Abstract
This essay argues that the physician is not culpable of a morally direct killing when acting to save the mother in a case of vital conflict. It defines these cases as those in which (i) the life of both the mother and unborn child are immediately at risk, (ii) there is no way to save the unborn child, whose continued presence immediately threatens the life of the mother, (iii) the mother can be saved (iv) but only through procedures that result—in a physically-direct way—in the immediate or accelerated death of the child. This essay proceeds according to what the encyclical Veritatis splendor calls “the perspective of the acting person” that characterizes virtue ethics, focusing on the virtue of justice. Although the previous late-nineteenth and early twentieth century debate on cases of vital conflict centered on the procedure of craniotomy, this essay will focus on the morality of some widespread contemporary treatments for tubal pregnancy such as salpingectomy, and salpingotomy or salpingostomy . It concludes that saving the mother through such treatments is not a violation of justice or a morally direct killing, a conclusion that would also apply to other cases meeting the above definition.
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Notes
- 1.
For a discussion of how this distinction was reflected in the understanding of a moralist like Hieronymus Noldin, S.J. (1838–1922), whose career covered the initial generations of debate on these questions, see Rhonheimer (2009, p. 18, n. 31). For a recent and valuable overview of the historical development of these questions, see Jones (2014).
- 2.
Against the widely-perceived legalism of the moral manuals (a deficiency which—in spite of the merits of the manuals—can be traced to their lack of appreciation for the perspective of the acting person , for their physicalism, and for their neglect of virtue ) the conciliar Decree on Priestly Training (Optatam totius) (Vatican II, 1965, n. 16) called for a renewal of moral theology: “Likewise let the other theological disciplines be renewed through a more living contact with the mystery of Christ and the history of salvation. Special care must be given to the perfecting of moral theology. Its scientific exposition, nourished more on the teaching of the Bible, should shed light on the loftiness of the calling of the faithful in Christ and the obligation that is theirs of bearing fruit in charity for the life of the world.” As the works of Servais Pinckaers (1996) and others have shown, the contemporary renewal of Thomistic virtue ethics is especially conducive to a fruitful appropriation of Aquinas’s moral theology at the service of New Testament revelation along the lines encouraged by the Council. We would argue that the directions encouraged by VS are more conducive to such a program than approaches that emphasize the analysis of physically caused effects.
- 3.
After a decline of physicalism from the conciliar era, recent efforts to resurrect a crude form of it appeared, primarily among especially moral philosophers (e.g., Long 2007), motivated especially by cases like that of vital conflicts . Subsequently, more serious efforts to ground moral objectivity in the physical order and caused effects were published (Jensen 2010). These tended to read Aquinas’s approach to human action in light of the analogy to physical action (as in the example of fire “acting” to heat a pan of water) as treated in Aquinas’s Commentary on Aristotle’s Physics (1999). Because Aquinas’s synthesis can be read from different perspectives, we would agree with much of what these scholars say about Aquinas’s writings, but this is not the place to go into detail about specific agreements and differences. Regarding particular cases, the two perspectives would suggest agreement on most, except perhaps cases of vital conflict , the use of condoms for the prevention of HIV, and making false enunciations in certain situations—e.g., when Nazi’s are at the door asking whether Jews are being hidden. Christopher Kaczor (2012, pp. 323f) wonders—in regard to “adjudicating between the views of Rhonheimer, Brock, Long, Flannery, and Finnis on the specification of the object of the human act ”—“if the texts of Aquinas are open, legitimately open, to a variety of plausible interpretations, which—though incompatible with each other—are reasonably credible readings of the Angelic doctor.” Rather than focusing action theory on the analogy to “physical action” and its caused effects, however, we remain convinced of the wisdom of the call of VS to consider distinctively human action from the perspective of the acting person and one’s acts as deliberately ordered to ends which are perceived as goods; this we would combine with a recognition of the place of the ends of the virtues in revealing a moral rationality that is grounded in natural inclinations and ultimately measured by the Eternal Law.
- 4.
- 5.
Katholischer Erwachsenenkatechismus (literally, the Catholic Adult Catechism), vol. 2: Leben aus dem Glauben (Freiburg: Herder 1995), p. 292. This second volume is not available in English.
- 6.
For a precise discussion of the text and surrounding controversy, with English translations of the relevant texts, see Rhonheimer (2009, esp. pp. 14–17).
- 7.
The relevant citation follows: “As my credibility on this point has been publicly called into question, I asked the Holy See for an official confirmation of my claim. I received this confirmation in a letter dated March 1, 2012, and signed by William Cardinal Levada, Prefect of the Congregation for the Doctrine of the Faith . I was also given permission by the Congregation to publicly refer to this letter in my further writings and to send copies of it to interested persons. (The NCBC is in possession of such a copy.) In this letter Cardinal Levada confirms the existence of two preceding letters from the CDF, dated November 16 and December 9, 2000, by which I was asked to publish Vital Conflicts in Medical Ethics. In the 2012 letter, the Cardinal writes that the Congregation welcomes the debate on the topic carried out in The National Catholic Bioethics Quarterly, emphasizing the freedom of those on each side to express their views. Moreover, he thanks me for my efforts in defending my position and encourages me to continue participating in this debate.”
- 8.
- 9.
Latin citations from the works of Thomas Aquinas are taken from the online Corpus Thomisticum http://www.corpusthomisticum.org/. English translations from the Summa theologiae (hereafter ST) will generally be taken from the 1920 second and revised edition of the English Dominican text available on http://www.newadvent.org/summa/index.html.
- 10.
For a contemporary effort to vindicate Thomistic virtue ethics in light of its subsequent philosophical rivals, including proportionalism, see Rhonheimer (2011a).
- 11.
- 12.
For an articulation and defense of Aquinas’s understanding of practical reason against some revisionist distortions, see “Practical Reason and the ‘Naturally Rational’: On the Doctrine of the Natural Law as a Principle of Praxis in Thomas Aquinas” in Rhonheimer (2008).
- 13.
ST I-IIae, q. 61, a. 5. For this doctrine of exemplar virtues , Aquinas draws especially upon Plato, Macrobius, Plotinus, and Augustine . We are indebted here to Sarah Byers for her unpublished manuscript on “Divine Ideas and Eternal Law in Augustine and Aquinas,” which notes how Aquinas’s mensura, regula, lex aeterna, and ratio correspond to the Greek metron/nomos, whereas Thomas’s exemplum or ratio corresponds to the Greek paradeigma.
- 14.
John Paul II (1995, n. 57) states solemnly with reference to his Petrine authority: “I confirm that the direct and voluntary killing of an innocent human being is always gravely immoral.” He immediately adds a helpful specification: “[t]he 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,” and continues that “it contradicts the fundamental virtues of justice and charity.”
- 15.
- 16.
This text of Aquinas is directly opposed to the thesis of a recent physicalist reading of Aquinas, which asserts that “the correct understanding of the object and species of the moral act … depends wholly on natural teleology,” where natural teleology is basically the natural end in the sense of what the natural act tends to cause (Long 2007, p. 137).
- 17.
See Rhonheimer (2009, pp. 131–8) for responses to possible objections to this.
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Murphy, W.F., Rhonheimer, M. (2017). Saving the Savable Mother: Why the Physician Is Not Culpable of (Morally) Directly Killing. In: Eberl, J. (eds) Contemporary Controversies in Catholic Bioethics. Philosophy and Medicine(), vol 127. Springer, Cham. https://doi.org/10.1007/978-3-319-55766-3_8
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