William E. May

Criteria for Withholding or Withdrawing Treatment

Introduction: My purpose here is to set forth the criteria for withholding or withdrawing treatment. To put it another way, it is concerned with distinguishing treatments which the Catholic tradition has called ordinary or, more recently, proportionate (morally obligatory means of preserving life) and treatments which the Catholic tradition has called extraordinary or, more recently, disproportionate (morally nonobligatory means of preserving life). But before discussing these criteria, it will first be helpful to set forth briefly some guiding principles and presuppositions relevant to the question of caring for the sick and dying. I will then note relevant Church teaching on the distinction between ordinary and extraordinary means of treatment, following this with a critique of some influential contemporary interpretations of this teaching which I believe are very mistaken and mischievous, and finally set forth objective criteria for distinguishing between ordinary and extraordinary means, i.e ., criteria for withholding or withdrawing treatment.

Caring for Persons in the “Persistent Vegetative State” and Pope John Paul II’s March 20 2004 Address “On Life-Sustaining Treatments and the Vegetative State”

L’autore parte da un breve resoconto del suo coinvolgimento nella questione, concentrandosi sugli incontri dei filosofi morali/teologi, medici, giuristi e infermieri che presiedette nel 1986 per discutere l’argomento in profondita, dopo la dichiarazione della Pontificia Accademia delle Scienze del 1985 che affermava che il trattamento delle persone in uno stato di incoscienza permanente non e obbligatorio ma che tutta l’assistenza, compresa la nutrizione, dovrebbe essere loro profusa. Questi incontri portarono l’autore stesso e alcuni altri a cambiare le loro precedenti opinioni, secondo cui non era obbligatoria la nutrizione, e a scrivere un documento, pubblicato nella rivista Issues in Law and Medicine nel 1987 e firmato da piu di 90 studiosi, in cui vengono fornite le ragioni per cui tale nutrizione e moralmente necessaria in modo ordinario. Egli analizza quindi i punti di vista delle diverse fonti sull’argomento, compresi i vescovi cattolici e gli studiosi, dai primi anni ‘80 fino al pronunciamento di Giovanni Paolo II del 20 marzo 2004. In particolare egli presenta l’argomento assai influente presentato da Kevin O’Rourke, O.P., che afferma che un’adeguata lettura del discorso del 1957 di Papa Pio XII sosterrebbe l’opinione secondo cui tale somministrazione di cibo/acqua e straordinaria perche non permette al soggetto in stato di incoscienza permanente di perseguire il fine spirituale della vita. L’autore mostra che questa interpretazione di Pio XII e grossolanamente imprecisa. L’autore, quindi, riassume il discorso di Giovanni Paolo II del 20 marzo affermando che la nutrizione di tali persone e una questione di assistenza ordinaria ed e obbligatoria. Egli poi esamina l’accoglienza estremamente ostile che questo discorso ha avuto da parte di molti teologi, che hanno affermato che esso non e compatibile con l’insegnamento della tradizione Cattolica, o che impone gravi pesi non necessari a coloro che forniscono le cure, o che non era ben ragionato, ecc. L’autore conclude con la difesa del discorso di Giovanni Paolo II, rispondendo alle obiezioni sollevategli contro. ---------- The Author begins with a brief account of his own involvement in the question, focusing on the meeting of moral philosophers/theologians, doctors, lawyers and nurses he chaired in 1986 to discuss the issue in depth after the 1985 declaration by the Pontifical Academy of Sciences that treatment of permanently unconscious person is not required but that all care, including feeding, should be lavished on them. These meeting led him and some others to change their carlier views that considered such feeding not obligatory and to prepare a paper, published in Issues in Law and Medicine in 1987 and signed by more than 90 scholars, proving the reasons why such feeding is ordinarily morally required. He then reviews the views of different sources, including both Catholic bishops and scholars, over this issue from early 1980s until John Paul II’s statement of March 20, 2004. He in particular presents the highly influential argument advanced by Kevin O’Rourke, O.P., claiming that a proper reading of a 1957 address by Pope Pius XII support the view that such provision of food/hydration is extraordinary because it does not enable the permanently unconscious to pursue the spiritual goal of life and shows that this interpretation of Pius XII is grossly inaccurate. He then summarizes John Paul II’s March 20 address affirming that feeding such persons is ordinarily a matter of ordinary care and is obligatory. He next surveys the extremely hostile reception this address received from may theologians, who declared that it was not compatible with traditional Catholic teaching, that it imposed unnecessarily grave burdens on care givers, that it was not well reasoned etc. He concludes by defending John Paul II’s address and responding to objections leveled against it.

