and actually permit involuntary euthanasia. The Arkansas statue of 1977 allows either parent of
a child, or the guardian of a mentally incompetent person, to execute a document 'on his behalf'
denying him not only extraordinary, extreme or radical treatment but also 'all artificial medical or
surgical means calculated to prol ong his life.' This could include antibiotics or an operation for
appendicitis.
Negative aspects of living wills: any advance directive may be revoked whilst the pateint
is competent. Once he becomes incompetent, it is binding. One's views and attitudes in a
dramatically different situation may change. However, one's past assessments and directives
now prevail over one's present desires, and over any assessment of best interests made by
family, friends, doctors or nurses. The euthanasia enthusiast may lose a little of his ardour for
extinction once death is close.
Secondly, the "living wills" movement is philosophically underpinned by a unilateral
emphasis on self-determination and autonomy: "the patient's right to refuse unwanted medical
treatment." Sometimes what you don't want is actually very good for you, like cod-liver oil for
children! Every nurse has to coax some patients like unwilling children. Concern for autonomy
unrestrained by consideration of any other goods or norms i.e. doing exactly what you please is an carte blanche invitation to suicide, complicity in suicide and voluntary euthanasia of a most
homicidal kind.
Thirdly, language can be ambivalent. "Burdensome treatment" "unwarranted medical
treatment" and "unreasonable distress to the patient" are perfectly acceptable terms within
Catholic moral theology. But legislation is not a Catholic morals textbook. In a pluralist society
and its lawcourts, such terms can be interpreted in ways which open the cellar trapdoor to all
kinds of euthanasia. As so often, the devil is in the detail.
Fourthly, the notion has grown that the incompetent have "autonomy rights". An agent
or guardian can then be appointed by the court to defend these rights. He may propose that
since the patient, if competent, would surely refuse treatment and prefer to die, his presumed
wishes should be respected and treatment withdrawn. A form of substituted judgement takes
over from the previously accepted legal criterion of the patient's best interests.
Appendix:
"A Christian Advance Declaration for the Management of Serious Illness"
"I consider life in this world a gift and a blessing from God, but not the supreme and
absolute value. I know that death is inevitable and that it puts an end to earthly life, but I hope
and pray that it opens my way to fullness of life with God.
"The following paragraphs are intended to direct those who must make decisions for me
should I become unable to do so.
"I wish to receive medical treatment appropriate to my condition and which offers a
reasonable hope of benefit. In no circumstances would I wish basic care, including (if
appropriate to my condition) the assisted administration of food and fluids, to be withdrawn with
the aim of ending my life. I ask that when faced with the irreversible approach of death, I be
provided with ordinary nursing and medical care, including pain relief, appropriate to my
condition.
"Nothing should be done which will directly and intentionally cause my death, nor should
anything be omitted when such an omission would directly and intentionally cause my death. I
forbid euthanasia (an action or commission which of itself or by intent causes death), whether
by commission or omission.
"I ask that if I am in danger of death, I be told of this so that I may prepare myself for it.
If I am unable to make decisions for myself, I direct that my spiritual needs be taken care of,
and that, in particular, the attendance of a Roman Catholic priest /minister be immediately
requested, who should be informed of the gravity of my condition."
(Guild of Catholic Doctors, Advance Directives or Living Wills, London, 1998)
-----------------------------------------------------------------------------------------------------------------SELF-CHECK (7.5):
1. Why has the advance directive become an issue?
2. Do you think that "living wills" may open the way to widespread euthanasia?
3. Is the proxy decision maker strategy better than the written document of the advance
directive? Justify your reasoning.
-----------------------------------------------------------------------------------------------------------------FURTHER READING:
F.J.E.Basterra, Bioethics, pp.194-7
Ashley & O'Rourke, Health Care Ethics (4th ed. only) pp.428-30
T.A.Shannon, An Introduction to Bioethics, pp.88-100.
B.M.A., Medical Ethics Today, pp.161-6.
