Chapter 8

Special Topics in Moral Theology: Bioethics

Introduction
This chapter

Learning Objectives
22. Understand the Catholic Church’s teaching on bioethical issues
23. Analyze and evaluate the Catholic Church’s teaching on bioethical issues
24. Reflect on and apply the teachings on bioethical issues to the students’ own life.

Exposition
Moral theology is also concerned with bioethics. Issues that concern the start and end of
life in particular have become more and more complicated due to the development of
technologies that can both aid and abet life. The science itself can also be unclear about what the
effects of all these technologies will be in the future.

The consistent ethic of life in Catholic moral theology emphasizes life as an important
criterion in decision making. Life, from the womb up until death, is equally precious, and no
one’s person’s life is “more important” than another person’s. There is also a sense

Start of Life Issues

Abortion and Contraception

Catholic moral theology’s pro-life stance has made it staunchly against abortion and
contraception, as abortion kills the baby in the womb, while contraception inhibits couples from
having children. Both of these go against the teaching that argues that marriage should not only
be unitive, but also procreative. However, there are exceptions. These exceptions are in moral
dilemmas, and if they are unintended effects of actions that seek to preserve life. For example,
we have seen in the previous chapters the case of a pregnant woman who may need an operation
that may indirectly kill the baby in her womb. A similar exception is made for contraception, if it
is used for therapeutic means.

Contemporary science cannot, for certain, pinpoint the exact moment when human
personhood and life begins. It is instead seen as a series of landmark moments, from the moment
of fertilization, and as the embryo continues to develop in the womb and is born. Personhood is
not a “switch” that is turned on, but is something that we become. Even in Catholic moral
theology, the exact moment when life begins or when human beings have souls has not been
explicitly defined; however, the tradition errs on the side of caution, acknowledging that
potential life is already there at conception. Therefore, Catholic moral theology has often held
the position of non-interference. If families wished to plan when they would have children,
Church teaching encourages families to use natural family planning methods, which are all in
tune with the body’s rhythms for child bearing. These methods include the body temperature
method, cervical mucus methods, and calendar methods; all these seek to familiarize the couple
as to when the woman is fertile and ovulating and thus help them plan their sexual life
accordingly.

This stance and teaching have been heavily criticized and questioned, especially by
women and families who find the natural family planning methods difficult due to their irregular
cycles, or if one of the spouses has a disease that may be transmitted through sex, such as HIV or
AIDS. Such cases, under the current teaching on contraception, would still not be considered as
exceptions wherein contraception can be used, though some theologians have argued that the
case of a spouse having a disease and using a condom may not be considered immoral.
Abstinence and natural family planning are things that many families and couples fall short on,
and thus there is a need for two things: there is a need to support families or couples who try to
continue abstaining or using natural family planning methods and there is a need to accompany
those who fall short and understand why this happens, especially since this may challenge
current Church teaching on what cases may count as exceptions in today’s contemporary
situation.

<Box: A Case Study on Abortion>

<Kate is a 17 years old patient, unmarried and 8 weeks pregnant. She is a rather remarkable girl
in that she lives independently while still a senior in a high school. She tells you that she was an
adoptee given back to foster care, and then abused in that system. She is now an emancipated
minor who works 30 hours per week at a service industry job while also earning a 4.0 GPA in
school, ranking in the top 10% of her class. She is college-bound, with a full scholarship for pre-
med undergraduate studies at a prestigious university.

Kate has absolutely no family support, and the former boyfriend who is the father of her unborn
child/fetus simply disappeared upon learning of the pregnancy. She is scared, uninsured, and
says she doesn’t want to be pregnant or a mom (“Perhaps someday, but not now!”). She rejects
the adoption option, based on her own experience growing up, and requests abortion only, at this
hospital where she has always received medical care.>115

In Vitro Fertilization and other Procedures on the Embryo

Church teaching on biomedical ethics focuses on respecting life in general and letting it
unfold, rather than always seeking to control the process. Children are also seen as gifts and their
own person, rather than as something that the parents “own” or “have a right to.” Thus, most

115
Tarris Rosell, “Case Studies - Abortion Rights and/or Wrongs,” Center for Practical Bioethics, accessed August
6, 2018, https://www.practicalbioethics.org/case-studies-abortion-rights-and-or-wrongs.html.
procedures in utero on the fetus are allowed, provided that they are there to heal the child with
minimal risk. The same argument is used to allow prenatal screening.

However, when it comes to using embryos for research purposes, Church teaching is
more cautious:

Human embryos obtained in vitro are human beings and subjects with rights: their
dignity and right to life must be respected from the first moment of their existence. It
is immoral to produce human embryos destined to be exploited as disposable
"biological material". In the usual practice of in vitro fertilization, not all of the
embryos are transferred to the woman's body; some are destroyed. Just as the Church
condemns induced abortion, so she also forbids acts against the life of these human
beings. It is a duty to condemn the particular gravity of the voluntary destruction of
human embryos obtained 'in vitro' for the sole purpose of research, either by means
of artificial insemination of by means of "twin fission". By acting in this way the
researcher usurps the place of God; and, even though he may be unaware of this, he
sets himself up as the master of the destiny of others inasmuch as he arbitrarily
chooses whom he will allow to live and whom he will send to death and kills
defenseless human beings.116

The same caution is mentioned when it comes to in vitro fertilization:

Techniques of fertilization in vitro can open the way to other forms of biological and
genetic manipulation of human embryos, such as attempts or plans for fertilization
between human and animal gametes and the gestation of human embryos in the
uterus of animals, or the hypothesis or project of constructing artificial uteruses for
the human embryo. These procedures are contrary to the human dignity proper to the
embryo, and at the same time they are contrary to the right of every person to be
conceived and to be born within marriage and from marriage.117

Interventions that seek to control how we have children as well as treat embryos as objects are
thus problematic in Catholic moral theology. If a couple wishes to have children but are having
trouble, Catholic moral teaching would encourage adoption rather than in vitro fertilization.

End of Life Issues

Death is something all human beings will one day face. How we die can be full of
complex ethical issues, especially when the dead person cannot speak for himself or herself. The
most fraught ethical issues are those of euthanasia and organ harvesting, which we will now
discuss.

116
Congregation for the Doctrine of the Faith, “Instruction on Respect for Human Life in Its Origin: Donum Vitae,”
Vatican.va, February 22, 1987,
http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-
human-life_en.html. Hereafter referred to as DoV. DoV 5.
117
DoV 6.
Euthanasia

Euthanasia, or “mercy killing,” is the practice of ending a person’s life in order to end
that person’s physical or even psychological suffering. This can be done through a direct act such
as overdosing, or indirectly through omission—by either withholding or withdrawing treatment
that would keep the person alive (e.g. unplugging life support and allowing the person to die
naturally). Euthanasia can be done voluntarily, wherein the person is conscious and does make
the request to undergo euthanasia; on the other hand, non-voluntary euthanasia is the case
wherein the person is unconscious, a child, mentally ill, or is otherwise unable to make a fully
informed decision.

In the Philippines, it is currently illegal to perform euthanasia, either directly or

indirectly. In some countries such as the Netherlands, however, euthanasia may be allowed for
those who are terminally ill or with psychiatric reasons. “As well as for reasons of a misguided
pity at the sight of the patient's suffering, euthanasia is sometimes justified by the utilitarian
motive of avoiding costs which bring no return and which weigh heavily on society. Thus, it is
proposed to eliminate malformed babies, the severely handicapped, the disabled, the elderly,
especially when they are not self-sufficient, and the terminally ill.”118

Catholic moral teaching raises the concern that freely allowing euthanasia would further
reduce people to whether they are useful or functioning people, rather than treating them as
intrinsically valuable. Catholic moral teaching challenges an ableist understanding of life that
only sees life as valuable or worth living if the person is at the peak of their health or can
function according to society’s standards. Lastly, Catholic moral teaching also argues that no
human being can dictate when a person lives or dies—this is part of the life process that God has
given each of us. Death is not something to be feared; it is part of our being finite creatures, and

Catholic moral theology does not allow for euthanasia. However, it also acknowledges
that, in preserving life, we should not use “extraordinary” means that will artificially prolong
life. What is counted as “extraordinary” means would vary from situation to situation, but in
general these would be means that would place an undue material, emotional, or psychological
burden on the family or community. A poorer family may have less “ordinary” means available
to them compared to a richer family, for example. The point is that we should preserve life when
possible, but also know when to let go if it is time for the person to die.

