Selected Bioethics Issues in a Morally Complex World

Selected Bioethics Issues in a Morally Complex World

Selected Reproductive Issues in a Morally Complex World Presented by James T. Bretzke, S.J., S.T.D. Boston College School of Theology & Ministry E-mail: [email protected] Examples of Reproductive

Technology Issues Debates Artificial Contraception Natural Family Planning Tubal ligations when no future pregnancy is safe Artificial Insemination with Husbands Sperm (AIH) In-Vitro Fertilization Artificial InseminationDonor (AID)

Surrogate Motherhood When Does Life Begin?

Recall Some Basic Principles God created the whole world, and saw that it was good. The nature of the good is to be done and fostered, and evil is to be avoided Grace builds on nature and perfects it Always follow your formed and informed conscience

We come from God and we are in the process of returning to God. Some Negative Starting Premises Morality is NOT Simply Black & White, Good & Bad, Right & Wrong Morality is NOT Analogous to Mathematics Morality is NOT Simply a Set of Laws

Morality is NOT Simply about Judging Others It is NOT Simply a Culture of Life vs. a Culture of Death Sacred Texts Normatively Human

Human Experience Tradtion(s) of the community Recall Our Moral Methodology: Let Every Sector Have its Appropriate Voice Be Heard!

Problematic Presumptions in Bioethical Moral Analysis Autonomy Presumes Right(s) to Do Everything Which is Legal (Legal = Moral) Limitation and/or Suffering Have No Redeeming Value Technological Capability Presumes Moral Obligation to Use

Slippery Slope Presumes Prohibition Genetic Manipulation Presumes Playing God OR Supporting Eugenics Debunk the Myth of Pure Science There is no such thing as value-free or neutral science since both the scope and

method of scientific inquiry are human driven Therefore both philosophy and theology have proper roles to play in theory construction in science As well as to help determine legitimate methods and boundaries for scientific research and application

Morality Is Necessarily Complex Recall Thomas treatment of levels of norms in the natural law Recall the distinction between speculative and practical reason

Locus of the real debate Middle axiom or Universal precept? Virtually exceptionless or intrinsically evil? in matters of action, truth or

practical rectitude is not the same for all, as to matters of detail, but only as to the general principles and where there is the same rectitude in

matters of detail, it is Though, Is EVERY Moral Decision ALWAYS Clear-Cut Black and White? Competing Moral Paradigms Only God Can Know the Whole of Reality Thus for the rest of us this knowledge is

necessarily incomplete and partial We tend to understand complex realities according to models and paradigms Physicalist paradigm & Personalist paradigm Strengths and weaknesses of both paradigms Necessary Openness to Revision of All Paradigms!

Some Problematic Popular Ethical Theories Consequentialism: moral rectitude is determined primarily by looking at the consequences of a given action Utilitarianism: morality is determined by what produces the greatest good for the greatest number

Problems with each of these approaches Alternative Ethical Perspectives Deontological: duties and prescriptions and proscriptions Teleological: respecting human nature and living according to an ethics of virtue Ethics of responsibility (and especially

with attention to the common good) Or a combination of all of the above Recall Basic Points of the Natural Law The good is to be done and fostered, and evil is to be avoided [ST I-II, q. 94, a. 2] However, this does NOT translate as a

simple imperative: Do good and avoid evil Rather, it is the work of reason to discover & promote the good, while minimizing & avoiding (if possible) the evil Source Content Questions

What is used, and why? What is ignored, and why? What is rejected, and why?

What is reinterpreted, and why? Which source(s) is (are) decisive when there is a conflict, and why? Common Fertility Problems & Respective Treatment Possibilities via Medical Technology

In Vitro Fertilization to Circumvent Blocked Tubes Artificial Insemination into the Uterus GIFT (gamete intrafallopian transfer) An ART procedure that involves removing eggs from the woman's ovary, combining them with sperm, and using a laparoscope to place the unfertilized eggs and sperm into the woman's fallopian tube through small incisions in her abdomen.

