Biomedical Ethics

Q: “My husband and I are trying to have children but are having problems. What reproductive technologies are ok with the Catholic Church?”

A: Children are a tremendous gift and an incarnate expression of the love of a husband and a wife. It is therefore no small suffering to struggle to conceive a child and to be faced with the prospect of infertility. Before this challenge, couples should know that Christ is very close to them and indeed desires to assist them with faith, hope and love, to respond faithfully to the promises they made on the day of their wedding and to continue to allow God to be the author of their marriage.

One way in which couples co-create with God is by always allowing their conjugal love to be unitive and procreative. Therefore, when faced with the prospect of infertility, one of the first things a couple should do is to learn a form of natural family planning. This will assist the wife in coming to understand the nature of her own cycle, and the husband to come to appreciate the gift of his wife’s body and her fertility. Infertility is generally understood to be a year of trying to conceive a child without success. Therefore, even if one were to approach the prospect of medical intervention, usually the first course of action is for a couple to begin some form of natural family planning.

Once a couple has learned a form of natural family planning, then the Church would encourage that a couple always respect a distinction between assisting a couple in conceiving a child and replacing that act by which a couple would conceive a child. And that is, as we mentioned, by allowing that both the unitive and procreative goods are always found together.

Therefore, if there were some underlying pathology of physical obstruction, or a difficulty with hormone balances, one could try to cure these things by medical interventions. But what is unacceptable from the perspective of the Church’s teachings and indeed the nature of natural law is to replace the conjugal act –that is, to conceive a child outside the womb of a mother. This is not only because the way in which the various gametes would be harvested as to permit the prospect ofin vitro fertilization is illegitimate, but also because often there are other injustices that are done to the newly fertilized eggs.

Q: “My doctor wants me to have prenatal testing done. No matter what the outcome, I wouldn’t want an abortion –should we do the testing?”

A: There is no obligation to engage in prenatal testing even at the recommendation of a doctor. If a couple is open to receiving the gift of life, one would always want to balance the prospect of the potential harm done by such testing (amniocentesis or other forms) and the possible curative assistance offered by such interventions. There are wonderful advances that allow intrauterine surgery on a child to assist their progress in gestation, but it is also the case that tests are often done in a way that can result in false positives or in fact create pressures on couples to think about terminating their pregnancy. Prenatal testing should be something that couples discuss with their doctor and if necessary with their parish priest.

Q: “I have heard that some of the vaccines that are routinely given to children come from aborted babies. Is this true? Should I have my child vaccinated?”

A: While it is the case that some forms of vaccine have come forth from testing upon aborted fetal material, the Church has taught that due to the lack of direct cooperation with these acts, most couples could if there were no other alternative, have their child vaccinated. The point here is one of material and formal cooperation. The important distinction is whether I share in the intention of what is taking place, and secondly whether, but for my participation, this act would have taken place.

Mindful of this, the Church acknowledges that the lines of responsibility have become so attenuated that couples can, in good conscience, have their children vaccinated. This being said, the Church also wants to encourage couples precisely for these same reasons to constantly seek to confirm the dignity of human life and to work for a culture of life in which even intrauterine life, even embryonic life, is protected.

Q: “My doctor wants to put me on ‘the pill’ to regulate my menstrual cycle. Is that ok with church teachings?”

A: Is it permissible for someone to be on the pill so as to regulate one’s menstrual cycle? At the basis of all moral deliberations is the question of the end and the intention of the act. Various forms of the pill and the hormones contained therein are used on a regular basis to regulate irregular cycles. There are often underlying issues or pathologies that would recommend a more holistic approach to assist a woman in regulating her menstrual cycle. That being said, someone who uses a pill specifically for the medical purpose of regulating her menstrual cycle, and not to separate the unitive and procreative natures of the marital act, would not be engaging in an immoral act. There are two important cautions, however. The first would be that the person, in this case the woman, was not intending to engage in marital acts. The second important caution is to make sure that this pill and its hormonal dose do not have abortifacient qualities—that is act as to thin the uterine lining and thus prevent implantation of the newly formed life in the womb.

Q: “I am nearing menopause and my doctor wants me to have a hysterectomy because of some difficulties I am having. My condition isn’t life threatening. Is it ok to have the surgery?”

A: It is very difficult to give a universal answer to the question of the hysterectomy in light of impending menopause. This is because, first and foremost, it is never a good thing to remove an organ of the body that is working properly. Menopause is part of the natural process of a woman’s maturation and it is not the case that a hysterectomy would in every instance be justifiable. That being said, it could well be the case that due to some underlying pathology it would be appropriate to remove the uterus. This of course will be an artful decision and it is best to be done only with the consultation of a doctor in the specific situation and perhaps also one’s parish priest.

Q: “I have had six miscarriages and there is little hope I can carry a child full term. Needless to say, this has left me emotionally raw and is difficult for my marriage. I don’t think I can go through another miscarriage. Is it against the church to go on contraception?”

A: It is indeed a very emotional and difficult thing to carry even one child with the hope of having it come to term and to suffer a miscarriage. A couple should be consoled by the fact that they are trying to cooperate with God’s providence in their life by generously receiving children from God. In this they have fulfilled the promises they made on the day of their wedding.