<Box: The Case of Charlie Gard>

<Charlie was born on 4 August 2016 with an exceptionally rare genetic condition called
encephalomyopathic mitochondrial DNA depletion syndrome (MDDS). Although he appeared
perfectly healthy when he was born, his health soon began to deteriorate. Great Ormond Street
Hospital (GOSH) said the moment Charlie was diagnosed, his prognosis was bleak.

118
John Paul II, “On the Value and Inviolability of Human Life: Evangelium Vitae,” Vatican.va, March 25, 1995,
https://w2.vatican.va/content/john-paul-ii/en/encyclicals/documents/hf_jp-ii_enc_25031995_evangelium-vitae.html.
Hereafter referred to as EV. EV 15.
Charlie now has severe brain damage and cannot open his eyes or move his arms or legs. His
condition also means he is unable to breathe unaided, which is why he needs to be on a
ventilator. His heart, liver and kidneys are also affected, and his doctors say it is not clear if he
feels pain.

Charlie's parents, Connie Yates and Chris Gard, from Bedfont in west London, wanted Charlie to
have an experimental treatment called nucleoside bypass therapy (NBT). The treatment is not
invasive and can be added to food. A hospital in the US agreed to offer Charlie the treatment,
and Charlie's parents had raised £1.3M in funds to take him there. No animal or human with
Charlie's condition (RRM2B deficiency) has been treated with NBT, but the treatment has been
previously offered to patients with a similar genetic disorder, TK2 deficiency. But TK2 affects
just the muscles, whereas Charlie's condition also affects other organs and his brain. GOSH did
apply for ethical permission to attempt nucleoside therapy on Charlie.
However, by the time that decision was made Charlie's condition had greatly worsened and the
view was his brain damage was too severe and irreversible for the treatment to help. After
contacting other experts in the condition from medical centres across the world, doctors came to
the conclusion that Charlie's life support should be switched off and he should be allowed to die
with dignity.
Charlie's parents disagreed with the hospital and did not want his life support to be withdrawn, so
doctors applied to the High Court for judges to decide Charlie's future. In April, the High Court
agreed with the GOSH doctors. Charlie's parents then appealed against the decision, but courts
ruled the original decision should stand and it would be in Charlie's best interests to be allowed
to die with dignity. The Supreme Court and the European Court both came to the same
conclusion.
[…]
Charlie's life support will be withdrawn at a hospice but lawyers acting for Charlie's parents were
in dispute with doctors over the detail of care plans. Chris Gard and Connie Yates had applied to
the High Court to keep Charlie alive for "a week or so" - longer than originally planned. But a
judge ruled that Charlie would be moved to a hospice to spend his final few hours before the
ventilator that keeps him alive is switched off. >119

Organ Donations and Harvesting

If we look at the back of our driver’s license, we see that there is an option to state that, in
the unfortunate event of our death, we opt to donate particular organs for those who may need
them. This is a noble and generous act, one which even Catholic moral teaching appreciates, and
which also seems straightforward: once a person dies, his or her organs can be taken and donated
to someone else who needs them.

119
“The Story of Charlie Gard,” BBC News, July 27, 2017, sec. London, https://www.bbc.co.uk/news/health-
40554462.
 What does it mean to die? How do we define death? Is it when the heart has stopped? Or
when the brain has stopped? While it might seem obvious when a person has died or not, in
reality it is not that simple. Take the case of Ruby Graupera-Cassimiro, who had no heartbeat
and pulse for 45 minutes before spontaneously reviving.

Medically speaking, death happens when there is no heartbeat, also known as flatlining.
Once this happens, if the deceased has opted to be an organ donor, there is only so much time
within which medical professionals can get the organs, before the said organs become unfit for
use. Thus, organs are harvested as soon as possible in order to ensure that they can still be
donated. However, cases such as those of Graupera-Cassimiro above can make it difficult to
immediately harvest organs.

Other dilemmas would be of those who are terminally ill or in persistent vegetative states
with little to no chance of improvement. If they are in such a state but also want to be organ
donors, how “soon” can their organs be harvested, especially if these organs are very much
needed? The question of allocation is also raised: once the organs are taken from the deceased,
how do we decide who to give it to, given that there is usually a long list of people needing these
organs. Do we give the organs on a first come, first serve basis? For example, if there is a healthy
heart that has been donated, do we give it to someone who may be older, who has already had
several cardiac problems but is first on the list, or do we give it to someone younger, though she
is second, third, or fourth on the list?

