Review and Reflections on "Bioethics Matters"

For Roman Catholics and all thoughtful persons who respect the dignity of life, the study and implementation of bioethics is both clear and complicated, as stand-alone biology is a science with its own history, principles, and ethical debates. If you have the time, scan the “Bioethics” entry in the Encyclopedia Britannica to see the complexity of the field even before one enters the religious questions raised by science. Our book at hand, “Bioethics Matters” is a beginner’s introduction to the Church’s reasoning and teachings on the morality of medical issues impacting the human being. Author Moira McQueen emphases focus upon abortion, contraception, marital intimacy, and end-of-life issues, including physician assisted suicide. It is worth noting that the author writes from Canada [St. Michael College/University of Toronto], where bioethics issues presently occupy much attention in the nation’s parliament. I call Chapter Four Dr. McQueen’s “hold my beer” section, for the author has plenty to say surrounding “Euthanasia and Physician-assisted Suicide” as it plays out in Canadian politics. [p. 97-124.]
 
The author states that “lay people deserve to be as educated as possible in Catholic teaching.” [p. 9] Right off the bat, I have difficulties with the passive stance assigned to lay Catholics in matters of morality. Church moral teaching in the present day is de facto authority-driven, from directives of the sitting pope and/or solemn instructions from the appropriate office of the Vatican Curia. The author’s introduction goes on to explain Church moral law as a product of divine and natural sources. Ideally, Catholic moralists today draw from Scripture, natural law, the scholastic medieval tradition, and the papal teaching office of the Church called the Magisterium. However, there is no mechanism to hear the life experiences and consciences of baptized Catholics on precisely how moral teachings are formulated, taught, received, and enforced both within the Church community and in public society.
 
Such dialogue might have prevented an embarrassing moment for the Church in 2022. The story of the 2022 Kansas Referendum is a good example of why laity needs to be heard in public moral formulations of Church life. The Kansas Referendum would have removed the civil legal right to an abortion from the state constitution; the ballot resulted in a 59-41% landslide vote to maintain the legality of abortion. Later analysis found that Catholic voters on the whole opposed abortion—but what Catholics opposed in the referendum was potential criminalization of minors, mothers of large families who would have died had they carried the pregnancy to term, the poor, victims of rape, etc. More nuanced discussion before the ballot might have had greater moral impact on the civil legislation. There are many instances in life where a human being is not willingly choosing evil over good, but rather, facing the lesser of two evils.
 
Chapter One defines the various schools of ethical thought across society, i.e., how humans make decisions about conduct. “Natural Law” ethical thinking is highlighted as “the time-tested ethical approach used by the Catholic Church.” [p. 19] The term “Natural Law” populates many Catholic texts, schoolbooks, catechisms, and Church documents as the innate wisdom of God made evident in creation; in the 1200’s A.D. St. Thomas Aquinas taught that it was possible to reason from nature even the very existence of God, with help from the ancient Greek philosopher Aristotle, proof that the natural law or wisdom of the Christian God was bestowed across the human species. The problem here is that our understanding of what is natural in the human species continues to evolve.
 
The Bible, as a moral source, is a complicated matter. McQueen goes on to explain the methods used by the Church to deduce the moral teachings of the Bible. We Catholics did not and do not approach the Bible with a simple literalism. If we did, we could justify the stoning of a homosexual couple, as Leviticus 20:13 commands, or similar punishment for a rebellious teenager, as Leviticus also commands in 20:9. The author goes on to explain how the modern science of Biblical study and meaning was brought forward in the debates of the Council Vatican II [1962-1965]. Natural law as a tight, specific moral code periodically reinforced by the pope faced a challenge as more Church scholars raised questions about how one determines right and wrong in an examination of conscience based upon his or her circumstances of life. The Conciliar reforms across the board are replete with a rediscovered Christo-centric refocusing of all aspects of Church life. What the Council could not do in its limited time was reorient the clergy and the laity toward specific Jesus-centered moral attitudes and actions. To be truthful, few of us were ready to integrate a Biblically inspired natural law into our personal practice of Catholicism.
 
The terms “natural law” and “biblical teaching” were not generally hot button items in everyday parish life before Vatican II. At the time I was making my first confession in 1956, the term “natural law” was not a significant phrase in my parish’s Catholic lay vocabulary. If my memory is correct, the term in catechetics for natural law was probably “conscience,” as reinforced on TV by Jiminy Cricket on the Disney Show. [See this offbeat summary of Jiminy’s moral reasoning.] “Conscience” was God’s inner prodding to do good. We were expected to use the Ten Commandments in the confessional as our moral guide, at least the commandments we understood. [Adultery? Idolatry? Coveting thy neighbor’s wife?] In high school and college, however, during and after the Council our teachers—priests—told us that the Council was pulling away from practical confessional attitude and advocating a rearranging of our moral thinking, i.e., away from individual sins with measured satisfaction toward a general embrace of the Gospel of Love preached by Jesus, as we interpreted it. Magisterial moral law-- fasting from meat on Friday, for example--was replaced by an attitude of love, peace, and justice. In graduate school we were taught Karl Rahner’s phrase, “fundamental option” to the Gospel. Like, it was the 60’s, you know. “All you need is love.” The curious thing is that the post-Council era Church might have been helped by dialogue with secular science. Every psychotherapist worth his or her salt writes a client-specific treatment plan with specific behavioral goals and objectives for every patient, which coincidentally is a secular model for what was happening, or supposed to happen, in the confessional when a penitent is laboring with habitual sin.
 