The simple case of in vitro fertilization and embryo transfer.

M any people, both Catholic and non-Catholic, can readily understand why the Catho li c Church teaches that it is morally bad to generate human life by inseminating a married woman with sperm provided by a man who is not her husband or by having sperm provided by her husband inseminate another woman, a so-ca lled surrogate mother, who would, after bearing the child, turn it over to the married couple. They recognize that choosing to generate human life in this way does violence to marriage and to human parenthood and does an injustice to the child. Such people can likewise understand why the Catholic Church rejects the deliberate creat ion in the laboratory of human lives which will be discarded or frozen or used for experiments designed only to gain knowledge which may benefit others, but which only poses harm to the lives upon which the experiments are performed. They recognize that such procedures do violence to the dignity of the human lives deliberately brought into existence in the laboratory. And such people also understand why the Catholic Church opposes the monitoring of human lives in utero for the purpose of detecting and then destroying, through abortion, those discovered to be of poor quality. Again they recognize that choosing to act in this way does a terrible violence and injustice to unborn human lives. But many of these same people, Catholic as well as non-Catholic, find the teaching of the Catholic Church (as recently expressed in the Sacred Congregation for the Doctrine of the Faiths Instruction on Respect for Human Life in Its Origin and on the Dignity of Human Procreation), on the immorality of the simple case of in Iitro fertilizat ion, a different matter. I n this case, there is no use of gametic materials from third parties; the child conceived is genetically the child of husband and wife, who are and will remain its parents. In this case, there is no deliberate creation of

The sacredness of life: an overview of the beginning.

To reflect on the sacredness of human life, especially in its beginning, is particularly appropriate this year, because on March 25 Pope John Paul II promulgated The Gospel of Life (Evangelium vitae), an encyclical letter addressed to the bishops, priests and deacons, men and women religious, lay faithful, and all people of good will on the value and inviolability of human life. This encyclical can be described as an impassioned and eminently reasonable appeal to every person of good will to recognize the dignity, indeed sanctity, of human life from its inception, to defend it from the vicious and at times subtle attacks launched against it today, to repudiate the culture of death that nurtures these attacks, to love human life as Gods precious gift and to protect and cherish it by accepting Gods invitation to develop a true culture oflife or civilization of love. Here I propose to begin with some brief considerations of the reasons why human life must always be treated with reverence and why human bodily life is a good intrinsic to human persons and not merely instrumental to them. I will then consider in more depth why it is reasonable to hold that human persons begin at fertilization and why it is unreasonable to deny this.

Is there a "right" to die?

The expression the right to die is ambiguous. It can mean a liberty to be immune from coercive interventions which would prevent death and prolong the dying process. But this meaning is better expressed by saying that it is an aspect of our right to life, bodily integrity, and personal inviolability. In another sense it can mean an entitlement to the means, including the acts of another, necessary to bring about death. This is the sense the expression has for those who subscribe to the philosophy of the Society for the Right to Die, formerly called the Euthanasia Society, and of the Hemlock Society. The right to die in this sense is also defended by those who accept the Plea for Beneficent Euthanasia drafted by Marvin Kohl and Paul Kurtz, who hold that belief in the value and dignity of the individual person requires respectful treatment, which entails the right to reasonable self-determination, and conclude that no rational morality can categorically forbid the termination oflife if it has been blighted by some horrible malady for which all known remedial measures are unavailing.1 It is a right to choose death, a right to be killed. It is not irrelevant, in my opinion, to note that a right of this kind seems to be implied by the understanding of the Fourteenth Amendment undergirding the recent Supreme Court decision in Planned Parenthood v. Casey. In that case Justices Souter, Kennedy, and OConnor gave as one of the central reasons for reaffirming the central holding of Roe v. Wade the meaning of liberty in the Fourteenth Amendment. According to them, matters involving the most intimate and personal choices a person may make in a lifetime, choices central to personal dignity and autonomy, are central to the liberty protected by the Fourteenth Amendment. At the heart ofliberty is the right to define ones own concept of existence, of meaning, of the universe, and of the mystery of human life. Beliefs about these matters could not define the attributes of personhood were they formed under compulsion of the State. 2 Surely, one of the most intimate and personal choices a person may make in a lifetime, and central to personal