These questions are not definitively answered in Catholic moral teaching, yet there has
been much back and forth on the subject. Such cases make it difficult to make decisions as to
when and how one can get the organs.

<Box: Should we harvest organs from patients who aren’t dead yet?
< A previously healthy middle-aged man has suffered a massive stroke from a ruptured artery in
his brain and fallen into a persistent, then permanent, coma. Now imagine that before the stroke
our hypothetical patient had expressed a wish to donate his organs after his death. If neurologists
could determine that the patient had no chance of recovery, then would that patient really be
harmed if transplant surgeons removed life-support, such as ventilators and feeding tubes, and
took his organs, instead of waiting for death by natural means? Certainly, the organ recipient
would gain: waiting too long before declaring a patient dead could allow the disease process to
impair organ function by decreasing blood flow to them, making those organs unsuitable for
transplant.

But I contend that the donor would gain too: by harvesting his organs when he can contribute
most, we would have honoured his wish to save other lives. And chances are high that we would
be taking nothing from him of value. This permanently comatose patient will never see, hear,
feel or even perceive the world again whether we leave his organs to whither inside him or not.

Yet harvesting a patient’s organs while he is alive raises all kinds of ethical questions and
triggers multiple alarms. The issue is especially complex because biomedicine, and the very
definition of death and even consciousness, are all in flux. Take our hypothetical patient, and the
nature of the coma itself. A small number of patients emerge from comas after long periods of
time, regaining full consciousness with many or most of their physical and mental functions
intact. Far more never recover any degree of consciousness and eventually die. And there are
many states of consciousness and wellbeing between these two extremes. Patients can recover
consciousness but find they are locked into paralysed bodies, unable to communicate. They
might progress to a vegetative state with sleeping and waking cycles and periods of arousal but
no awareness of themselves – or they might enter what doctors call a minimally conscious state,
in which they have some degree of awareness but significant, often devastating, cognitive and
physical impairment. No matter where on the spectrum a patient falls, it might be impossible to
predict the likelihood of death. The Israeli prime minister Ariel Sharon suffered a haemorrhagic
stroke in 2006. Although he had no chance of recovering consciousness, there was no specific
point at which a neurologist could say that his death was imminent. He lived in a prolonged
coma until his death in 2014.

The question is this: should we be able to harvest organs from patients who are not yet dead but
are imminently dying?>120

Other Creatures

With the recent focus on the environment and on climate change, vegetarian and vegan
lifestyles have become more popular, sparking a debate as to whether Christian moral teaching
should support such lifestyles. On the one hand, a Christian case for vegetarian and vegan
lifestyles has been made: some theologians have argued that Christianity would support a
lifestyle that seeks to avoid eating animal products that have not been allowed to flourish. This
argument focuses on the high environmental footprint that raising animals for consumptions has,
as well as concern for the flourishing of all creation—including animals—as part of the Christian
concern.121

This article makes a fair point—as Christians, we should not be consuming food that was
made by an industry that does not treat animals with dignity, such as poultry farms where
chickens are simply cramped in cages, being fattened for slaughter without seeing the light of
day. We are called to consume properly, respecting the life that was taken to feed and nourish us,
be it a plant or an animal. Thus, it is not simply about not eating animals, as this would then
simply be reinforcing a hierarchy of human beings on top and animals, then plants at the bottom.
Rather, it is about being responsible and ethical consumers that respect the environment and the
creatures we use to live.

What complicates this point, however, is that most often the “free range” organic animals
that do respect the life of the animal, for example, are more expensive, which not everyone can
afford. Thus, while many want to support better conditions for the plants and animals they eat, a
good number cannot, because these are not affordable options, at least not yet. Thus, it is easy to

120
Walter Glannon, “Should We Harvest Organs from Patients Who Are Not Dead yet? – Walter Glannon | Aeon
Essays,” Aeon, July 27, 2015, https://aeon.co/essays/should-we-harvest-organs-from-patients-who-are-not-dead-yet.
121
For more on this please see David L. Clough, “Consuming Animal Creatures: The Christian Ethics of Eating
Animals,” Studies in Christian Ethics 30, no. 1 (2017): 30–44.
say that we should consume mores responsibly, but there can be certain barriers to doing so for
many people who do not earn much money to support such a lifestyle.