In Chapter Two, “The Human Person: Church Teaching,” the author reviews Church teaching and thinking on the nature, rights, and dignity of the human person in the face of modern science. She cites Canadian law that “we are not persons until we are actually born, and even then, not until we are completely delivered from the birth canal.” [p. 45] Obviously, this law is radically at odds with the 1987 papal teaching, Donum Vitae, that we are to be regarded as persons from the moment of conception.” Donum Vitae’s measure of precision regarding the moment of life does run up against scientific studies that most fertilized eggs do not attach to the womb, a significant point in considerations of abortion and birth control, particularly the latter.
 
Dr. McQueen notes parenthetically that “for many in our society the prospect of new life is not greeted with joy.” [p.44] When a Catholic picks up a morality study for the first time, the first hurdle is the challenge of balancing what ought to be versus what is. The Book of Genesis, interestingly, cites the twin curses of Adam and Eve as work for the man and childbirth for the woman, which might give us some clue as to why a working mother might not automatically dance with glee at the clinical confirmation of another pregnancy. Church teaching documents, and many theological writers, do not fully acknowledge how painful life can be. To its credit, over the centuries the Church has sacramentalized forgiveness in a fashion where personal circumstance and pain play a significant role in the reconciliation process when the confessor learns how to listen as well as instruct.
 
Most of Chapter Two is devoted to the issue of infertility and the clinical efforts to facilitate conception. This is valuable information for a Catholic, and it does clarify why the Church hold deep reservations about ancillary medical and social implications. When I became a full-time psychotherapist, one of the things that surprised me the most was the number of adult patients wrestling with infertility. [My third-party payers listed me as a “Christian psychotherapist” which perhaps skewed my intake population. My marriage counseling roster certainly increased when the word “Christian” was added to my other concentrations.]  
 
It is interesting, though, how the discussion of bioethics in this work seems to circle back to reproduction, reflecting the trend of the Church’s teaching office itself. Which is why I was most surprised at Chapter Three’s omission of the true game changer in Church and medicine, “the pill.” I don’t say this as a criticism of the author; many moral authors tiptoe around one of Catholicism’s best or worst kept secrets: a formal moral teaching that was not “received,” to use the theological term, by the faithful. If you are unfamiliar with the release of the encyclical Humanae Vitae [July 25, 1968], Wikipedia’s essay is surprisingly thorough and fair.
 
When I think of Humanae Vitae, which in 1968 reiterated the teaching of Pius XI [1931] that artificial contraception is immoral, I think of Sunday Mass when I watch the assembly of two or three children families process to the altar to receive communion. It is hard for me to imagine that all these couples employ the “rhythm method” as it was called in the recent past, periodic abstinence during the fertile days of the cycle, Natural Family Planning, to space their children. Humanae Vitae was a watershed moment in the United States and Canada, among many other places, where most Catholics took the reins of sexual decision-making on all matters of their personal lives. Strangely, the Humanae Vitae event was a rare instance where laity was consulted, but the pope did not accept the strong recommendation of a commission to change the teaching.
 
Chapter Four, “Euthanasia and Physically Assisted Suicide,” goes further into numerous moral dilemmas surrounding care of the sick and the dying. The author notes several changes over the last century in Church directives, including definitions of what constitutes “ordinary means” and “extraordinary means” of keeping a person alive. For most of my lifetime withholding food and water was considered an extraordinary means of keeping a dying person alive. It was Pope John Paul II who defined that all persons in such circumstances are entitled to food and water as a basic right of a human being. An issue not treated in the book but certainly a major one for my generation [upper 70’s] is the right to decline line-altering, expensive, and painful treatments in favor of palliative care and a probable shorter life. My wife and I gave considerable thought on this matter when we prepared our wills and instructions to our executors, but my understanding at the time—and remains so today—is that there is no Catholic moral prohibition of palliative care. In many cases, it may be the wise moral option.
 
Of course, in much of Catholic moral teaching, we circle round to the Humanae Vitae teaching and the reality that only a small percentage of Catholics even think of such personal issues as Church matters. As a result, the good work of the author of Bioethics Matters and countless other teachers, preachers, and authors starts off at a deficit, that Catholics as a rule are not inclined to consider the Catholic tradition as a major source in personal decision making, most notably in matters of health and sexuality. Of course, this is a two-way street.