Chapter IV
Life and Bodily Integrity
by John A. Hardon, S.J.
A superficial observer might wonder why a course in moral theology should include
a full-scale treatment of murder and mutilation, when even the most primitive
peoples had laws against unjust aggression and punished offenders with severest
penalties. The fact is that our present age has seen mass-killing practiced
as never before in history, and, under the guise of eugenics, social welfare
and pragmatism, has condoned actions that not only Christianity but all religious
systems have condemned as crimes against humanity.
Two world wars, with a total death casualty figure of almost thirty million
men killed in battle, have done much to reduce the horror of taking another
person's life. And all the evidence indicates that the trend is in favor of
a still more lenient view of homicide and its correlatives. Over six million
Jews were slain in cold blood during the Nazi purge of the Semitic peoples during
the thirties. The estimated number killed by the Communists in their numerous
pogroms runs in the millions, with the figure rising annually in Red China and
elsewhere.
The same attitude prevails in other countries that are presumably more enlightened,
and if the language in which homicide is described seems more humane, this is
deceptive. There is no difference in basic inhumanity of man to man. Sweden
and Denmark are a case in point. There contraceptive legislation (1937-1938)
had to be supplemented by more liberal abortion laws. In Sweden the State Insurance
began to pay the cost of abortion after the sixth child. Since then, abortions
have increased eight hundred to a thousand per cent in less than twenty years.
In the United States powerful voices are being heard in the legal profession
and state legislature, urging that penalties for doctors performing abortions
be removed. "It is a degrading, soul-searing experience for many women
(to have an illegal abortion performed), partly because of the kind of people
usually involved in its performance and also because of its clandestine nature."
(1) Thus argues a leading physician, crusading in favor of legalized abortion.
Euthanasia or mercy-killing has equally strong support. Where the medical profession
for centuries has been dedicated to saving lives and forestalling death, men
in and out of medicine are now promoting a new concept of physician-patient
relationship. If the patient would rather die than continue suffering, the doctor
is told to terminate life and hasten the end – with no concern about the duty
to practice medicine and not murder.
A century ago, textbooks in moral theology could afford to dispose of the Decalogue
commandment, "Thou shalt not kill," in a few paragraphs and speak
about such exotic things as duelling. But nowadays few mandates of the Christian
religion need more careful attention or demand greater concern among those who
still believe that taking an innocent person's life "cries to heaven for
vengeance," and that wanton injury to one's own or another's bodily integrity
is a violation of the temple of God.
Foundations in Judaeo-Christianity
The criminal nature of murder is clear from the narrative in Genesis about
Cain and Abel. After Cain had slain his brother, the Lord said to him, 'Where
is your brother, Abel?" Cain answered, "I do not know. Am I my brother's
keeper?" To which the Lord said, "What have you done? The voice of
your brother's blood cries to me from the ground. And now cursed are you in
the soil which has opened its mouth to receive your brother's blood from your
hand. When you till the soil, it shall not give its fruit to you; a fugitive
and a wanderer shall you be on the earth." (2)
After the deluge, Yahweh imposed the death penalty for shedding blood. In the
Decalogue given to Moses on Sinai, taking another's life was prohibited, with
the same injunction repeated in the Covenant Code and other sections of the
Pentateuch. Among the Jews, it was a religious duty to punish a murderer, which
was to be fulfilled by the relatives of the murdered man. In fact, the avenger
of blood was not allowed to accept a ransom as substitute. (3) Even an animal
that had caused the death of a man was to be killed. (4)
Exodus gives detailed laws about bodily injuries. When a man suffered a permanent
injury, just requital had to be given, i.e., lex talionis (law
of retaliation). "If injury ensues" from a quarrel, "you
shall give life for life, tooth for tooth, hand for hand, foot for foot,
burn for burn, wound for wound, stripe for stripe." (5) While theoretically
this could be taken in a literal sense that an offense must be satisfied
by an identical punishment, in practice these cases were mostly settled
by compromise. Similar provisions are found in the laws of other ancient
peoples.
Christ confirmed the teachings of the Old Law when He demanded
the keeping of the commandments as a condition for following Him. But
then He added further injunctions that raised the external keeping of
the precept to the internal obedience of mind and will.
You have learned that your forefathers were told, "Do not commit murder;
anyone who commits murder must be brought to judgment." But what I tell-you
is this: Anyone who nurses anger against his brother must be brought to judgment.
If he abuses his brother he must answer for it in the court; if he sneers at
him, he will have to answer for it in the fires of hell.
You have learned that they were told, "An eye for an eye, and a tooth
for a tooth." But what I tell you is this: Do not set yourself against
the man who wrongs you. If someone slaps you on the right cheek, turn and offer
him the left. If a man wants to sue you for your shirt, let him have your coat
as well. If a man in authority makes you go one mile, go with him two. Give
when you are not asked; and do not turn your back on a man who wants to borrow.
(6)
Christians have always taken these directives to imply that the essential malice
of murder or mutilation is not in the death or injury caused, but in the malice
by which they are inspired and the injustice which lies at their root. The distinction
is important for evaluating such difficult problems as participation in war,
resistance of an unjust aggressor, and indirect killing of a viable fetus. Lord
Acton summarized the idea in a crisp statement: the greatest crime is homicide;
the accomplice is no better than the assassin, the theorist worse.
Suicide
It is common belief in Christianity that to take life on one's own authority
is suicide and gravely sinful. Behind the precept is the implication that destroying
life is an exercise of dominion over something which is given to us in trust,
but which belongs by right to God alone. He has exclusive authority over life,
as its sovereign Creator and Lord. We are only custodians to preserve and protect
the bequest under divine mandate and according to God's conditions.
Sometimes we read in the lives of the martyrs that they cast themselves into
the flames, when condemned to be burned. If the accounts are correct, the best
explanation is that such people were miraculously inspired to do what they did,
in which case they would be acting with divine authority and not on their own.
Moralists also say that probably a criminal, justly condemned to death, may
be his own executioner when the state appoints him to that unwholesome task.