-------------------------------------------------------------------------------------------------------------------7.E. Experiences and effects of euthanasia in society
7.E.1. The Dutch and other experiences of euthanasia
In 1984 the Alkmaar case came to the Netherlands Supreme Court. A G.P. had been
convicted of voluntary euthanasia and assisting suicide by the Amsterdam Court of Appeal. He
had killed an elderly patient who had asked to die. His defence, that a "condition of necessity"
existed, "according to responsible medical opinion" measured by the "prevailing standards of
medical ethics", was accepted by the Court. He was therefore not criminally liable and was
acquitted.
In this and other decisions, the Dutch courts laid down a set of criteria in order to judge
whether the defence of 'necessity' applied to doctors administering euthanasia to seriously ill
patients. They can be summarized as follows:
1. The request for euthanasia must come only from the patient and must be entirely free
and voluntary.
2. The patient's request must be well-considered, durable and persistent.
3. The patient must be experiencing intolerable (not necessarily physical) suffering, with
no prospect of improvement.
4. Euthanasia must be a last resort. Other alternatives to alleviate the patient's situation
must have been considered and found wanting.
5. Euthanasia must be performed by a physician.
6. The physician must consult with an independent physician colleague who has
experience in this field.
The Royal Dutch Medical Association (KNMG) produced similar guidelines, three
months before the Alkmaar case. John Keown (see L Gormally, ed. Euthanasia, Clinical
Practice and the Law, 1994, pp.193-240) demonstrates that these guidelines are neither so
"strict" nor so "precise" as the KNMG claims. Doctors usually cannot be sure that a patient's
request for euthanasia is "free and voluntary" and not the result of subtle family pressures. The
request is supposed to be "well-considered, durable and persistent." Can a pain-wracked
patient give such a "well-considered" judgement? The van der Wal report (by a medical
examiner) found that the time from the first euthanasia request to its execution was one day in
13% of cases; one week in 35%; no more than a fortnight in a further 17%.
As to "intolerable suffering", van der Wal reported that only 42% of euthanased patients
had mentioned this as a reason, and for only 18% was it the most important reason. 29%
mentioned "senseless" suffering and 24% fear/anticipation of mental degeneration. A 1987
Health Council report found that 54% of Dutch cancer patients who were in pain suffered
unnecessarily because their doctors and nurses had insufficient understanding of pain control.
Under the sixth criterion, consultations are usually with an assistant.The guidelines do
not say that the colleague must agree with the euthanasia proposal. 25% of G.P.s admitted to
having no consultation, and less than half would consult a patient's district nurse about his
euthanasia request.
The Dutch government set up the Remmelink committee to check how the euthanasia
system was working. Its 1991 report states that in 1990 there were 2300 cases of voluntary
euthanasia; 400 cases of assisted suicide; 1000 cases of life termination without specific
request; 16,850 cases where it was the doctor's 'explicit' or 'partial' intention to shorten life,
either by administering pain-killing drugs (8100 cases) or by withholding or withdrawing
treatment (8750 cases). The Netherlands has 15 million population and 130,000 deaths p.a.
It is not possible to determine how many euthanasia deaths satisfy the legal criteria,
because it appears that the overwhelming majority of cases are falsely certified as death by
natural causes and are never reported and investigated. Remmelink conceded that doctors
intended to shorten life without request in some 15,000 cases. In van Wijmen's study (a
medical lawyer), 41% of doctors responding admitted to performing euthanasia without the
patient's request.
The principal argument advanced in the Netherlands for legalising voluntary euthanasia
was that it respects the individual's right to self-determination. Prof. Dessaur and Dr Rutenfrans
(Nijmegen, Criminology) estimate that genuinely voluntary euithanasia amounts to only 10% of
the real euthanasia total per year. Euthanasia requests come more frequently from the family
than the patient (Hilhorst). Non-voluntary and involuntary euthanasia are common and openly
defended in medical journals (van der Sluis). Nurses have been convicted of killing
handicapped children.