Another issue has been on testing products on animals and plants, either for consumer
products or for medical research. While there have been some breakthroughs in medicine and
research using animal testing, this has involved much pain on the part of other creatures. Is their
suffering “less important” compared to the breakthroughs in research that we may get? Studies
have shown that animals, and even plants, have some form of sentience and are able to feel pain
and thus suffer. There have been both advantages and disadvantages to animal research and
testing—are the advantages truly worth it? Are human beings “more important” than animals in
such cases? Or are we being “specist” and uncaring to the rest of creation?

Again there has been much back and forth on this issue, with not definitive answer yet.
There have been those who agree that the lives of the animals and plants are worth sacrifice for
the good of human beings, while there are those who would disagree, saying that we cannot say
that human beings are more important than these plants and animals simply because we are made
in God’s image and likeness. After all, animals and plants also have intrinsic value and reflect
some of God’s image by being God’s creatures, and thus being stewards of creation does not
automatically translate to privileging human beings over the rest of creation all the time.
Sample photos on the advantages and disadvantages of animal testing

Conclusion

Bioethical issues are never easy issues to resolve. They are complex, and with the various
technologies now available to help improve life, we walk a fine line between helping keep
people alive and well, and not overly prolonging life to the point of fearing death.

This chapter outlines some guidelines and thoughts that Catholic moral theology has used
to make sense of these specific bioethical issues as a way of shaping one’s conscience. As
mentioned earlier in this text, ultimately, it is the person making a decision. However, if a person
cannot make a decision (in the case of babies, children, or the comatose), thorny complex
questions on who can speak and make decisions on their behalf, as well what criteria do we use
to choose who can speak on their behalf, can make the situation even more complex.

Other creatures are also a concern in bioethics. Christianity has often been accused of
being specist and extremely anthropocentric, due to the emphasis Christianity has given to
human beings, to the detriment of the rest of creation. Thus, Christianity has been accused of
contributing to the environmental crisis. In response, recent papal moral teaching corrected this
anthropocentric bent by emphasizing the important and value of other plants and animals as well
as the fact that we as human beings are also fellow creatures, despite having some characteristics
that other plants and animals may not have that give the power to have greater impact on this
world. This teaching now also affects how we respond to bioethical issues such as veganism and
animal testing.

Ultimately, Catholic teaching on bioethical issues is rooted in the belief that all life is
sacred, and that this sacredness translates into a dignity that should not be easily tampered with.
There is a respect for the processes of life and death that are part of what it means to be a human
being. It is this respect and sacredness that underpin many of the concerns raised by Catholic
moral teaching on the various biotechnologies being developed.
Guide Questions

1. What is the teaching on abortion and contraception? What are the issues surrounding
these teachings?
2. Why is euthanasia a complex issue?
3. Pick one of the case studies and discuss this with a partner. What course of action or
whose side would you agree with and why, based on Catholic moral teaching?
Bibliography

Clough, David L. “Consuming Animal Creatures: The Christian Ethics of Eating Animals.”
Studies in Christian Ethics 30, no. 1 (2017): 30–44.
Congregation for the Doctrine of the Faith. “Instruction on Respect for Human Life in Its Origin:
Donum Vitae.” Vatican.va, February 22, 1987.
http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_1
9870222_respect-for-human-life_en.html.
Glannon, Walter. “Should We Harvest Organs from Patients Who Are Not Dead yet? – Walter
Glannon | Aeon Essays.” Aeon, July 27, 2015. https://aeon.co/essays/should-we-harvest-
organs-from-patients-who-are-not-dead-yet.
John Paul II. “On the Value and Inviolability of Human Life: Evangelium Vitae.” Vatican.va,
March 25, 1995. https://w2.vatican.va/content/john-paul-
ii/en/encyclicals/documents/hf_jp-ii_enc_25031995_evangelium-vitae.html.
Rosell, Tarris. “Case Studies - Abortion Rights and/or Wrongs.” Center for Practical Bioethics.
Accessed August 6, 2018. https://www.practicalbioethics.org/case-studies-abortion-
rights-and-or-wrongs.html.
“The Story of Charlie Gard.” BBC News, July 27, 2017, sec. London.
https://www.bbc.co.uk/news/health-40554462.