Professional studies in suicide causes and patterns indicate a close connection
between tensions of various kinds and the index of suicides. The American average
is about three times as many suicides among men as among women; the average
age for men is forty-six, for women forty-three. The scale of frequency, in
inverse ratio, is divorced, widowed, single and married--with about the same
proportion for Italy, France, Germany and Switzerland. There is a very slight
suicide ratio in the United States among the Irish, Italians and Poles; and
the Negro is much lower than the white population. While the American figures
are not the highest in the world, they are high enough to cause sociologists
concern; with the latest available number of suicides for a given year amounting
to over twenty thousand, for an annual rate of more than ten per hundred thousand
population which, incidentally, is higher than the death rate for tuberculosis.
Technically suicides are to be deprived ecclesiastical burial, according to
the Catholic code of canon law. The obvious exception would be if the person
showed signs of repentance before he died, but more commonly there is good evidence
that the one who took his own life was not mentally balanced, and therefore
not responsible for what he did. Case studies reveal a period of brooding and
dark introspection before the final collapse, and persons saved from suicide
attempts later confess to a mental blackout which quite erases any sense of
guilt over their self-destructive plans.
Taking one's life indirectly is not suicide, and may be done for sufficient
reasons. Indirect killing of self (sometimes wrongly called "indirect suicide")
occurs when a man has no intention of ending his life but consciously does something
which has two effects, one of which is intended and good, and the other a foreseeable
but unwanted death. It is presumed that the good effect follows from the action
as immediately as one's death. For example, an executive suddenly discovers
that his entire investment in a corporation was lost, with no chance of recovery.
He is now a poor man. So he turns a gun on himself and ends his life to escape
the future. In this case, death is the purpose of his act; it is not the means
to an end. Moreover, if a person were trapped in a sinking ship and to avoid
the suffering he anticipates, shoots himself – he intends death directly as
the means of escaping the pains of suffocation by drowning. In both cases, the
actions are morally evil and forms of suicide.
On the other hand, if a pilot in time of war tries to approach and set fire
to an enemy ship loaded with ammunition, he does not by that fact directly want
to cause his own death. No doubt he foresees what will happen and may even be
sure that the strafing mission will cost him his life. Were it possible, he
would prefer to carry the mission out successfully and survive the ordeal.
What he directly intends is to cripple the enemy, and to do this he allows (but
does not desire) his own concomitant destruction.
In the same category belong such actions as a man jumping from a great height
to escape burning to death, especially if there is some chance of survival.
A woman may do the same to avoid being taken by a man who wants to force her
by rape. However, sexual violation would not be sinful on her part, provided
she resisted to the best of her ability and then withheld internal consent to
the actual intercourse.
Abortion
Medically defined, abortion is the expulsion of a pregnant womb of its contents
in order to terminate further development of the embryo (through the first three
months of pregnancy) or fetus (from the end of the third month until birth).
Used technically, abortion refers to expulsion within the first three months.
When it occurs from the end of the third month to the time when life is possible
outside the womb (six months) it is called miscarriage or immature delivery;
from six to nine months (full term), premature delivery.
The same term, abortion, is used to describe the product of the womb expelled
before maturity. It is called accidental or spontaneous abortion when the emptying
of the womb is unexpected; it is artificial (or induced) when pregnancy is intentionally
terminated by means of medicine or surgery; criminal (or illegal) is probably
the commonest form of medical malpractice, always involving great danger to
the patient. Successive accidental abortions are said to be habitual; an incomplete
abortion takes place when the contents of the womb are only partially expelled
with some of the birth tissue remaining in the womb, normally requiring surgical
intervention to complete. Inevitable abortion is one that has proceeded to the
point where it cannot be prevented; missed abortion is a condition in which
death has occurred within the womb but in which the contents are retained for
several weeks afterwards. In multiple pregnancy it sometimes happens that one
of several developing infants is expelled.
Psychiatric abortion is the term coined to justify termination of pregnancy
because of the mental disturbance of the mother; therapeutic (or medical) when
pregnancy threatens the mother's physical health or life; a threatened abortion
describes the state of an imminent expulsion from the womb, while tubal abortion
means expelling the contents of conception products through the Fallopian tubes
which convey the ova that are discharged by the ovary to the uterus.
The foregoing medical details were necessary to clarify by anticipation a complex
subject. Our concern here is with any kind of intentional emptying of the womb
before a child can survive outside the uterus, i.e., a nonviable fetus. However
the term "abortion" is popularly used also to cover what is technically
infanticide, killing a viable fetus in order to prevent its live birth.
From the moral standpoint, therefore, abortion means the expelling of an immature
fetus from the womb of its mother. Of course, the fetus must be alive, because
if it is certainly dead, removal is not only allowed but normally necessary.
Its immaturity varies somewhat; normally a fetus is considered mature at the
end of the twenty-eighth week or at the end of the twenty-sixth week if the
child is to be born at a hospital where incubator care is provided.
Historical Survey. It is hard to appreciate the change
of moral climate that is currently taking place without some advertence
to the centuries of contrary tradition until modern times. The earliest
abortion laws of which we can speak with certainty are those of Hammurabi,
Babylonian King of Sumer and Akkad from 1728 B.C. His code was promulgated
in the first year of his reign, and, among its provisions, declares that
"if a seignior struck another seignior's daughter and has caused
her to have a miscarriage, he shall pay ten shekels of silver for her
fetus. If that woman has died, they shall put his daughter to death."
(7) Similar provisions existed among the Assyrians in their laws from
the fifteenth to the twelfth centuries B.C., in laws that surpassed those
of the Babylonians for severity: "If a woman has had a miscarriage
by her own act, when they have prosecuted her and convicted her, they
shall impale her on stakes without burying her. If she died in having
the miscarriage, they shall impale her on stakes without burying her."
(8)
In the early Greek and Roman Empires, abortion was
no doubt practiced, yet at least among the Romans, we have no indication of
its existence until we reach the decay of the Republic. By the turn of the fifth
century, B.C., the Athenian Empire had reached the zenith of its power, and
the Greeks of this period were familiar with the idea of an expanding population.