"By referring to medical ethics the Supreme Court left the problem of the criteria for the
acceptability of euthanasia on request in essence unresolved. Moreover, the reference is
useless because of the . . . disagreement within the medical profession upon ethics." (Leenen)
The KNMG now condones the killing, in certain circumstances, of babies, patients in persistent
coma or with severe dementia. "There is an almost total lack of control on the administration of
euthanasia." (H.J.J.Leenen is Emeritus Professor of Health Law at Amsterdam and a leading
proponent of euthanasia legalisation)
Remmelink used the narrow legal definition of what constitutes euthanasia: "the
deliberate termination of the life of a person on his request, by another person.". The Van der
Maas survey (1992) by the professor of Public Health at Erasmus University, took a broader
picture, and came to a total of 26,350 (20% of the total) deaths in 1990 in which doctors partly
or wholly intended, by act or omission, to shorten life. In 58% of these there had been no
explicit request for death to be hastened. 88% of Dutch doctors had performed euthanasia or
would be willing to do so.
In a remarkably short tim the Dutch have gone down the slippery slope from voluntary to
involuntary euthanasia. It seems that the patient's consent is no longer the sine qua non for
permissible euthanasia. The Remmelink report seeks openly to defend the 1000 killings without
request.
With some justification Holland is described as the "euthanasia paradise" of the modern
world. So many Dutch elderly are afraid of their lives being terminated that Sanctuary
Associations sprang up. Members sign a document which specificalIy excludes any form of
euthanasia: certain nursing homes and hospitals undertake never to perform euthanasia on
their patients.
Dr. Adrian Rogers writing in The Independent related how one Dutch doctor encouraged
his more reluctant patients to request euthanasia: "The only thing I have to do to get a request
for active euthanasia is to shoot them up with a cytostatic agent, ignore their pain, and above
all, devote little time to them." A cytostatic agent (drug which attacks growing cells, especially
cancer cells) makes them feel weak and ill. In pain, lonely and abandoned, they soon come to
think they might be better off dead.
The Dutch newspaper NRC Handelsblad has cIaimed that many people are being
subjected to euthanasia against their will. There are hearsay accounts of doctors telling a
senior nurse: "I don't want to see that patient here after the weekend," which is the coded
message for administration of euthanasia. These may be isolated unscrupulous cases, but the
very fact that there is no redress against them is extremely worrying.
Dr. Pieter Admiraal, a leading Dutch euthanasiast, describes how he prefers to see the
doctor-patient relationship in terms of friendship. "He is a very nice doctor and cries with the
patient." "It is good for the family to see the doctor cry at losing a friend, losing a human being."
He says to the patient being euthanazed: "I wish you a good journey into the unknown you have
never seen." Elsewhere he is on record as remarking: "I only kill my friends."
At the 1984 meeting of the "Right to Die!" societies, Helga Kuhse, a philosophy
professor from Monash University, Australia, said: "If we can get people to accept the removal
of all treatment and care - especially the removal of food and fluids - they will see what a painful
way this is to die, and then in the patient's best interests, they will accept the lethal injection."
Dr. Colin Brewer (Los Angeles National Voluntary Euthanasia Conference 1985) was
asked what could be done immediately to assist one to "leave the body." He replied: "I want to
offer you the humble plastic bag. People seem to feel it has aesthetic limitations, but, given a
small amount of sedatives, it's very effective." Even a doctor sympathetic to euthanasia would
not want the patient to be found to have died from a large dose of sedatives. "But even a small
dose of sedatives will be sufficient to let one use effectively a plastic bag with minimal distress."
(Reported in Human Life International, Spring 1985).
Could this type of thing happen in Britain? Referring to a book about Nazi euthanasia
programmes, Dr. Anthony Clare, psychologist, wrote "Anywhere that doctors remain
half-educated, ethically blinkered, scientifically over-developed and easily subverted away from
their primary responsibility to the patient...it could happen again..."
(Sunday Telegraph, 23.11.86).
