BIOETHICS PART II – ORAL FINALS (see previous reviewer on Bioethics for nos.

1 – 9)

10. What is the moral evaluation by official Catholic Church teaching of the various forms of assisted
reproduction? How do the ARTs measure against the key themes and principles of the Church? What
further critique do contemporary moral theologians make on ARTs?

ART – fertility treatments; egg and sperm handled in the lab

Forms:
1) Infertility work-ups
- involves obtaining sperm/semen
- for fertility tests/fertilizing ova
2) Artificial insemination
- Involves unfertilized egg and sperm introduced into female genital tract e.g. GIFT
- Fertilization INSIDE the woman’s body
- Procedure types according to relationship between gamete sources
 Homologous or AIH(usband) is sperm source: for genital anatomical defects and sperm motility
problems
 Heterologous or AID(onor) is sperm source: for genetic or qualitative sperm problems; for
widowed, divorced, single women and lesbians in stable relationship
3) IVF
- Involves multiple unfertilized egg and sperm
- Fertilization OUTSIDE the woman’s body
- then the “best” embryos are transferred in the womb to be carried to term
- implantation of 2-5 embryos  multiple pregnancy  high risk for prematurity, neonatal deaths,
and physical/mental disabilities
- involves PIGD (pre-implantation genetic diagnosis), eugenic selection, fetal reduction to increase
chance for healthy births, disposal or freezing of “spare” embryos for stem cell research, and
possibly surrogate motherhood (full – egg and womb; genetic – egg only; gestational – womb only)
- Procedure types: homologous (spousal gametes) and heterologous
4) Cloning – insertion of a donor somatic cell nucleus into enucleated fertilized egg; resultant embryo is the
genetic parent’s twin

Key Themes and Principles in Official Church Teaching: Donum Vitae, Dignitas Personae, Evangelium
Vitae and Humanae Vitae

Key Themes and Principles Moral Evaluation of ARTs

1. Infertility/sterility contradicts
gift of procreation
2. Dignity and defense of human
life from conception
 Efforts to overcome it are praiseworthy
 Admissible AIH methods that uses technology to facilitate
procreation and not substitute for it
 includes: use of syringe/cervical spoon immediately
postcoital and methods  sperm density of semen (emitted
during coitus)
 violated by IVF where multiple embryos are produced and
implanted: instrumental use (means), others disposal

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 Key Themes and Principles Moral Evaluation of ARTs
3. Transmission of life must  violated by use of donor gametes and surrogate
always be within marriage motherhood
4. Inseparability of unitive and  violated by IVF in general as well as by masturbation and
procreative meanings of coitus interruptus which are the means for obtaining semen
marital act for ARTs
Nuanced evaluation:
 Many agree with first 3 themes and principles.
 The value of humanization of reproduction (1st theme) can outweigh the disvalue of
contradicting inseparability of the two meanings (4th theme). Therefore,
 Consider as moral ARTs
limited to use of spousal gametes (homologous)
limiting the number of fertilized and implanted ova

Further Critique by Contemporary Moral Theologians RE:

1. Origins of the demand/impetus for fertility treatments

 Biological: congenital infertility, disease-related infertility, diminishing fertility due to age
(beginning in their 40’s for both women and men)
 Sociological: pressure on women with motherhood as goal and ideal (fulfills or exhausts meaning
of their life)
 Economic: ART is a costly industry with a 66% failure rate, responding only to needs of those
who can afford it  reproductive tourism and exploitation of the infertile couple
 Psychological: leads to an all-consuming drive to bear a child biologically-related to at least one
among the couple; high physical, emotional and economic tolls
2. Control over infertility
 Affirms use of human freedom to relieve suffering, generating choice where previously there
was none
 Supportive role of religion: use of spirituality and liturgy for ministering to the concrete realities
of the infertile couple; avoid portrayal of barrenness as a curse while fertility a blessing
LIMITS from –
 Sociology: there are cultural and religious assumptions about family bonds which are related to
offspring from sexually consummated, permanent male-female relationships; role of kinship and
biology in defining family relations not resolved; excesses of control or choice can distort and
destroy what is most precious in families [unconditional acceptance, compassion, loyalty]
 Gender: ARTs are medical remedies that enable women’s choices about pregnancy and
motherhood but the same can aggravate desperation in the face of coercive social constructions
about motherhood
 Science: only addresses physical causes of infertility
 Justice: right to ART versus basic health care; maintains privilege of some by disadvantaging
others  lack of solidarity with the poor, disproportional in the context of the common good
3. Control over children
 Dignity issue: PIGD creates bias against children predicted to have “abnormalities”; valuing of
children based on traits rather than as persons (dignity)

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  Justice issue: High cost creates inequities in access to health care; more income means greater
access to medically indicated and elective genetic intervention
4. Freedom of choice
 Social and medical ideologies predetermine free choice
 Recognition of need to regulate ARTSs: prohibition of “boundary-crossing” innovations
(cloning and sale of embryos), respect for embryos, resisting a totally market-driven industry,
valuing of children as persons, human well-being as basis for responsible choice
5. Promoting adoption as an alternative
 Receiving side: exercise of hospitality; responsibility of all in social justice framework
 Giving side: ensures children have families and childless couples have children
 Greater priority: try to keep [original] families together

11. According official Church teaching, what conditions justify an instance of “allowing a person to die”?
Explain the various considerations involved in judging benefits and burdens. How is “terminally ill”
crucial in deciding on the care of PVS patients?