Two centuries later the problem had shifted to the other extreme, and the fear
of overpopulation was replaced by the dread of underpopulation. Writing in the
second century B.C., Polybius declared that the people of Greece were dying
out because of the practice of infanticide. Some evidence of the practice of
abortion among the Greeks is seen in the famous oath of Hippocrates, to which
physicians still subscribe (at least nominally) and which dates from somewhere
between the fifth and first centuries B.C. The doctor said, "I swear by
Apollo Physician ...that I will not administer poison to anyone when asked to
do so, nor will I suggest such a course. Similarly I will not give a woman a
pessary to cause abortion. But I will keep pure and holy both my life and my
art." (9)
One of the most dramatic descriptions of the low state to which feminine virtue
descended in Rome occurs in the poet Ovid (43 B.C.-17 A.D.), whose works are
commonly regarded as the opposite of puritanical. A certain Corinna is rashly
trying to commit abortion, and lies languishing in peril of her life.
Of what avail to fair women to rest free from the burdens of war, nor choose
with shield in arm to march in the fierce array, if, free from peril of battle,
she suffers wounds from weapons of her own, and arm her unforeseeing hands to
her own undoing?
She who first plucked forth the tender life deserved to die in the warfare
she began. Can it be that, to spare your bosom the reproach of lines, you would
scatter the tragic sands of deadly combat? If vicious ways like this had found
favor with mothers of olden times, the race of mortal men would have perished
from the earth.
Women, why will you thrust and pierce with an instrument, and give dire poisons
to your children yet unborn? Tell me, what Tereus provokes you on, what Jason,
to pierce your bodies with aggrieved hand? This neither the tigress has done
in jungles of Armenia, nor has lioness had the heart to destroy her unborn young;
yet tender woman does it – but not unpunished. Often she who slays her own in
her bosom dies herself. (10)
Significantly, the Romans on the eve of Christianity began making a distinction
between infanticide and abortion, like that of abortion proponents today, at
a time when morality had become mainly a matter of emotion. The shift from infanticide
to abortion was merely the change from doing something which the perpetrator
could see to something he could avoid seeing – while the effect in both cases
was the same.
Juvenal (60-140 A.D.) was Rome's greatest satirist. He spoke out in plain terms
at what was happening to his nation at the beginning of the Christian era. "We
are all suffering," he complained, "the evils of longcontinued peace.
Luxury, more ruthless than war, broods over Rome, and exacts vengeance for a
conquered world. No guilt or deed of lust is wanting, since Roman poverty has
gone." Money, he exclaimed, the nurse of debauchery, was the first to introduce
foreign ways, and "enervating riches sapped the sinews of the age with
foul luxury. For what cares Venus in her cups?" Then, he adds, as only
Juvenal could, what men have not yet learned twenty centuries after Juvenal
wrote.
Yet these, the poor, when circumstances so require, are ready to encounter
the perils of childbirth, and endure all the irksome toils of nursing. But
rarely does a gilded bed contain a woman lying-in; so potent are the arts and
drugs that can insure barrenness, and for bribes kill men while yet unborn.
Yet grieve not at this, poor wretch, and with your own hand give your wife the
potion, whatever it be. For if she chose to bear her leaping children in her
womb, you would perhaps become the sire of an Ethiopian; a blackamoor would
soon be your sole heir, one whom you would not see of a morning. (11)
With the coming of Christianity, the Judaic decalogue entered the stream of
Western history, and promptly took stock of pagan immorality in the Mediterranean
world. At some point between 65 and 80 A.D. appeared the Didache, the
earliest Christian writing so far known outside the canonical books of the New
Testament. It came to the heart of the matter. After stating that the first
commandment was to love God with one's whole being, it continued.
But the second commandment of the teaching is this:
You shall do no murder; you shall not commit adultry; you shall not commit sodomy;
you shall not commit fornication; you shall not steal; you shall not use magic;
you shall not use philtres (love potions); you shall not procure abortion nor
commit infanticide; you shall not covet your neighbor's goods. (12)
Throughout the centuries since then, Christian teaching has always been; You
shall not commit abortion. Apologists for Christianity compared the vicious
customs of the pagans with the demands for virtue of those who followed Christ.
"I see your newly born sons," wrote the Christian lawyer, Minucius
Felix (180 A.D.), "exposed by you to wild beasts and birds of prey, or
cruelly strangled to death. There are also women among you who, by taking certain
drugs, destroy the beginnings of an unborn human being while it is still in
the womb, and are guilty of infanticide, before they are mothers." (13)
Until fairly modern times, the civil law commonly recognized abortion as a
crime and imposed heavy penalties on those who took the life of an unborn child.
In 1803, for example, the first English statute on abortion removed the requirement
that the act come after quickening (about three month's pregnancy), while it
still preserved a distinction. It condemned those who wilfully used medical
agents with the purpose of inducing an abortion. It made no difference whether
the attempt was effective, or whether death resulted for the mother. In every
case it was a felony, punishable by death if a potion was given "after
quickening." Otherwise the penalty was imprisonment or deportation up to
fourteen years, whipping, or other corporal punishment.
In the United States, the first state to formulate a law directly against abortion
was Connecticut, which in 1821 made the attempt to abort a fetus by poisoning
a criminal offense. It substituted life imprisonment for the English death penalty.
By 1860, however, the law extended to similar attempts on any woman (and not
only on a late pregnancy), while the penalty was reduced to a prison term of
one to five years. Also for the first time appeared the qualification, unless
the act was considered "necessary to preserve the life of such woman."
Other states have similar provisions, although none of them specifies when "quickening"
takes place and therefore the upper time limit beyond which an abortion becomes
illegal. All but a few of the states punish acts done with the intent of destroying
the fetus, regardless of whether an abortion actually occurs.
The major change in attitude towards American abortion laws was reflected in
the model Penal Code, which the American Law Institute proposed in 1959 to state
legislatures for adoption. The proposal has since been supported by heavy propaganda
in the newspapers and magazines, calling for a more realistic appraisal of existing
abortion laws. Typical of the strong reaction it aroused, the Catholic bishops
of Illinois publicly protested against the code's enactment by the state legislators.
The code is entitled Abortion and Related Offenses.
1. Unjustified Abortion. A person who purposely and unjustifiably terminates
the pregnancy of another otherwise than by a live birth commits a felony of
the third degree or, where the pregnancy has continued beyond the twenty-sixth
week, a felony of the second degree.
