Comprehensive overview of Catholic teaching on practical issues in modern medicine and bioethics. This second edition includes a new chapter on bodily modifications and a series of new figures, as well as bringing the original text up to date in light of the teachings of Pope Francis and recent events such as the covid-19 pandemic.

In lieu of an abstract, here is a brief excerpt of the content:The Ethics of Surgical Interventions for Body Integrity Identity Disorder and Gender DysphoriaNicanor Pier Giorgio Austriaco, O.P.IntroductionOn May 20, 2009, Fox News featured a report that described the life of a man named "John" who had spent his life struggling with Body Integrity Identity Disorder (BIID).1 In a phone interview, John admitted that he remembers wanting to amputate his leg when he was between seven and eleven years (...) of age, by sticking his leg under the rear wheel of a bus. He never went through with it but continued to experience an intense desire to amputate his healthy limb for the following fifty-plus years. Described for the first time in 1977 as apotemnophilia, BIID was originally thought to be a psychological disorder characterized by sexual arousal associated with the desire to be an amputee. However, it was renamed when Dr. Michael First, a professor of clinical psychiatry at Columbia University, proposed that the primary motivation behind the condition was an issue of identity rather than of sexual desire.2 This proposal is controversial.3 Despite much [End Page 1003] debate, BIID was not included in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which was published on May 18, 2013.In this essay, we will consider the ethics of surgical interventions for BIID and Gender Dysphoria (GD).4 We begin with a discussion of the principle of totality that distinguishes ethical from unethical modifications of the body. We will refer specifically to the latter category of surgical interventions as "mutilations," though the Catholic moral tradition's use of the term is itself ambiguous.5 This is followed by an extensive moral discussion of (1) amputations of healthy limbs for patients struggling with BIID and (2) sex reassignment surgeries for those who identify themselves as transgender persons. I will propose that an ethical argument can be made to justify the former but not the latter.The Principle of TotalityBecause of the goodness of the human body, its integrity is a good that has to be protected and preserved. The ethical principle that is used to judge the morality of bodily interventions that impinge upon this bodily integrity is the principle of totality.6 It was articulated by St. Thomas Aquinas in his Summa theologiae as follows:Since a member is part of the whole human body, it is for the sake of the whole, as the imperfect for the perfect. Hence a member of the human body is to be disposed of according as it is expedient for the body.... If, however, the member be decayed and therefore a source of corruption to the whole body, then it is lawful with the consent [End Page 1004] of the owner of the member, to cut away the member for the welfare of the whole body.7Over the centuries, Catholic moral theologians appealed to the principle of totality to justify three different scenarios that involved the sacrifice of a bodily organ for the sake of the whole human organism. The first case involves a diseased organ that has to be removed to save the life of the soldier wounded on the battlefield—say a gangrenous, decaying limb as in the example of Aquinas. The second case involves the healthy foot of a man who is trapped on a railroad track that has to be amputated to save his life from a collision with a train, and the third case involves the healthy limb of an individual that has to be amputated in response to a tyrant who orders him to cut off his own hand or lose his head to the executioners instead. In these cases, the sacrifice of the part would be morally permitted as a necessary means of preserving the life of the individual. As Fr. Gerald Kelly, S.J., points out, this final case is particularly significant because it involves a healthy limb whose very presence—and not its diseased or trapped condition—becomes a source of vital harm for the organism.8How does one justify the principle of totality? In 1944, Pope Pius XII explained it this way: "Man's power over his... (shrink)

Patrick Lee and Germain Grisez have argued that the total brain dead patient is still dead because the integrated entity that remains is not even an animal, not only because he is not sentient but also, and more importantly, because he has lost the radical capacity for sentience. In this essay, written from within and as a contribution to the Catholic philosophical tradition, I respond to Lee and Grisez’s argument by proposing that the brain dead patient is still sentient because (...) an animal with an intact but severed spinal cord can still perceive and respond to external stimuli. The brain dead patient is an unconscious sentient organism. (shrink)

