Random Fundamental Principles

1. Random Fundamental Principles Bioethics

2. question • Are there absolute truths? Truths that cannot change? • Did the martyrs believe in absolute principles or truths? Explain • Review: What is Moral Relativism?

3. Principle of non-contradiction • Something can not “be” and “not be” at the same time. • Relativism says truth depends on your perspective. MORAL RELATIVISM: morality depends on your opinion How does this apply to bioethics?

4. Faith and Reason • JCCHS motto: • Where faith and reason flourish • Scientific learning can never contradict the faith. • “Fides et Ratio”: Church document showing how Faith and Reason work together.

5. But, what about feelings? • feelings are morally neutral; •  may be clouded by psychological needs, cultural bias, focus on personal advantage (burning for witchcraft, racism…). •  help us empathize or stay zealous for a right cause

6. Morality • Morality deals with choices. Judgments are about actions and NOT the person. • What actions are intrinsically evil? CCC 1756 It is therefore an error to judge the morality of human acts by considering only the intention that inspires them or the circumstances (environment, social pressure, duress or emergency, etc.) which supply their context. There are acts which, in and of themselves, independently of circumstances and intentions, are always gravely illicit by reason of their object; such as blasphemy and perjury, murder and adultery. One may not do evil so that good may result from it.

7. 4 bioethical principles from Oxford Univ. Press • 1. Autonomy • 2. beneficence • 3 utility • 4 justice

8. Principle of autonomy • Persons should be able to exercise their capacity for self-determination: • A person should be well informed • A person must give consent to procedure Prima Facie (not absolute) because autonomy may be curtailed • When undermined by nature or nurture (mental instability, drug addictions, age…) • when a danger to self or others

9. Principle of paternalism Overriding a person’s actions or decisions for his own good There are many issues when this principle is applied and it is controversial Eg. A doctor withholds truth from terminally ill patient to spare feelings; experimenting with life-saving treatment without consent; families claiming mental incapacity

10. Principle of beneficence Principle of nonmaleficence • We should do good to others and avoid doing them harm • No question doctors should show “due care” • There are debates over to whom this applies – are we all our brothers keepers? What is our obligation to strangers, the poor…What is the government’s obligation, etc…

11. Principle of beneficence Principle of nonmaleficence Negligence The legal criteria for determining negligence are as follows: • the professional must have a duty to the affected party • the professional must breach that duty • the affected party must experience a harm; and • the harm must be caused by the breach of duty. • This principle affirms the need for medical competence. This principle affirms the need for medical competence.

12. Principle of Utility We should produce the most favorable balance of good over bad (i.e. weighing risks…) Eg: • should a doctor perform risky surgery or try medicine and diet, etc… • should immunization against deadly communicable disease be required if there is a probability some may have a fatal allergic reaction? • A company has resources to develop medicine for either a fatal heart disease or a fatal skin cancer – if used for both, neither will succeed, so which do they choose?

13. Principle of justice Justice in health care is usually defined as a form of fairness, or as Aristotle once said, "giving to each that which is his due." This implies the fair distribution of goods in society and requires that we look at the role of entitlement. The question of distributive justice also seems to hinge on the fact that some goods and services are in short supply, there is not enough to go around, thus some fair means of allocating scarce resources must be determined. • Can you articulate the current concerns about the health care debate?

14. Variations on distributive justice Libertarian theories: emphasize personal freedoms and rights in a free market – against government assistance and universal healthcare – people have dignity and entitled to only what they require through own work Egalitarian theories maintain that a just distribution is equal distribution Can you articulate the difference between Capitalism and Socialism? What do you think? What does the Church say?

15. Physical and Moral evil • Physical evil may be tolerated • Moral evil should be avoided at all cost

16. There is a natural law • What principles have been held by most generations and cultures? 1. Do good avoid evil 2. Self-preservation • How is this related to bioethics? (see video on natural law)

17. Do good. Avoid evil. Natural Law! Review: • Can behaviors be good, evil or neutral? Explain. • What is moral relativism? • How are these distinctions important to bioethics?

18. Each person has dignity • How can people be treated as objects? • How do people potentially place a value judgment on the quality of one’s life? • Is there ever a person who is not made in the image and likeness of God? If not, what ramifications does that have? • How is this related to bioethics?

19. God loves each personWe don’t determine a person’s value How is belief in this important in bioethics?

20. Principle of Solidarity • Am I my brother’s keeper? YES!!! • Solidarity: "mutual responsibility," a coinage of the "Encyclopédie" (1765), from solidaire "interdependent, complete, entire," from solide (see solid).

21. Principles of integrity and totality The well being of the whole person must be taken into account in deciding therapeutic procedures. St. Thomas: “a member of the human body is to be disposed of according as it may profit the whole… if a member is healthy and continuing in its natural state , it cannot be cut off to the detriment of the whole” (good to cut into someone to heal – but not to mutilate)

22. Integrity cont…. • Tests, treatments and surgeries include a risk which must be considered… • Vasectomies and tubal ligations violate the dignity of the human person • Anytime we treat a person simply as a physical body without regard to his spiritual soul, we violate his integrity.

23. The end does NOT justify the means • i.e. One may never do evil that good may come from it {Machiavelli said the end does justify means} • Give examples how this principle applies to bioethics. Apply both to a same situation.