2. Justifiable Abortion. A licensed physician is justified in terminating
a pregnancy if:
a. He believes there is substantial risk that continuance of the pregnancy
would gravely impair the physical or mental health of the mother, or that the
child would be born with grave physical or mental defect, or the pregnancy resulted
from rape by force or its equivalent as defined (in later sections), and
b. Two physicians, one of whom may be the person performing the abortion, have
certified in writing their belief in the justifying circumstances, and have
filed such certificate prior to the abortion in the licensed hospital where
it was to be performed, or in such other place as may be designated by law.
(14.)
This proposed change in law corresponds to the Danish abortion code of 1939.
Yet Denmark has not succeeded in solving the problem ostensibly aimed at by
this law. While the number of legal abortions in that country increased in twelve
years to about 5,000 a year, the number of criminal abortions, instead of being
done away with (as was hoped), increased to 9,000 a year. In Copenhagen only
seventy per cent of all pregnancies were allowed to go to full term to deliver
a living child; the rest were terminated by induced abortion.
The arguments of those who propose to make the American laws equally lenient
on abortion are familiar. It is said that, since abortions take place anyhow,
better give the women adequate medical care than have them suffer at the hands
of quacks and amateurs. A great deal is also made of the heartless cruelty to
unwed mothers, who are forced by present legislation to evade the law and seek
to be freed of an unwanted child by illegal means, at considerable risk to their
health and financial expense.
All discussion in favor of women pregnant out of wedlock is academic, since
the majority of those who want abortions today are wives who do not wish to
have a child. Moreover, to be consistent, other crimes like theft and homicide
should then be legalized, seeing that so many people are committing them, and
at some risk or inconvenience to themselves!
A sober illustration of how effective legalized abortion can be, is the case
of post-war Japan. In 1948, the Japanese passed a Eugenics Protection Law legalizing
abortion, sterilization, and the sale of contraceptives in an effort to curb
population. The law was passed during the Allied Occupation, in which the United
States was primarily in control.
Within a year, the number of abortions per thousand live births was over two
hundred; two years later it rose to three hundred; and recently the figure stands
at more than fifty per cent, or a million and a quarter abortions performed
annually under the aegis of the government. This mass-destruction of unborn
children has brought about the sharpest birth rate decline in modern history.
It has also done something drastic to the Japanese character, as competent observers
within the nation testify. The conscience of the people has become hardened
and only time will tell the further results of this dulling of national morality.
Moral Principles. There has never been any doubt in Christian
tradition that abortion is murder. If the exact time when the embryo acquires
a rational soul was long in dispute, this could not affect the basic teaching
of the Church. If, as some would have it, we cannot scientifically speak of
a human fetus before the lapse of six days after conception (or coitus), yet
any deliberate attempt to destroy what may already then be a human being is
murder in intention and therefore criminal. Actually the more common teaching
of Catholic moralists is that the human soul is infused into the body at the
moment of conception; and canon law requires that "care must be taken that
all abortive fetuses, no matter when delivered, if they are certainly alive,
be baptized absolutely; if they are dubiously alive, then conditionally."
(15) Baptism, we know, cannot be given except conditionally if there is a prudent
doubt about its validity; and there would be such a doubt, unless it were certain
that the fetus was a human being. Yet the Church prescribes absolute Baptism
of a fetus, no matter when delivered, with only one condition, provided the
fetus is alive.
In order to protect the dignity of motherhood and the helplessness of the unborn
child, a severe censure is attached by the Church to the crime of abortion.
The law is crisply strict: whoever procures an abortion, if the effect is produced,
incurs excommunication, from which only the bishop can absolve the woman and
all her accomplices, whether husband, doctor, pharmacist, or counselor.
But if direct abortion is always a grave sin, there are times when it is permitted
to give medication or perform an operation on the mother that will result, as
a side effect, in the death of the child. This is obviously not the same as
direct abortion, even though the net effect for the fetus is the same. It is
an application of the principle of the two-fold effect: 1) the action performed
on the mother is good, e.g., removal of a diseased womb or giving X-Ray treatments
to heal a cancerous growth; 2) the good effect, which is to save the mother's
life, is not secured by means of the death of the unborn child; and 3) there
is sufficient reason to permit, without intending, the evil effect of the child's
death to follow.
Behind this process stands the principle that a person always has the moral
right to remove a part of his body, or have therapy done to him, in order to
save the rest of his body (the whole man) which is threatened by some disease.
This right is not lost by the presence of a fetus in the womb, although in saving
himself the fetus in unavoidably lost. A few typical medical cases will illustrate
the principle.
Suppose a pregnant woman has an operable cancer of the uterus and the fetus
is not viable. If the pregnancy is in its first three months, the doctor may
proceed as if the pregnancy did not exist. If the fetus is so close to viability
that it might be saved, the doctor should use doses of radium that can hold
the cancer in check without harming the child in the womb, and then deliver
the child by caesarean section when viability is reached. However, if at any
stage in the case the doctor sees that, if he tries to save the fetus, the mother
will probably or certainly die, he may use surgery or radiation that is so heavy
the fetus cannot survive. One recommended choice is to use surgery rather than
radiation, because in this way the fetus has a chance of being baptized on delivery.
In another case, the pregnant patient undergoes an emergency appendectomy,
during which the surgeon discovers that the uterus is so scarred there is grave
danger of its rupturing if pregnancy is allowed to continue for any length of
time. The fetus cannot live to viability. Here again the doctor may operate,
remove the uterus, and provide for the child's baptism on delivery of the fetus.
Pregnancy or gestation, when normal, is uterine. But it may also be abnormal,
where the egg cell that has been penetrated by the sperm is not deposited in
the womb but elsewhere. Such pregnancies are called ectopic (out of place),
and may be one of three kinds: tubal pregnancy, when the fertilized ovum
settles in the Fallopian tube (one of two channels carrying the ova to the womb);
ovarian pregnancy in which the fertilized egg clings to an ovary; and
abdominal pregnancy if the impregnated ovum develops in some part of
the abdominal cavity. Of the three, the tubal kind of ectopic pregnancy is the
most common.
A classic case involves a pregnant patient who is discovered to have a six
to eight week old fetus in the Fallopian tube. Her general condition is not
good and the physician has reason to fear she could not survive another laparotomy
(surgical cutting into the abdominal cavity) if it were not done within a month.
If the patient's condition were better, the doctor would postpone the operation,
but in this case he may remove the tube at once. The reason is that the tube
is assumed to be gravely pathological, and further delay for another operation
would greatly increase the risk to the mother's life. In other words, the greater
probability of saving her life by an immediate excision allows the operation,
either because of the woman's delicate condition or because surgical facilities
would not be available when needed.
In a less familiar case of abdominal pregnancy, the fetus may have reached
maturity but the placenta (organ that develops on the wall of the womb and to
which the infant is attached by the umbilical cord) is hopelessly attached to
the intestines. If the surgeon removes the fetus, the operation will likely
kill the mother. If he lets the fetus die before removal, the operation would
be less dangerous to the mother. Here the doctor should weigh the probabilities,
namely, the probable risk for the mother, and the probability of saving the
child. If the chance of saving the child is at least as good as the chance of
causing the mother's death, he should operate, on the premise that the mother
should submit to an operation that will insure her child's baptism. But if the
probabilities are in the other direction, i.e., less likelihood of saving the
child, the surgeon need not operate even though he foresees that the fetus may
die as a consequence.
Always important to keep in mind is the gravity of danger to the mother's life
because of a pathological condition during her pregnancy. Unless there is real
danger, the fetus has prior rights. Thus, a woman may have a double pregnancy,
one in the womb and another in the Fallopian tube. Both are two months old.
The question is whether the tube may be removed (salpingectomy) in order to
safeguard the uterine pregnancy. It all depends. If the tube is presently a
grave threat to the mother's life, it may by excised. But if such is not the
case, it may not be tampered with. Notice here the difference between two purposes
of such an operation. If it is done to remove a pathological condition, this
is licit according to the principle of the two-fold effect; but if the reason
were merely to safeguard the uterine pregnancy, this would be inadequate grounds
for surgery.
Medical Advancement. Any discussion of abortion should include
some evidence of the great development of medicine which practically eliminates
(in most cases) the necessity of even indirect abortion, i.e., where an immature fetus is allowed to die in order to save the mother's life.
As far back as 1931, the Margaret Hague Maternity Hospital had opened in Jersey
City as one of America's leading obstetrical institutions. Dr. S.A. Cosgrove,
head of Obstetrics at Columbia University, was medical director at Hague for
over twenty years. He had one therapeutic abortion (TA) among the first four
thousand deliveries. When he reported this to the medical profession, he caused
a sensation because other hospitals were doing from one in six hundred to one
in a hundred deliveries. But his report jolted the medical profession and became
typical of a trend in the best-operated maternity wards. A standard medical
book, Principles and Practice of Obstetrics, has been thoroughly revised
to meet the new situation. "Therapeutic abortion.," declares the tenth
edition, "is rarely indicated and medical therapy has improved so much
that few affections justify its performance." (16)
In the meantime, Hague maternity was pointing the way to practically dispensing
with therapeutic abortion. It had delivered one hundred thousand babies with
only eight cases of TA, and by 1939 had abandoned the use of TA entirely.
Medical specialists in obstetrics have been outspoken in clarifying the issue.
Dr. Roy J. Heffernan, nationally known authority from Tufts University, told
a Congress of the American College of Surgeons that, "anyone who performs
a therapeutic abortion is either ignorant of modern medical methods of treating
the complications of pregnancy or is unwilling to take the time to use them."
For thirty-five years, Heffernan wrote, he had watched the progress of medicine
changing the previous attitude towards therapeutic abortion. In the early thirties,
practically any complication of early
Strangely enough, during this time those of us who held intrauterine life inviolate
were not piling up tremendous mortality lists. Our task was not easy. Many patients
with serious complications required long, painstaking, expert care. With proper
care, these women did not die.
It has been most pleasing in recent years, to watch how science is at last
catching up, so to speak, with ethics. Following bitter experiences, the advocates
of therapeutic abortion have, in the past twenty years particularly, consistently
narrowed down what they felt were proper indications for this procedure. When
therapeutic abortion in the presence of pneumonia increased the mortality by
fifty per cent, when therapeutic abortion in cardiac disease reached the state
that obstetricians and cardiologists alike were publishing the statement that
cardiac decomposition plus interruption of pregnancy equaled death, and when
succeeding reports of successful management of the complications of pregnancy
without abortion were published in literature, so much professional embarrassment
was engendered that therapeutic abortion lost much of its popularity.
In the past ten years the indications for interruption of pregnancy for organic
disease have fallen off sharply and during that time so-called psychiatric disorders
have become more popular substitutes. This popularity bids fair to be short-lived
as psychiatrists are beginning to point out in the literature that the anxiety
state, guilt complex and conversion neuroses, which have followed therapeutic
abortion, have made the patient's psychiatric condition worse. (17)
With all this mass of evidence against therapeutic abortion on medical grounds,
why should anyone want to relax the existing statutes against criminal abortion
and, as the model code of the American Law Institute urges, make abortion available
to anyone who asks for it? The reasons are neither medical nor psychiatric,
but social. They reflect the growing impatience in some circles with any restriction
on human liberty, even when the object of liberty is morally reprehensible.
Most abortions practiced in the United States (as in the world) are those of
married women who did not wish to become pregnant. Behind their desire
to be given more freedom in terminating pregnancy is a new philosophy
of womanhood, which proponents are brutally frank in describing. In the
past, it is said, the rearing of children has been an unqualified contribution
to society because of high mortality, but in the twentieth century it
is a questionable achievement. In fact, it is a self-indulgence. "As
soon as babies become a distraction, a sedative, or a justification to
a life which has succumbed to outer pressures at the expense of inner
development, their birth is lamentable …Girls and women in their
new, their own unfolding will but in passing be imitators of masculine
vices and virtues and repeaters of masculine professions." (18)
Much of this is hidden beneath the smooth diction of professional abortionists
who are pressuring state legislatures to amend the existing laws in order to
expedite their trade.