ICSI (intracytoplasmic sperm injection) A procedure in which a single sperm is injected directly into an egg; this procedure is most commonly used to overcome male infertility problems. Induced or therapeutic abortion A surgical or other medical procedure used to end a pregnancy. http://www.fertility-docs.com/glossary.phtml#ZIFT

In Vitro Fertilization Process 8-cell stage Blastomere Extraction IVF Risks & Costs

Donum Vitae (1987): Natural Law Premise NOT Physicalist The natural moral law expresses and lays down the purposes, rights and duties which are based upon the bodily and spiritual nature of the human person. Therefore this law cannot be thought of as simply a set of norms on the biological level;

rather it must be defined as the rational order whereby man is called by the Creator to direct and regulate his life and actions and in particular to make use of his own body Key Moral Principle Used The Church's teaching on marriage and human procreation affirms the inseparable connection,

willed by God and unable to be broken by man on his own initiative, between the two meanings of the conjugal act: the unitive meaning and the procreative meaning. Indeed, by its intimate structure, the conjugal act, while most closely uniting husband and wife, capacitates them for the generation of new lives, according to laws inscribed in the very being of man and of

woman. Moral Conclusion Reached Thus, fertilization is licitly sought when it is the result of a "conjugal act which is per se suitable for the generation of children to which marriage is ordered by its nature and by which the spouses become one flesh".(41) But from the moral point

of view procreation is deprived of its proper perfection when it is not desired as the fruit of the conjugal act, that is to say of the specific act of the spouses' union. Initial Condemnation of AIH Homologous artificial fertilization, in seeking a procreation which is not the fruit

of a specific act of conjugal union, objectively effects an analogous separation between the goods and the meanings of marriage. Further Condemnation of AIH Masturbation, through which the sperm is normally obtained, is another sign of this

dissociation: even when it is done for the purpose of procreation, the act remains deprived of its unitive meaning: It lacks the sexual relationship called for by the moral order, namely the relationship which realizes 'the full sense of mutual self-giving and human procreation in the context of true love.

Condemnation of IVF The facts recorded and the cold logic which links them must be taken into consideration for a moral judgment on IVF and ET (in vitro fertilization and embryo transfer): the abortion-mentality which has made this procedure possible thus leads, whether one wants it or not, to man's domination over the life and death of his fellow human beings

and can lead to a system of radical eugenics. Donum Vitaes Authority During an audience granted to the undersigned Prefect after the plenary session of the Congregation for the Doctrine of the Faith, the Supreme Pontiff, John Paul II, approved this Instruction and ordered it to be published. Given at Rome, from the Congregation for the Doctrine of

the Faith, February 22, 1987, the Feast of the Chair of St. Peter, the Apostle. JOSEPH Card. RATZINGER Prefect ALBERTO BOVONE Titular Archbishop of Caesarea in Numidia Secretary In Forma Communi

Distinguished from In Forma Specifica Has the authority of a document of a Congregation Is an Instruction Is NOT a papal act nor document Is NOT infallible Archbishop (later Cardinal) Sgreccia

on Reproductive Technologies "Once the road to the separation between procreation and the act of conjugal love has been taken, the possibility of arresting the series of applications that stem from it is out of the question. It is therefore extremely difficult to prevent people from using procreation and the human being thereby `produced' according to convenience or caprice. In the Catholic context, when we denounced this danger in 1978

[1968?] the response from the secular world was that abusus non tollit usum ["abuse does not abolish use"]. But the fact is that that first step was already an abuse and of such portent that it made all subsequent abuses possible." Ongoing Points of Contention Inseparability of unitive and procreative dimension?

Moral reading of the will of God Debate over the masturbation of AIH Act-centered vs. Person-centered paradigms Life sacred from the moment of conception Slippery Slope & Contraception Let men reflect on the consequences of

methods and plans for artificial birth control. Let them first consider how easily this course of action could open wide the way for marital infidelity and a general lowering of moral standards. Not much experience is needed to be fully aware of human weakness and to understand that human beingsand especially the young, who are so exposed to temptationneed

incentives to keep the moral law, and it is an evil thing to make it easy for them to break that law Humanae vitae 17 Debate over Tubal Ligation

Finis Operis: Preventive Contraception Medicine Physicalist Paradigm & Contra Personalist

Principle naturam of Totality Intrinsically Ontic evil allowed Evil for proportionate reason Strengths of the Argument

Arguments Weaknesses of the Arguments CONGREGATION FOR THE DOCTRINE OF THE FAITH RESPONSES TO QUESTIONS PROPOSED CONCERNING "UTERINE ISOLATION" AND RELATED MATTERS

Q. 1.When the uterus becomes so seriously injured (e.g., during a delivery or a Caesarian section) so as to render medically indicated even its total removal (hysterectomy) in order to counter an immediate serious threat to the life or health of the mother, is it licit to perform such a procedure notwithstanding the permanent sterility which will result for the woman?

R. Affirmative. Explanation In the first case, the hysterectomy is licit because it has a directly therapeutic character, even though it may be foreseen that permanent sterility will result. In fact, it is the pathological condition of the uterus (e.g., a hemorrhage which cannot be

stopped by other means), which makes its removal medically indicated. The removal of the organ has as its aim, therefore, the curtailing of a serious present danger to the woman independent of a possible future pregnancy. Q. 2.When the uterus (e.g., as a result of previous Caesarian sections) is in a state such

that while not constituting in itself a present risk to the life or health of the woman, nevertheless is foreseeably incapable of carrying a future pregnancy to term without danger to the mother, danger which in some cases could be serious, is it licit to remove the uterus (hysterectomy) in order to prevent a possible future danger deriving from conception?

R. Negative. Q. 3.In the same situation as in no. 2, is it licit to substitute tubal ligation, also called "uterine isolation," for the hysterectomy, since the same end would be attained of averting the risks of a possible pregnancy by means of a procedure which is much simpler for the doctor and less

serious for the woman, and since in addition, in some cases, the ensuing sterility might be reversible? R. Negative. From the moral point of view, the cases of hysterectomy and "uterine isolation" in the circumstances described in nos. 2 and 3 are different.

These fall into the moral category of direct sterilization defined as an action whose sole, immediate effect is to render the generative faculty incapable of procreation . It (direct sterilization) is absolutely forbidden ... according to the teaching of the Church, even when it is motivated by a subjectively right intention of curing or preventing a physical or psychological ill-effect which is foreseen

or feared as a result of pregnancy . In point of fact, the uterus as described in no. 2 does not constitute in and of itself any present danger to the woman. Indeed the proposal to substitute "uterine isolation" for hysterectomy under the same conditions shows precisely that the uterus in and of itself does not pose a pathological problem for the woman.

Therefore, the described procedures do not have a properly therapeutic character but are aimed in themselves at rendering sterile future sexual acts freely chosen. The end of avoiding risks to the mother, deriving from a possible pregnancy, is thus pursued by means of a direct sterilization, in itself always morally illicit, while other ways, which are morally licit, remain open to free choice

Remaining Points of Contention Contention over the physicalist vs. personalist interpretation of the principle of totality If a woman were to become pregnant when medically counter-indicated then a hysterectomy (with the loss of the fetus) would still be allowed, whereas a tubal ligation would have prevented the pregnancy in the first

place Thus, issues of greater ontic evil caused without proportionate reason. Dispute over meaning of finis operis and finis operantis in the tubal ligation Moral Triangle

t Stra iple s As

sum s ture Fea ptio ns

Issues Angle egi Prin c

and Truth Claims Judgment Angle es

Tubal Ligation Goals Application Angle Liminal Issues in Stem Cell

Debates Presented by James T. Bretzke, S.J., The Human Genome Project: Scientific and Ethical Prospects Research, Interpretation, Application, Policy: Where Does Ethics Enter?

Genetic Research and Human Moral Behavior? Fact or Science Fiction? How To Decide? Maybe Science Can Us Help After All! Stem Cell Research

Definition Current Research

Prospects Dilemmas Arguments Pro Arguments Con Stem Cell Research Debate Stem Cell Timeline

Initial Ethical Concerns With Embryonic Stem Cell Production & Research What is Human Life & When Does It Begin? Where Do We Get the Embryos For Stem Cell Research?

Basic Embryonic Stem Cell Creation Somatic Cell Nuclear Transfer Stem Cell Leaving Embryo Intact Adult Stem Cell Process

MUSE: Pluripotent Adult Stem Cells MUSE: Multilineage-differentiating Stress Enduring stem cells The researchers in Japan succeeded in isolating and cultivating these cells from adult skin cells, and they appear to have promising potential for therapeutic applications.

When implanted in mice, the cells differentiated according to where they were transplanted, i.e. into muscle, nerve, liver, etc. cells. [I.e., pluripotent stem cells] MUSE cells are quite rare as 1 in 5,000 are found in bone marrow. They cannot multiply indefinitely but stop dividing after 2 weeks. However, they appear to be less risky, as shown by an experiment in which MUSE cells were injected into rat testicles: after 6 months, the rats did

not develop any tumors, unlike embryonic stem cells which caused cancer after 8 weeks. Framing the Moral Issues? Values Debate in Cloning: Reproductive vs. Therapeutic

2004: Human Embryo Cloned in Seoul, Korea Later Admitted to Be Fudged Data Therapeutic Cloning Putting A Human Face on the Debate

A Closer Look at Probabilism In case of practical doubt When credible, prudent arguments exist And/or trusted authorities hold a position One may in good conscience choose the option which has greater freedom Even if safer counter-arguments and/or authorities hold the opposite, and it is more

probable (I.e. probabiliorism) Roles of the Magisterium Guidance of the Holy Spirit in Authentic

Natural Law Interpretation Distinction between Principles & Their Concrete Applications Principle of Subsidiarity Role of Experience(s) Processes of Consultation Attitudes toward the Laity and Others

Where Are We Now? The Notion of Liminality: An in-between place, e.g., the doorway between old frame of reference and a new framework In this in-between place nothing seems fixed Yet in time one passes into the new frame of reference Example of moment of death: cessation of

breathing, stopping of the heart, or flat EKG? What will be the next liminal points to cross? Three Legs of Moral Discernment Openness to Gods Spirit Individual Effort

Community Discussion Remember the 6 Cs of Moral Discourse

Comprehensive (to the situation) Comprehensible (to the target audience) Consistent (internally and externally) Credible (dialogical and realistic)

Convincing (to the target audience) Christian (the ultimate test criterion) Remember the Principle of Conscience in Moral Living Sanctuary of Conscience Sacred Place: Where we meet God Safe Place: No outside authority may enter

Primacy of Conscience Always follow your conscience Even when erroneous But take care to form and inform Bring it all together Both Axes, Sacred and Rational Claim

Our Christian understanding of moral goodness grounded in our relationship with God, who is for us our Exitus et reditus and Summum Bonum 6 Cs of the Modes of Moral Discourse Moral Triangle of Moral Analysis Neither the Answers Nor the

Processes Are Simple. Need for genuine search for the truth Need for openness to the Spirit wherever it moves Need for prayer Need for dialogue

What Might Shift? If we move to integrate the Sacred Claim Axis, what might change? Different emphases? Different insights?

Different pastoral responses? A Final Word In fide, unitas: in dubiis, libertas; in omnibus, caritas "In faith, unity; in doubt, liberty; in all things, charity." Attributed to St. Augustine, this is an important

principle of Christian discernment: unity in faith is important, but in cases of doubt a plurality of opinions and practices should be allowed, and the over-riding principle must always be charity towards each other. For Further Reading Bretzke, James. Bioethics Bibliography: (on his web-page: https://www2.bc.edu/james-bretzke/default.htm)

Cahill, Lisa Sowle. Theological Bioethics: Participation, Justice, and Change. Washington, D.C.: Georgetown University Press, 2005. Chapman, Audrey R. Unprecedented Choices: Religious Ethics at the Frontiers of Genetic Science. Theology and the Sciences. Minneapolis: Fortress Press, 1999. Kass, Leon R. Life, Liberty and the Defense of Dignity: The Challenge for Bioethics. San Francisco: Encounter

Books, 2002. Mitchell, C. Ben, and Edmund D. Pellegrino, Jean Bethke Elstain, John G. Kilner and Scott B. Rae. Biotechnology and the Human Good. Washington, D.C.: Georgetown University Press, 2007.

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