Table Of ContentCATHOLIC PERSPECTIVES ON MEDICAL MORALS:
FOUNDATIONAL ISSUES
PHILOSOPHY AND MEDICINE
Editors:
H. TRISTRAM ENGELHARDT, JR.
Center for Ethics, Medicine, and Public Issues,
Baylor Col/eRe of Medicine, Houston, Texas, U.S.A.
STUART F. SPICKER
School of Medicine, University oj" Connecticut Health Center,
Farmington, Connecticut, U.S.A.
VOLUME 34
CATHOLIC
PERSPECTIVES
ON MEDICAL
MORALS
Foundational Issues
Edited by
EDMUND D. PELLEGRINO
Kennedy Institute of Ethics, Georgetown University, Washington, D.C.
JOHN P. LANGAN
Kennedy Institute of Ethics and Woodstock Theological Center,
Georgetown University, Washington, D.C.
and
JOHN COLLINS HARVEY
School of Medicine, Georgetown University, Washington, D.C.
KLUWER ACADEMIC PUBLISHERS
DORDRECHT I BOSTON I LONDON
Library of Congress Cataloging in Publication Data
Catholic perspectives on medical morals.
(Philosophy and medicine; v. 34)
Includes bibliographies and index.
1. Medical ethics. 2. medicine-Religious aspects
Catholic Church. 3. Catholic Church-Doctrines.
I. Pellegrino, Edmund D., 1920-- . II. Langan,
John,1940-- III. Harvey, John Collins.
IV. Series.
R725.56.C37 1989 174'.2 88-13159
ISBN-13: 978-94-010-7647-0 e-ISBN-13: 978-94-009-2538-0
DOl: 10.1007/978-94-009-2538-0
Published by Kluwer Academic Publishers,
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TABLE OF CONTENTS
EDMUND D. PELLEGRINO, JOHN LANGAN, AND JOHN COLLINS
HARVEY / Introduction 1
PART I: A PROLOGUE
CARLO MARIA CARDINAL MARTINI, S. J. / Some Basic
Considerations on Moral Teaching in the Church 9
PART II: THE PHILOSOPHICAL FOUNDATIONS
WILLIAM A. WALLACE / Nature and Human Nature
as the Norm in Medical Ethics 23
DAVID C. THOMASMA / The Human Person and Philosophy
of Medicine: A Response to William A. Wallace 55
BRUNO SCHULLER / Philosophical Foundations of Catholic
Medical Morals (translated by E. E. Langan) 61
JOHN LANGAN / Moral Disagreements in Catholicism:
A Commentary on Wallace, Schuller, and Thomasma 79
PART III: THE THEOLOGICAL FOUNDATIONS
JOSEPH FUCHS / "Catholic" Medical Moral Theology? 83
LISA SOWLE CAHILL / "Theological" Medical Morality?
A Response to Joseph Fuchs 93
KLAUS DEMMER / Theological Argument and Hermeneutics
in Bioethics 103
MONIKA K. HELLWIG / The Doctrinal Starting Points
for Theology and Hermeneutics in Bioethics: A Response
to Klaus Demmer 123
JOHN COLLINS HARVEY / A Brief History of Medical Ethics
from the Roman Catholic Perspective: Comments on the
Essays of Fuchs, Cahill, Demmer, and Hellwig 129
VI TABLE OF CONTENTS
PART IV: PLURALISM WITHIN THE CHURCH
RICHARD A. McCORMICK / Pluralism within the Church 147
JUDE P. DOUGHERTY / One Church, Plural Theologies 169
GERARD J. HUGHES, S. J. / Is Ethics One or Many? 173
WILLIAM E. MAY / Can Ethics Be Contradictory?:
A Response to Gerard J. Hughes, S. J. 197
PART V: PLURALISM IN SOCIETY
J. BRYAN HEHIR / Religious Pluralism and Social Policy:
The Case of Health Care 205
WALTER J. BURGHARDT / Consensus, Moral Witness, and
Health-Care Issues: A Dialogue with J. Bryan Hehir 223
ROBERT F. LEAVITT / Notes on a Catholic Vision of
Pluralism 231
JOHN H. WRIGHT / A Brief Commentary on "Notes on
a Catholic Vision of Pluralism" 255
PART VI: AGAPEISTIC MEDICAL ETHICS
ROBERT SOKOLOWSKI/The Art and Science of Medicine 263
EDMUND D. PELLEGRINO / Agape and Ethics: Some
Reflections on Medical Morals from a Catholic Christian
Perspective 277
NOTES ON CONTRIBUTORS 301
INDEX 303
INTRODUCTION
CATHOLIC PERSPECTIVES AND CONTEMPORARY
MEDICAL MORALS
A Catholic perspective on medical morals antedates the current world
wide interest in medical and biomedical ethics by many centuries[5].
Discussions about the moral status of the fetus, abortion, contraception,
and sterilization can be found in the writings of the Fathers and Doctors
of the Church. Teachings on various aspects of medical morals were
scattered throughout the penitential books of the early medieval church
and later in more formal treatises when moral theology became recog
nized as a distinct discipline. Still later, medical morality was incorpor
ated into the many pastoral works on medicine. Finally, in the
contemporary period, works that strictly focus on medical ethics are
produced by Catholic moral theologians who have special interests in
matters medical.
Moreover, this long tradition of teaching has been put into practice in
the medical moral directives governing the operation of hospitals under
Catholic sponsorship. Catholic hospitals were monitored by Ethics
Committees long before such committees were recommended by the
New Jersey Court in the Karen Ann Quinlan case or by the President's
Commission in 1983 ([8, 9]).
Underlying the Catholic moral tradition was the use of the casuistic
method, which since the 17th and 18th centuries was employed by
Catholic moralists to study and resolve concrete clinical ethical dilem
mas. The history of casuistry is of renewed interest today when the case
method has become so widely used in the current revival of interest in
medical ethics[ll].
Until recently the Catholic perspective was the most influential,
formal, and comprehensive source for what is now called biomedical
ethics. The writings of most physicians outside that tradition were until
that time largely hortatory, and concentrated on professional ethics -
the relationships of physicians to patients and to each other rather than,
on the more fundamental philosophical principles undergirding their
practices. 1 Few if any philosophers took any interest in the specific prob-
1
Edmund D. Pellegrino et al. (eds.) , Catholic Perspectives on Medical Morals, pp. 1-6.
© 1989 Kluwer Academic Publishers.
2 INTRODUCTION
lems of medical morality. The field was generally left to the theologians.
Two decades ago all of this changed abruptly. New and unprece
dented moral dilemmas emerged from the prodigious advances of
medical technology. Moral pluralism became more explicitly the rule in
American life than it had ever been before. Public awareness fostered
by media reports of controversial and sensational cases grew rapidly.
The courts were increasingly called on to settle conflicts among decision
makers whose fundamental values differed sharply. Today medical
ethics is a topic of everyday discussion, and a constant presence in all the
media, in the courts, and in state legislatures.
One of the most significant of the recent changes has been the entry of
professional philosophers into the dialogue. Until recently, philo
sophers had not been engaged in formal analyses of medical ethical
issues. They began by teaching in medical schools and university hospi
tals[7]. Soon they were writing the scholarly papers and treatises that
have become the dominant intellectual resources for contemporary
medical ethics.
This philosophical turn has changed the whole complexion of medical
ethics. The centuries-old theological approach has been superceded. Its
normative thrust has given way to secular methodology. A strongly utili
tarian, pragmatic, and eclectic bias has replaced the previous deontologic
character of medical ethical discourse. These characteristics of philoso
phical ethics make it more attractive than theological ethics to medical
schools and to physicians in a secular, pluralistic society. Its spirit and
methodology have dominated the reports of Presidential Commissions,
as well as hospital ethics committees, the courts and the media. As a
result, theologians - Catholic, Protestant and Jewish - have lost influ-.
ence in the field even among their own denominational colleagues.
Historically the Catholic perspective placed a heavy emphasis on
sexual, reproductive, and marital morality. This arose from the concern
of confessors, moral theologians, and the Church for adherence to
Catholic teachings respecting marriage, the family and the virtue of
chastity. The Church's concerns are heightened today not only by the
revolution in sexual morality and marriage that characterizes our times,
but also by the availability of a multitude of new reproductive techno
logies that separate reproduction from the procreative act[lO].
Despite this emphasis on sexual morality the Catholic perspective has
attended seriously to other important dimensions of biomedical ethics.
INTRODUCTION 3
The moral obligations of the physician, for example, were topics of
serious concern in the 15th-century work of St. Antoninus of Florence
([5], p. 26). They were addressed usually in later works under the rubric
of "duties of one's station" in life. More recently the Church has taken
leadership in a dimension of biomedical ethics largely neglected else
where - the social ethics of medicine, the obligations of society regard
ing the care of the sick, and of the sick poor ([1, 3, 4, 10, 12]).
But even aside from its history and specific concerns, a Catholic
approach presents several fundamental anomalies when considered
from the view point of modern-day biomedical ethics.
For one thing, it employs sources of moral insight - scripture, tradi
tion, and authoritative teachings - which are neither central nor norma
tive for a purely philosophical ethics. Its theory, at least in the area of
medical ethics, is commonly taken to be deontological. At the same
time it relies heavily on Aristotelian teleology and virtue theory. In
addition, the metaethical structure of a Catholic perspective is framed
by belief in an objective order of morality and a specific philosophical
and theological anthropology, which takes into account the spiritual as
well as the material destinies of human life. This runs counter to the
historicist bias in much of ethics today. A Catholic perspective tran
scends ethics as a discipline. Its ultimate norm is the law of Charity as
enunciated in the Sermon on the Mount. This goes beyond coherent
analytical argumentation based on traditional medical ethical principles,
though it is not inconsistent with such principles. Finally, the Catholic
perspective depends on that special fusion of theology and philosophy
that is the distinctive mark of the Catholic intellectual tradition.
The conference which served as the foundation of this volume was
convened with several convictions in mind. First of all, there is a
pressing need to provide some alternatives to the prevalent tenor of
ethical discourse, which is today so largely secular, analytical, and
procedural. Substantive issues are often slighted to the discomfiture not
only of Catholics but of persons of other religious persuasions as well.
There are still large numbers of people for whom the religious sources of
ethics are still determinative.
Moreover, there is a need to clarify the Catholic perspective itself,
since internal pluralism has grown steadily within post-conciliar Catholic
moral theology. Catholic thinkers have entered into dialogue with the,
mainstream thinkers in secular biomedical ethics, but their contribu-
4 INTRODUCTION
tions are sometimes compromised by internal differences about the
place of ecclesiastical authority or debates about what in fact defines
Catholic Christian ethics.
Finally, the breadth of a Catholic perspective needs to be asserted
beyond a narrow concern for sexual and reproductive morality with
which it is too frequently misidentified. It is necessary for Catholics as
well as non-Catholics to realize that a Catholic perspective also has
much to say about what is required of the good physician, nurse, or
hospital administrator; about the nature of the healing apostolate; lhe
collective responsibility of the Christian community for the care of the
sick; justice in the allocation of scarce resources; responsibility for care
of the poor; medical profiteering; and a host of other specific questions
about the obligations that flow from a commitment to Christianity.
Obviously one conference can not touch on all these questions.
Instead, we have selected a few "foundational" issues which we con
sider most pertinent at this juncture - (1) the philosophical and theo
logical groundings for a Catholic perspective, (2) the issue of pluralism
within and outside the Catholic tradition, (3) the crucial question of the
relationship of ethical inquiry to the legitimate teaching authority of the
Church, and (4) the place of the virtue of Charity in medical morals[2].
A wide variety ofq uestions is touched on, directly or tangentially, by
the contributors to this volume: Does the Catholic perspective entail
differences in the content or method of the ethical enterprise? What
dimensions does a faith commitment add to the obligations of philo
sophical ethics? Is the enterprise of ethics as a rational and reasoned
discipline compatible with a commitment to Catholic Christianity which
must take into account the teachings of an authoritative Church? What
is the proper relationship of authority and freedom of inquiry which
permits Catholic thinkers to engage new questions and re-examine old
ones, in order to deepen our understanding of the obligations that bind
Catholic Christian health professionals, institutions, patients, and the
entire Catholic community? What differences does a commitment to
Christian charity as an ordering principle make to the theory and
practice of medical ethics? How can the reality of pluralism, within and
outside the Catholic community, be fruitfully and constructively
addressed?
This wide range of questions impels us to assemble these essays under
the rubric of "medical morality", though we are cognizant of the
relative infrequency of this usage. Our intent is to encompass the topics