Sterilization
Comparable to the practice of abortion is the custom of sterilizing people
as a means of preventing them from having any more children. In general, sterilization
is any method of making an individual incapable of reproduction. It may be surgery,
as tying off the tubes in the female or the spermatic cord in the male, X-rays
or intravenous injection. Various drugs may also be given to render the male
or female generative organs sterile.
As with abortion, sterilization is direct when its purpose is precisely to
remove the power of procreation; it is indirect if permitted in order to remedy
some pathological condition. Indirect sterilization is also called therapeutic.
Heading the list of direct sterilizations is the punitive type, performed on
persons convicted of certain crimes, notably sex offenses. The argument in favor
of such sterilization argues from the grounds that, if the state has a right
to inflict capital punishment, it may also inflict penalties that are less severe,
like mutilating the procreative organs. Furthermore, it is argued that sterilization
is truly punitive because it deprives the criminal of a real benefit, the integrity
of his body and the power of having children.
But contrary reasons are more weighty. No doubt there is some punishment, but
scarcely for the type of man (or woman) concerned in sex criminality. So far
from restraining, sterilization actually gives the person freedom to indulge
in sexual aberrations without the risk of inducing pregnancy or becoming pregnant.
Criminologists concur with moralists on the inefficacy of sterilization as a
legal penalty.
In theory, it is true, the state has a right to sterilize criminals, if such
penalty were truly punitive. But in view of the encouragement this gives to
sex offenders, the practice of punitive sterilization must be declared morally
unjustified.
A more common form of sterilization, called eugenic (well born), has for its
purpose the prevention of propagating abnormal offspring, whether mentally deficient
or congenitally diseased. According to its proponents, certain kinds of defect
and evil tendencies are directly transmitted from parents to offspring, or at
least acquired from early association with defective parents. The most familiar
defect that eugenists claim should be checked by sterilization is feeblemindedness.
Feeblemindedness is a broad term which covers numerous varieties. Not a few
children are born mentally deficient for reasons entirely distinct from their
immediate ancestors. It may have been injury sustained in pregnancy or birth,
or the terminal result of "multifactorial inheritance," namely, the
hereditary factors received from both parents, themselves sound in mind, when
pooled together happen to form a combination that results in the development
of a below normal intellect. However, the occurrence of such a condition could
not be foretold in advance, and so the case for sterilization is absent. Even
though the pair were to produce one feebleminded child, there is no special
chance they will produce another who is anything but normal in every way.
Imbecility and idiocy are deeper grades of feeblemindedness. An idiot has practically
no use of intelligence; an imbecile is mentally defective, but shows glimmers
of rationality, while a feebleminded person has never had completely normal
mentality. All three differ from the insane who once had a sound mind but lost
it as a result of disease or injury.
Eugenists appear to have more of a case in favor of sterilizing idiots and
imbeciles, whose condition is not only more severe than ordinary feeblemindedness
but may even prove fatal – as in the case of the inherited "amaurotic"
idiocies which kill a child in his early years. Moreover idiocies and imbecilities
are often caused by a single drastic hereditary factor which runs straight down
the family tree.
However, specialists in genetics point out that here, too, inheritance is not
so simple as is usually thought, and most of such children (for example all
amaurotics) are born of perfectly normal parents coming from families in which
the malady has never previously appeared. This may seem to conflict with the
idea of inherited characteristics, except that a child who is an amaurotic idiot
needs to receive two doses – one from each parent – of a certain hereditary
factor, which in itself has no harmful effect and cannot even be detected when
present in a single dose. Each of the parents, therefore, might be carrying
a single dose of the dread disease for centuries without anybody being the wiser.
In fact, it is reasonable to suppose that not a single person in the whole country
is entirely free from carrying some hereditary condition which, if it were to
pair up with some second similar factor in the conception of a baby, might produce
a fatal or imbecile condition in the child. To be consistent, then only the
sterilization of the whole nation could eradicate hereditary factors of this
type!
Another element is the extra-hereditary source of many so-called congenital
diseases, like some unpredictable error in the chemistry of the processes of
growth before birth, which sterilization could not anticipate. Some of the mongoloid
idiots are believed to be of this type. They are often children of more elderly
mothers, in whom some bodily deficiency explains their failure to supply the
child with what it needs during gestation.
Lastly, it may be admitted that a few types of mental degeneracy are inherited
directly from parent to child, so that theoretically sterilization might forestall
the birth of children with such disease. But the net effect would be only to
reduce their frequency, because all hereditary traits start at some time or
other by a mutation (rearrangement of the actual atoms in a transmissible hereditary
factor). A white forelock of hair, for instance, can have been inherited from
one's parents; but not everyone in the family has a white forelock, and they
are known as "mutants," i.e., persons in whom a fresh mutation shows
its effects. They can hand on the condition to their offspring, although they
themselves did not receive it from their parents. If we substitute "mental
defect" for "white forelock," we have some idea of the impossibility
of controlling fresh crops of mutants, whose number would run into a considerable
figure.
Statistically it can be shown that sterilization is most ineffective in reducing
the incidence of mental deficiency. Carefully estimated studies have proved
that it would take at least two thousand years of constant sterilization to
reduce feeblemindedness from a proportion of one per thousand to one per ten
thousand population.
Yet the real issue is not statistical but moral. Human beings are not mere
animals and carriers of certain hereditary traits, whether desirable or undesirable.
They have inherent rights to bodily integrity which no one, whether private,
individual, or the state, has any license to ignore. A good example of the contrary
is what happened under the National Socialists in Hitler's time. Hitler introduced
in 1934 compulsory sterilization for nine medical conditions, mostly mental
ones, that were considered hereditary. Before long the logical extension of
this theory was to conclude: it is equally correct to prevent (by sterilization)
the life of a new defective as to prevent (by killing) the life of a defective
already born. Accordingly over fifty thousand adults, and a large (perhaps greater)
number of children were disposed of on the grounds of mental deficiency.
One would think the evidence against eugenic sterilization was so strong that
no one would seriously advocate its practice, let alone have it become mandatory
by legislation. The fact is that most states in America have laws which favor
sterilization, and existing manuals in Sociology simply assume the validity
of the practice.