Ethics and Human Identity: The Challenge of the New Biology

The major reason why ethics seeks to determine the rightness or wrongness of human acts is that it is principally concerned with the question of our identity as human beings, an identity that we shape for ourselves by our willingness to choose to do specific kinds of deeds or acts. Questions of morality, in other words, are at root questions of human identity. We make or break our lives as human beings by the deeds we choose to do. With this underlying theme the essay seeks to assess the adequacy of diverse moral methodologies insofar as these have been employed in an effort to confront the challenges posed by the new biology. Three types of approaches are examined: the consequentialist type exemplified by Joseph Fletcher, the “mediating” approach discernible in many contemporary writers and given its most systematic articulation by Richard McCormick, and the deontological type so ably presented by Paul Ramsey and Germain Grisez. The author argues that the Ramsey-Grisez type of approach is the most adequate, contending that the other two types of approaches are more concerned with what our deeds get done than they are with what our deeds have to tell us about the meaning of our existence as moral beings.

Changing the Hearts and Minds of Those Embracing the Culture of Death: A Suggested Strategy

It is important to understand why excellent arguments developed by those who propose the “culture of life” are not able to persuade advocates of the “culture of death” to change their minds. Our freely chosen deeds “do not produce a change merely in the state of affairs outside of man but, to the extent that they are deliberate choices, they give moral definition to the very person who performs them, determining his profound spiritual traits.” 1 Those who embrace the culture of death will not accept pro-life arguments because they have freely committed themselves to a way of life that closes their eyes and ears to the truth. They do not want to hear arguments incompatible with their basic commitments. Arguments are presented from Patrick Lee, Mortimer Adler, John Macquarrie, Pope John Paul II, and Pope Benedict XVI that can be used as a conceptual basis for reaching those imbued in the culture of death. This includes pointing out the intrinsic value of human life, the consequences of instituting a hierarchy of individuals based on their “worth” to society, and the yearning of all for the good and the true. These considerations can help persons think more deeply about who they are and their identity as persons, and evoke an “anamnesis” in the minds of some of our contemporaries who disagree with us so greatly on issues regarding the rights of all human beings, born or unborn.

Humanae Vitae , Natural Law, and Catholic Moral Thought

This paper will (I) present the context of Humanae Vitae and summarize its principal teachings regarding the natural moral law; (2) set forth the understanding of natural law common to those theologians (hereafter referred to as revisionists) who reject the specific teachings of Humanae Vitae; (3) offer a critique of their conception of natural law; and (4) present and defend an understanding of natural law rooted in the thought of St. Thomas Aquinas, one shared, in large measure, by theologians who accept the specific teachings of Humanae Vitae.

Can Ethics be Contradictory?: A Response to Gerard J. Hughes, S. J.

My comments on Father Hughes’ paper will focus on the following matters: (1) his crucial thesis regarding defensible pluralism in ethics, (2) the silence of this thesis with respect to the critically important issue of contradictory opposition between ethical theories, (3) his suggestion that one gather facts where there is an argument over their moral relevance, and (4) his handling of the question of personhood.

Roman Catholic Ethics and Beneficence

There is ambiguity in both ‘Roman Catholic ethics’ and ‘beneficence’. The former can mean either the body of moral norms, both general and specific, authoritatively proposed by those who hold the teaching office or magisterium within the Roman Catholic Church, namely the pope and the bishops throughout the world in communion with him,1 or the diverse ethical theories, along with their substantive conclusions, that have been developed by various Roman Catholic moral theologians and philosophers. This paper will attempt to describe both the moral teachings authoritatively proposed by the magisterium, particularly with reference to issues relating to health care, and the debate currently taking place among Roman Catholic writers over normative ethical principles and the sorts of human choices and actions justifiable in terms of these principles, particularly with reference to health care questions.