Intentionally causing death vs. allowing to die: object of the moral act is key to moral difference

ICD: death as end or means to other ends (pain relief, retain dignity, terminate the decrepit/useless life);
e.g., suicide and euthanasia; morally a violation of dignity and value of person

ATD: a morally justified and right choice --

1. in/of a terminally ill person
2. of withholding or withdrawal of life-sustaining measures that do not offer reasonable benefit or entail
excessive burden
3. involves refusal or discontinuation of the measures (no introduction of an agent that causes death)
4. consented to by the person if he/she is conscious

Considerations in Judging Benefits and Burdens:

Benefits:
 Medical: preservation and restoration of health and pain relief  optimal functioning (more
prominent goal in health care decisions)
 Non-medical: indirectly social and spiritual benefits  enables pursuit of goods of life ordered
towards friendship with God (not prominent)
Burdens:
 Types: economic, physiologic (physical), psychological, social, spiritual
 Bearer: primarily the patient; family; caregivers (medical professionals & health facility); society at
large
 Relative to the PERSON: assessment of excessive burden is highly individualized; (CDF 1980) it
pertains to the conscience of the sick person or his/her legitimate proxy to decide
 Relative to SITUATION: persons’ assessment of what is burdensome changes when in good health
and when one is already in need of certain medical interventions
 Relative to DURATION: burden increases with the length of time and financial resource necessary
to maintain a patient on a certain medical intervention; some are required

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 Quality of Life: ambiguous criteria for assessment (better avoid) with 3 senses
 In relation to God: All have same quality f life and dignity before God: basic starting point of moral
assessment
 Human function: discriminatory against the disabled; persons as means; immoral
 Determined by the person: who discerns benefits and burdens (thus same as above)

Care of PVS (persistent vegetative state) Patients

PVS – patients in long-term coma (permanent 3 months after anoxic injury and 1 year after traumatic injury)
MCS – (minimally conscious state): patients who may regain from a low to full degree of consciousness
Terminally ill – one with serious illness or lethal pathology; does not mean imminent death
A person with a terminal illness or his/her proxy may refuse/discontinue life-sustaining measures if it s
ineffective or burdensome.

VS patients cannot be considered terminal patients; their condition can be enduring and stable.
(Ashley and O’Rourke): for PVS patients, the benefit of treatment or care beyond that required to show
respect for the person can be withdrawn

JP II in a 2004 allocution: In principle, ANH (assisted nutrition and hydration) is ordinary, basic, and
obligatory.
“In principle” may be taken to mean: there may be exceptions when medical diagnosis of irreversible and
permanent unconsciousness has been conservatively made and when burdens outweigh benefits.

12. What is the moral evaluation by official Catholic Church teaching of euthanasia and suicide? What are
the theological critiques of the practices of “intentionally causing death” including physician-assisted
suicide?

Suicide – intending one’s own death

Euthanasia- intending another person’s death often to stop suffering and pain
Both immoral based on the sanctity of human life.

Motivations for ICD of the degenerating:

 Common Good: question of elderly consuming more than their share of resources; “rights” language
emphasize good of the majority at the expense of the weak
Autonomy: PAS (doctor prescribes lethal drugs as means to end their life; indirect killing) claimed as
a “right” by those with unendurable suffering or intolerable loss of control over physical and mental
capacities; often decided upon rashly and with little justifiability;
PAS undermines medical profession as contradiction of traditional role as healers

Theological Critique
1. Recognizing limits
- Ambiguity about adequacy, effectiveness, humaneness of alternatives to euthanasia/PAS
- Ambiguity about human intentions
- ICD not easy to distinguish from ATD esp. with use of terminal sedation

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 - Adverse virtue: integrity in the midst of unavoidable conflict and adversity  perpetuated
by injustice
 forced choices
≠ golden mean ≠ balance between extremes ≠ reasonable
≠ sin because it values the difficulty, worth and courageousness of human attempts to discern
the best way in impossible situations
≠ truly virtuous rather an indictment of a system that perpetuates inhumanity and injustice

2. Affirming the Christian message to resist dehumanization

- It is a response to illusion of autonomy as isolated power of self-determination; true freedom is
the ability to pursue values and goals as socially embedded and physically embodied beings;
there are limits and constraints; take into account relational histories and contexts
- Redemptive value of suffering and death
Jesus as witness to this human condition with its power to transform and redeem
Diminishment and harm have to be resisted but not at all cost.
Cultivate virtues throughout life to attain a meaningful death: patience in adversity and loss
 acceptance of dependency and loss of control
- The practice of presence: even when helpless to relieve suffering; communal act of biblical
lament as one of solidarity; plea for euthanasia is often a plea for help and love
Euthanasia and suicide can signal abandonment by the community.

3. Meaningful alternatives
- prohibition insufficient
- includes: psychological and spiritual accompaniment; palliative care; (terminal) sedation;
reasonable withdrawal of life-sustaining measures; hospice (holistic, patient-centered care for
the dying), Catholic Health Association (advocates for government policies; publishes
theologically-based educational and service materials to guide decision-making at the end-of-
life; intervention programs to benefit the vulnerable esp. the elderly)
- provision of alternatives is an issue of global justice