(Sterilization is) the policy of preventing propagation,
especially of the congenitally feebleminded, insane, epileptic, and others revealing
grave hereditary defects, by means of surgical operation rendering the subject
sterile. The operation is slight in the case of men but more serious in the
case of women. During the last thirty years the educated public has gradually
awakened to a realization of the enormous costs involved in permitting the congenitally
unfit to propagate. Movements for the sterilization of these unfortunates, under
proper safeguards, have sprung up not only in America but in Great Britain and
Germany. Since 1907 sterilization laws have been passed in at least thirty states
of America. (19)
The "proper safeguards" supposedly provided in American sterilization
laws are so notoriously discriminatory that community pressures have in many
cases successfully prevented the full application of the statutes. In states
where sterilization is not legal, civil officials (like the judiciary) sometimes
take the law into their own hands and order individuals brought before them
to be forcibly sterilized.
One aspect of sterilization follows the same moral pattern as abortion, where
an evil effect is permitted for the sake of a proportionate good. Indirect or
therapeutic sterilization is licit when a competent doctor decides it is necessary
to save a person's life or cure him of some grave disability or disease.
Prolapsus uteri is a condition in which the womb has fallen downwards
through the vaginal canal, carrying with it the walls of the vagina so that
they hang outside the vaginal opening. A textbook case shows the patient with
such a malady, along with erosion and infection of the cervix. If the doctor
believes that the latter may become cancerous and therefore should be amputated,
he may do so. If he thinks a complete hysterectomy (excision of the uterus) is
preferable for the permanent cure of the patient, this operation may also be
performed. However, there should be something more than unfounded fears that
carnoma is possible; a test would have to be made beforehand, say by a positive
Papanicalaou smear or a positive biopsy specimen.
Or again, a woman has a double uterus. To prevent her having two pregnancies
at the same time and reduce the risk of premature labor or other complications,
the surgeon removes one womb. A year later the patient suffers severe internal
bleeding from a large fibroid in the remaining uterus, and the doctor wants
to remove the second womb. He may do so to save the woman's life. The prior
question about whether he should have removed the first womb, should be answered
affirmatively. True it was not jeopardizing the patient's life, but then neither
was the surgeon suppressing the generative function nor preventing future fertilization.
He was simply eliminating a part of the body which was not necessary and which
would hinder the right functioning of the other womb. The space left by the
excised organ would serve during pregnancy for the healthy growth of the fetus.
The doctor was actually helping the generation of children and remedying a natural
defect.
Many sterilizations are not licit, of course. Even when they pass technically
for therapeutic, the reason advocated may be insufficient or merely an excuse
for avoiding future conceptions. Say a doctor has excised one ovary because
of a dermoid cyst. He wants to prevent the development of another cyst in the
second ovary. So to avoid the necessity of a second operation, he removes the
other ovary, which is unquestionably in normal health. The operation was illicit
on two grounds: the second ovary in no way endangers the life or sound health
of the woman; nor is excision needed to prevent the spread of a disease. Just
because a disease is possible gives no warrant to mutilate the body or deprive
an organ of its function.
Parallel with sterilization arises the question of using drugs during pregnancy.
As a general rule, drugs may be used for the purpose of healing a disease or
relieving pain. Quinine is a familiar example. Although it does not induce abortion
regularly, it sometimes has this effect and women have been known to take the
drug for just that purpose, since it is easy to obtain and is often effective.
Other drugs which relieve pain, like morphine and demerol, can harm the fetus
just before delivery, when its delicate centers of respiration no longer receive
oxygen through placental circulation, and heavy doses of analgesics may harm
the fetus at earlier stages of gestation.
If therefore, the immediate purpose of taking such drugs is the legitimate
one of providing a remedy for sickness or pain, they may be taken, while permitting
certain undesired side effects, for a proportionately grave reason. Doctors
can normally be trusted to know how much of which drug may be taken safely,
and pain relievers can be measured in doses that will both alleviate discomfort
and not be dangerous to the unborn child.
An obvious case would be that of a woman suffering from malaria, who is pregnant
with a non-viable fetus. In order to cure the malaria, the doctor prescribes
quinine, which may be taken if no other medication is available that would be
less dangerous to the fetus. It happens, however, that several drugs (atabrine,
aralen and pamaquine) have been developed for the treatment of malaria, that
are even more effective than the older drug and have little effect upon uterine
contractility, which is the well-known objection to quinine.
Even such a thing as a common cold might be treated with quinine, where the
doctor knows from experience it proves effective, provided the doses prescribed
for a pregnant woman will not injure the fetus.
Euthanasia
Euthanasia, derived from the Greek eu (well) + thanatos (death),
means bringing about a gentle and easy death to save suffering. Proponents of
euthanasia can make out a strong case for permitting euthanasia in certain circumstances. Suppose that one of two men were shipwrecked on an uninhabited
island was bitten by a deadly snake, or had fallen off a cliff and suffered
terrible injury. In either case the only outcome was increasing agony until death intervened. Would not his companion be showing true mercy
by shortening his time of pain?
However, euthanasia is by no means a fanciful possibility limited to exotic
situations on some remote South Sea island. It is favored by numerous people
in America and elsewhere, and, though presently unsupported by the law or medical
ethics, received almost fifty percent approval in a recent poll. among persons
who were asked whether they wanted euthanasia under government supervision.
Cases of doctors practicing mercy killing are frequently publicized, and many
others never become known. Public sympathy tends to defend euthanasia, and many
modern juries simply refuse to convict a mercy killer, like the girl of twenty
who poisoned her mother, whom she could not bear to see suffering acute pain
from an incurable disease, or the young mother who shot a daughter that was
born blind. Not many years ago two thousand New York physicians drafted a bill
to make euthanasia a legal means of what they called "merciful release."
In a survey of four thousand doctors of the state of New York, eighty per cent
favored mercy killing, and in the same state, almost four hundred Jewish and
Protestant clergyman urged the passage of a bill that would authorize doctors
to kill their patients, under safeguards, when afflicted with certain diseases.