Human beings rarely if ever accept evil as pure evil in itself, but they can be deceived to
accept evil once it has successfully disguised itself as something good. The evil of euthanasia
is therefore cloaked by such words as compassion, love, mercy, commitment to the
transformation of society. In this way it is made palatable to a majority who fail to analyse the
issue critically.
Only a minority of doctors still swear the Hippocratic Oath or the Geneva Declaration.
The public would do well to press their Universities and Medical Schools to re-introduce the
1968 U.N. Geneva Declaration into the graduation ceremonies for medical doctors.
Declaration of Geneva (1948, amended 1968)
At the time of being admitted as a member of the medical profession:
I will solemnly pledge myself to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude which is their due;
I will practise my profession with conscience and dignity;
The health of my patient will be my first consideration;
I will respect the secrets which are confided in me, even after the patient has died;
I will maintain by all the means in my power the honour and the noble traditions of the
medical profession;
My colleagues will be my brothers;
I will not permit considerations of religion, nationaIity, race, party politics or social
standing to intervene between my duty and my patient;
I will maintain the utmost respect for human life from the time of conception; even under
threat, I will not use my medical knowledge contrary to the laws of humanity.
I make these promises solemnly, freely and upon my honour.
Note the specific differences between the Hippocratic Oath (ch.1) and the Geneva
declaration: no specific rejection of euthanasia, no mention of the seduction of patients, and no
reference to a personal life of holiness and purity.
7.E. 2. Likely effects of legalised euthanasia upon medicine and society in Britain
General acceptance of euthanasia would be likely to produce the following effects:
(i) Any sense of the unique and irreplaceable value of the individual is further corroded.
(ii) The physician becomes increasingly a technician and a tool of public policy.
Cash-saving closure of geriatric wards to save funds requires 'active co-operation' by doctors.
The medical profession's independence is further threatened.
(iii) Society ceases to deal constructively with certain health problems. Progress grinds
to a halt in geriatric medicine and care of the severely disabled, because euthanasia is the
economically favoured alternative. Increasingly treatment is refused to certain classes of
patient - the elderly, incurably sick, handicapped, AIDS sufferers, and others whose care is
expensive.
(iv) Some elderly patients lose trust and confidence in their doctors, leading to
greater isolation of the sick and aged. They view their doctors as potential assassins rather
than carers. As a BMA spokesman recently remarked, if the government wanted voluntary
euthanasia, it must do it properly and appoint qualified executioners. It should not involve the
medical profession in the job of kiIling, because that is never their role.
(v) Elderly and senile patients worry increasingly. They do not want to be a burden to
others. Anxiously they wonder if they should be euthanazed. Distress is multiplied where
unscrupulous family members pressurise them for financial reasons: to save nursing home
fees, or to enjoy the estate immediately.
The issues of euthanasia and abortion take us beyond the limits of pluralism in a
civilised society. We reach the point where choice is undermining and threatening the most
basic of all human rights - the right to life, the right not to be murdered. There can be no place
for euthanasia in the medical profession, and there should be no place in the medical
profession for those who advocate euthanasia.
---------------------------------------------------------------------------------------------------------------------SELF-CHECK (7.6):
1. See what you can find out about hospices for the dying in your local area. Learn
about their ethos. Has this helped to neutralize euthanasia campaigns? What
misunderstandings lead people to want euthanasia legalised?
2. Research the growth and practice of euthanazia in the Third Reich. Are there any
parallels with the Dutch experience?
----------------------------------------------------------------------------------------------------------------------FURTHER READING:
F.J. Fitzpatrick, Ethics in Nursing Practice, pp. l85-224, Linacre Centre, London. 1988.
An excellent and specialised text is Euthanasia, Clinical Practice and the Law, ed. L.
Gormally, Linacre Centre, London (1994) with an accompanying Study Guide by T. Iglesias.
M. Burleigh, Euthanasia and the Third Reich, in History Today, Feb. 1990, pp.11-16.