There are two competing accounts for a theory for human action proposed by Catholic theologians working within the received moral tradition today: a hylomorphic account and an intentional account. In this article, the author compares each of the rival theories for its ability to explain both the structure and morality of the human acts surrounding the elective termina­tion of the pregnancy of a woman with pulmonary arterial hypertension. This scenario of PAH is a superb test case to compare the explanatory (...) power of the two rival action theories. The author’s analysis reveals that the hylomorphic account is the superior account, which can explain better not only the norma­tive conclusions of the Catholic moral tradition but also our lived experience as acting persons in a world governed by cause-and-effect relationships. National Catholic Bioethics Quarterly 11.3 (Autumn 2011): 503–518. (shrink)

There are two competing accounts for a theory for human action proposed by Catholic theologians working within the received moral tradition today: a hylomorphic account and an intentional account. In this article, the author compares each of the rival theories for its ability to explain both the structure and morality of the human acts surrounding the elective termina­tion of the pregnancy of a woman with pulmonary arterial hypertension. This scenario of PAH is a superb test case to compare the explanatory (...) power of the two rival action theories. The author’s analysis reveals that the hylomorphic account is the superior account, which can explain better not only the norma­tive conclusions of the Catholic moral tradition but also our lived experience as acting persons in a world governed by cause-and-effect relationships. National Catholic Bioethics Quarterly 11.3 : 503–518. (shrink)

The COVID-19 pandemic has raised questions about the just allocation of limited medical resources. In this essay, I consider four pressing moral questions raised by the scarcity of mechanical ventilators, using the guiding principle that the primary criterion should be the conviction that each and every human being has equal moral status because each has an intrinsic dignity that makes him or her inestimable and inviolable. I propose that any legitimate criteria for ventilator allocation cannot discriminate among patient populations on (...) the basis of any judgments that are not medically relevant. Instead, ventilators should be distributed solely on the basis of the likelihood that they will benefit patients and enable them to heal. (shrink)

For many contemporary Christian theologians, evolutionary biology rules out any account of an Adam and Eve that would explain the origin of our species. In response, I propose that they have uncritically embraced the anti-essentialist presuppositions of the dominant scientific narrative for the origins of our kind. In fact, there are sound and robust reasons to think that human beings share an intrinsic essence that puts them into a natural kind. I also propose that our natural kind can be defined (...) by our developmental capacity for language, which I suggest is needed for abstract thinking. Thus, it is still reasonable to trace the origins of our natural kind to an original individual. He would have been the first anatomically modern human to have evolved this capacity for hierarchical and non-linear language that allowed him to construct an abstract internal map of the world. (shrink)

Human cell lines are well-characterized laboratory cultures of human cells derived from a single source. In recent years, much moral controversy has surrounded human cell lines and biological materials obtained from aborted fetuses and destructive human embryo research. Dignitas personae instructs scientists of good conscience to avoid using biological materials of illicit origin, to distance themselves from evil, and to avoid scandal. The author suggests that the Instruction allows a scientist to delay discontinuing the use of a morally controversial cell (...) line for a reasonable amount of time and allows a citizen of conscience to financially support—in a limited and restricted manner governed by prudence—philanthropic organizations that fund controversial biomedical research programs. National Catholic Bioethics Quarterly 10.2 : 265–272. (shrink)

In his encyclical on the environment, Laudato si’, Pope Francis proposes that the natural moral law can be reimagined as an ecological moral law that challenges us to evaluate the morality of our actions not only within our personal and nonpersonal relationships in society but also within the greater reality that is creation. In this essay, the author offers several reflections on the ramifications of this innovative proposal on a contemporary Catholic bioethics that seeks to be faithful to the classical (...) moral tradition. (shrink)

In our postmodern, secular, and liberal society, many individuals are struggling with a crisis of meaningful desire. In response, the goal of preaching Catholic bioethics should be to help people to order their desires so that they are all oriented toward their authentic good. This is done by infusing their intellects with truth and by exhorting them to order their appetites and emotions with virtue. Specifically, preachers should speak about bioethics in a way that shows our brothers and sisters that (...) the moral truths of the Gospel will help them to find joy. However, it is not enough to speak about joy. One should never speak about these controversial and deeply personal issues without also speaking about the mercy of God. National Catholic Bioethics Quarterly 14.2 : 217–226. (shrink)