In spite of the arguments of sentimentalists, euthanasia stands condemned at
the bar of reason and faith as a crime against nature and should be called by
its right name, mercy murder.
The basic reason why euthanasia is morally unjustified is that God alone has
the right over man's life and death. No one may usurp this ownership. Along
with oblivion of this fact is the practical denial that pain and suffering have
any value. Yet Christians recognize that pain has been raised by faith to the
plane of sacrifice, where a person willingly accepts suffering from the hands
of God in order to purify himself spiritually and better dispose himself for
the life to come.
It is useless to appeal to the principle of the double effect in the case of
euthanasia, as though a doctor is simply choosing the lesser of two evils because
the patient is going to die anyway. Actually the choice in euthanasia is between
these two alternatives: allowing nature to run its course in causing a painful
and lingering death, or quickly administering a murderous blow to induce a speedy
and painless death. Admittedly both cases involve evil, but with a vast difference.
In the first case the evil is physical, in the second it is moral, i.e., sin,
which may never be deliberately intended or committed. The unjust killing of
an innocent person is always murder and remains morally reprehensible under
any circumstances.
Morals aside, euthanasia would be the death knell of the medical profession,
and most doctors recognize this. Not long ago, the World Medical Association,
composed of national medical associations in forty-one nations, adopted in general
assembly a resolution that called euthanasia "contrary to the public interest
and to medical principles as well as to natural and civil rights." Individual
physicians have expanded on the reasons for this attitude.
By no means unimportant to consider are the possible effects of legalized euthanasia
upon the status of the medical profession and, thus ultimately, upon the health
of the people.
The elevated conception of the dignity and the high seriousness of the physician's
calling were not easily gained. It was only after centuries of convincing proof
that the sole purpose of the physician as a physician was to prolong life and
relieve pain that medicine was able to advance.
It was only after law no more demanded infallibility on the part of the physician,
nor even the highest degree of skill, knowledge and care, but only that degree
of skill, knowledge and care commonly possessed and exercised by the average
reputable practitioner in the locality, that it was possible for medicine to
improve the accuracy of diagnosis and to better the methods of its treatment,
and that came about only after one development --absolute confidence that the
aim, and only aim, of the physician was to prolong life and to relieve suffering.
Now there are those who would assign to the physician a duty of shortening it.
(20)
Typical cases will illustrate the principle. A two-day old child is found
afflicted with severe spina bifida. This is a defect in the development
of the spinal column, which is not closed, but often has a protrusion of the
covering of the spinal cord and at times nerve tissue. Although the parents
may request the doctor to give a fatal drug, he may not do so, since the parents
have no right to decree the death of their child.
Another patient, an adult of mature years, has been wounded by a bullet in
the spine. As a result, he is suffering from paraplegia (paralysis of the legs),
incontinence of the natural functions, and intense pain. He may live a few weeks
or a couple of months. If the doctor is asked to end the man's life and he complies,
his action is murder or, from another viewpoint, he is formally cooperating
with the man's act of suicide.
Sympathy for the nursing profession may occasion similar reactions. Take the
case of a man whose tongue and jaw are completely replaced by cancerous growth.
Because of the stench and the constant flow of saliva mixed with blood, he is
repulsive to all who attend him. Attending physicians may say that no one should
be expected to nurse a man in such a condition. If they order a fatal drug,
they are guilty of murder, since the patient's intolerable state does not deprive
him of his right to continued life.
As formulated by the Euthanasia Society of America, euthanasia is "the
termination of human life by painless means for the purpose of ending severe
physical suffering." Thus defined, mercy killing is murder and may never
be done. However, doctors also speak of "therapeutic euthanasia,"
which is an unfortunate term, where a patient is made unconscious by the use
of drugs in non-lethal doses in order that he may have a painless death.
In general, even so-called "therapeutic euthanasia" is forbidden.
Behind this prohibition is the Christian belief that a person should be rightly
prepared for death in the sense of being in the state of friendship with God.
Consequently administering drugs to a person who is not prepared for death is
never allowed, on the premise that hope remains for his eventual spiritual dispositions
to enter eternity. In such cases, one should oppose as far as possible the doctors
and relatives who desire to see the patient die while he is unconscious. If
the dying person is well prepared for death and there is danger of his falling
into sin, drugs may be given: but such practice is not permitted merely to remove
the ordinary anxieties that accompany the death agony.
Always in problems connected with euthanasia stands the irreconcilable conflict
between two sets of values, one material or this worldly, and the other spiritual
or supernatural. Where those who have no faith logically seek to end their misery
as soon as possible, because they find no purpose in "useless suffering'
and expect no reward for their pains – the Christian believes that death is
the entrance into eternity and suffering on earth a means of insuring greater
happiness in the life to come. The Christian, in his own way, also favors euthanasia,
in the sense of a "happy death" whose joy derives from the assurance
of dying to the grace of God.
Chapter IV
Life and Bodily Integrity References
- A. F. Gutmacher, "Abortions," in Modern Marriage and Family
Living, Oxford Univ. Press, 1957, p. 410.
- Genesis 4:9-12.
- Numbers 35:31.
- Exodus 21:28-32.
- Exodus 21:23-25.
- Matthew 5:21-22, 38-42.
- Ancient Near Eastern Texts, p. 175, Law num. 209-210.
- Ibid., p. 185.
- Medical Dictionary, New York, Ungar, 1955, p. 283
- Ovid, Amores, II, 13-14.
- Juvenal, Satires, VI.
- Didache (Teaching of the Twelve Apostles), II, 1-2.
- Minucius Felix, Octavius, 30.
- Model Penal Code, 207.11 ; Tentative Draft No. 9, 1959.
- Canon 747.
- Joseph DeLee, Principles and Practice of Obstetrics, Philadelphia,
1951, pp. 97-977.
- Roy J. Heffernan, in Medical Ethics (E. F. Healy), Chicago, 1960,
pp. 197-198.
- Population versus People, Population Bulletin 16, 1960, p. 145.
- Willystine Goodsell, "Sterilization," Dictionary of Sociology,
Paterson, N.J., 1961, p. 308.
- I. M. Rabinowitch, Medical Ethics, p. 269.
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