At issue here is whether or not a couple or a woman may engage in contraceptive sex so as to avoid the prospect of another miscarriage due to its difficult emotional consequences and potential health threat. Here once again the Church’s teaching is quite clear and, in fact, quite compassionate: She calls each married couple in their conjugal love to be an image of Christ’s love for the Church. That is to say, the couple is called to a self-gift which is totally unitive even in the procreative dimensions of their lives. It would however be the case if the couple, after discernment before God, has made a decision, that their family size is properly at its limit, or that any further pregnancy creates a great psychologically difficult situation for the marriage that they could limit their family size by natural family planning. The church encourages couples to learn a natural family planning model that can sustain their love and help them balance the difficult goods that are at issue.

Q: “I am pregnant and I just found out that I have cancer. The surgery would end my pregnancy. What should I do?”

A: It is a most difficult prospect to realize that one is suffering a potentially fatal disease at a time when a mother is filled with the hopes of a child and thus also of carrying their child to term. When, in fact, a woman is facing a life-threatening situation she does have the right to try to address her health. In so doing, she must always act to address the disease in question while respecting the gift and the integrity of the child that is in her womb.

Therefore, one may never directly act against that human life, that child in the womb, although one may engage in curative therapies aimed at assisting mother’s overall health. Under the double effect principle, therefore, even if it were the case, that a surgery or some sort of therapy was necessary, the following questions would first have to be considered. Could such surgery or therapy be delayed until such time that the child is able to come to term or at least to live assisted outside of the womb (usually in the 24th week)? If this is not possible, and the need to act is imminent, then it is permissible to act directly against the diseased organ even if one were to foresee that the child might die as a result of that. To address this specific situation one would have recourse to Double Effect.

Q: “My grandfather is in the hospital at the end stages of cancer. My siblings and I are in disagreement on further treatments and having a DNR order put on him. What is the right thing to do?”

A: The purpose of medicine and indeed healthcare as a whole is to return health to the body. It is however also the case that, as a result of original sin, death and disease are a part of our existence here on earth.

Therefore, when death is imminent, such as when one is in the end stages of cancer, it is not necessary to engage in experimental treatments (or for that matter any treatments) if in fact they have become disproportionate or extraordinary. This could even go so far as to allow do not resuscitate orders, or even the cessation of nutrition or hydration. The important distinction here is that death is imminent, and no action is performed which deliberately intends death.

If in fact cancer is near its end stages and is an incurable prospect, it is therefore appropriate to try to assist the family member in becoming comfortable—known as palliative care—and to look forward in hope to the prospect of eternal life. Here it would be most appropriate to call one’s parish priest to ask that the loved one receive the last rites and indeed gather in a vigil that will assist the person passing from death to eternal life.

Q: “My niece was in a car accident five years ago and never recovered from her brain injury. She has no awareness of the things around her. What is the difference between ordinary care and extraordinary treatments? How do we make that decision?”

A: Someone who has suffered a trauma to the brain, especially to the higher functions of the brain still remains a person who has a right not only to his or her life but also to the goods that are proper to sustaining human life. In such a case, death is not imminent (although the person might die from some other disease or infection). However, due to his or her dignity, such a person has the right to receive—and therefore caregivers have a duty to provide—the hydration and nutrition that would be necessary for the sustenance of the patient’s life. As long as death is not imminent, and nutrition and hydration can accomplish their proper end, it would never be permissible to withhold or to deny nutrition and hydration. When in fact death is imminent or nutrition, hydration, and treatment no longer achieve their end, such acts are considered extraordinary. In that case, the presumption to provide nutrition and hydration might in fact be overcome.

Q: “I am thinking about signing a living will but I am not sure I should. I have also heard about a durable power of attorney –what is that?”

A: It is permissible to execute a medical directive or complete a living will to assist one’s loved ones in having one’sown medical wishes appreciated and indeed fulfilled. It should always be done in a matter that respects human dignity and indeed human life. In this the Church desires to be of assistance. You can find information about medical directives and living wills that are in accord with Catholic teaching on this website and on the Minnesota Catholic Conference website.

Q: “My cousin has Parkinson’s Disease. It is a devastating illness. I heard that there is research using stem cells to find a cure. What is the difference between adult stem cells and embryonic stem cells? Can I support the research?”

A: It is the case that Parkinson’s and Alzheimer’s are both devastating diseases in part because the loved one whom we experienced as being so full of life, is now experiencing some form of mental and often muscular diminishment. The difference in the proposed therapies here is the prospect of never doing a harm so as to do a good—that is to say, never doing an evil so that good would come of it. Therefore when one is faced with the prospect of various therapies one would have the right to use any therapy that did not involve the deliberate harm to human beings, or destruction of human life.

Embryos used for their embryonic stem cells are only obtained by destroying new human lives. It would therefore never be permissible to use an experimental therapy that was based upon embryonic stem cells. It is however fully permissible to employ a therapy using adult stem cells (since they are obtained without the destruction of human life). In fact, there have been several cases of curative therapies that have been developed using adult stem cells. Adult stem cells are cells that are found in our hair follicles, our finger nails or in umbilical cords that have the potential of becoming pluripontent cells (cells having more than one potential outcome) and therefore are able to be used in various therapies.