25. Principle of Double Effect • Principle of Double Effect • An action that is good in itself that has two effects--an intended and otherwise not reasonably attainable good effect, and an unintended yet foreseen evil effect--is licit, provided there is a due proportion between the intended good and the permitted evil. • When there is a clash between the two universal norms of "do good" and "avoid evil," the question arises as to whether the obligation to avoid evil requires one to abstain from a good action in order to prevent a foreseen but merely permitted concomitant evil effect. The answer is that one need not always abstain from a good action that has foreseen bad effects, depending on certain moral criteria identified in the principle of double effect. Though five are listed here, some authors emphasize only four basic moral criteria (the fifth listed here further specifies the third criterion): (see next slide…)

26. Principle of Double Effect (remember the trolly scenarios) • Women with Uterine Cancer • Deliberate administration of pain-killer 9even if it weakens immune system) • Homicidal self-defense

27. Double Effect: • The nature-of-the-act condition. The action must be either morally good or indifferent. • The means-end condition. The bad effect must not be the means by which one achieves the good effect. • The right-intention condition. The intention must be the achieving of only the good effect, with the bad effect being only an unintended side effect. • The proportionality condition. The good effect must be at least equivalent in importance to the bad effect. • The second of these four conditions is an application of the more general principle that good ends do not justify evil means (cf. Romans 3:8).

28. Direct and Indirect Abortion • What is the difference between consequence that is willed and a consequence that is tolerated? • How is this related to bioethics? Direct Abortion is ALWAYS wrong An indirect abortion may be tolerated

29. Principle of Subsidiarity Holds that a larger body and greater body should not exercise functions which can be carried out efficiently by one smaller or lesser • Give an example involving authority structures at school? • Give an example using govt. structures • What does the Catholic Church advise re: political structures? (violation of this pinc is the risk of socialism – too much govt. control) • How is this related to bioethics?

30. Suffering is a powerful prayer • How do we know this? Dante’s levels of Purgatory

31. The Law of Love All is governed by charity • What is the definition of love? to will the good of the other • Considering that union with God in Heaven is a greater good than life, how does this apply to bioethics? • Should one do evil out of love?

32. Principles of Cooperation Formal and material cooperation Can you guess what they mean? HHS Mandate Sweat Shops Planned Parenthood sponsors Vaccines with aborted fetuses (pepsi products)

33. Principle of Cooperation • Formal Cooperation. Formal cooperation occurs when a person or organization freely participates in the action(s) of a principal agent, or shares in the agent’s intention, either for its own sake or as a means to some other goal. Implicit formal cooperation occurs when, even though the cooperator denies intending the object of the principal agent, the cooperating person or organization participates in the action directly and in such a way that the it could not be done without this participation. Formal cooperation in intrinsically evil actions, either explicitly or implicitly, is morally illicit (http://www.ascensionhealth.org/index.php?option=com_content&view=article&id=82:principles-of-formal-and-material-cooperation&Itemid=171)

34. Immediate Material Cooperation. Immediate material cooperation occurs when the cooperator participates in circumstances that are essential to the commission of an act, such that the act could not occur without this participation. Immediate material cooperation in intrinsically evil actions is morally illicit. There has been in the tradition a debate about the permissibility of immediate cooperation in immoral acts under "duress." When individuals are forced under duress (e.g., at gunpoint) to cooperate in the intrinsically evil action of another, they act with diminished freedom. Following Church teaching, the matter of their action remains objectively evil, but they do not intend this object with true freedom. In such cases, the matter remains objectively evil as such, but the subjective culpability of the cooperator is diminished. Very recently, the Vatican has rejected the arguments of those who would apply this concept of duress to Catholic organizations as a way to justify their immediate material involvement in certain objectionable actions. • (http://www.ascensionhealth.org/index.php?option=com_content&view=article&id=82:principles-of-formal-and-material-cooperation&Itemid=171)

35. Mediate Material Cooperation. Mediate material cooperation occurs when the cooperator participates in circumstances that are not essential to the commission of an action, such that the action could occur even without this cooperation. Mediate material cooperation in an immoral act might be justifiable under three basic conditions: • If there is a proportionately serious reason for the cooperation (i.e., for the sake of protecting an important good or for avoiding a worse harm); the graver the evil the more serious a reason required for the cooperation; • The importance of the reason for cooperation must be proportionate to the causal proximity of the cooperator’s action to the action of the principal agent (the distinction between proximate and remote); • The danger of scandal (i.e., leading others into doing evil, leading others into error, or spreading confusion) must be avoided.

36. The devil is real • When Peter tried to dissuade Jesus from suffering and dying, Jesus replied “Get behind me Satan” • We pray “Deliver us from evil” Keeping “Screwtape Letters” in mind, how might the devil be involved in bioethics?

37. Declaration of Independence • We hold these truths to be self evident (objective truth) • That all men are created equal • That they are endowed by their creator with certain inalienable rights • That among these are life liberty and the pursuit of happiness

38. Purpose of sex • Unitive and procreative (babies and bonding) • All ‘problems’ are from denying one or both What are practices that deny one or the other?

39. Principle of Proportionate and Disproportionate Means(Ordinary vs extraordinary) As conceived in the Catholic moral tradition, the principle holds that one is obligated to preserve his or her own life by making use of ordinary means, but is under no obligation to use extraordinary means

40. Legally ok does not mean morally ok • Dred Scott decision – 1853 slaves are property with no rights, like ‘chattel’ • Roe v Wade 1973

41. CCC on ordinary vs. extraordinary • 2278    Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of “over-zealous” treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected. (1007) • 2279    Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted. The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable. Palliative care is a special form of disinterested charity. As such it should be encouraged.

42. Ethical and Religious Directives • 56. A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.39 • 57. A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community. • 58. In principle, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally. This obligation extends to patients in chronic and presumably irreversible conditions (e.g., the “persistent vegetative state”) who can reasonably be expected to live indefinitely if given such care.40 Medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to prolong life or when they would be “excessively burdensome for the patient or [would] cause significant physical discomfort, for example resulting from complications in the use of the means employed.”41 For instance, as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort