The National Catholic Bioethics Quarterly

Some Catholic theologians are redefining the meaning of “direct” and “indirect” by including only the agent’s intention in defining the moral object, while simultaneously excluding the physical actions that the agent consciously and deliberately chooses. The net effect is that these theologians now approve of many kinds of abortions traditionally understood to be morally evil in situations of maternal–fetal vital conflict. Such an error has grave implications for Catholic bioethics and health care. When the intentionalist method is applied to other disputed questions in bioethics, however, it becomes clear that its ideology is fundamentally erroneous.

Medical and nursing personnel have an obligation to provide the medication necessary for every patient’s pain relief. This includes patients whose life-supporting mechanical ventilation is being removed, who may not exhibit traditional signs of pain or dyspnea. The purpose of this paper is not to argue a position on withdrawing life support. Rather, it argues that nurses and physicians have an obligation to provide pain-relieving medication, such as opiates, when life support is removed, to ensure that those entrusted to their care do not experience pain or significant distress. This is based on the principle of double effect, by which two actions, one intended and one unintended, may be permissible if there is a proportionate reason. The goal in these situations is never to hasten death intentionally but to make patients’ pain and suffering tolerable as a matter of compassionate and loving care.

Euthanasia advocates argue that end-of-life decisions should be based on patients’ autonomous evaluations of their own quality of life. The question is whether a patient’s quality of life has deteriorated so far as to make death a benefit. Criteria for evaluating quality of life are, however, unavoidably arbitrary and unjust. The concept is difficult to define, and human autonomy has limits. This essay discusses the moral issues raised by quality-of-life judgments at the end of life: who makes them, what criteria they use, and what clinical actions the conclusions justify. It then looks at ways in which quality of life can be considered legitimately, in relation not to euthanasia, which is always illicit, but to specific proposed treatments. If a patient decides to forgo treatment, the decision should be based on the judgment that the treatment, its side effects, or its long-term consequences would be excessively burdensome or useless.

Not all actions that are legal are necessarily morally correct. However, there are few protections for providers who are pressured to comply with actions and procedures that infringe on their religious beliefs regarding human dignity. The right of health care providers to freely act on religious convictions and refrain from cooperating with morally reprehensible tasks is often eschewed in favor of political correctness or is branded as discrimination. Adequate safeguards are urgently needed for health care workers at all levels to ensure that they can continue to care for the sick and most vulnerable members of the community without violating the dictates of their conscience. This article examines the free exercise of religion as it pertains to medical provider conscience protections. The author argues for conscience protection legislation with a right of action.

Central to the message of Christianity is the doctrine of suffering as redemptive; therefore, this doctrine must continue to occupy a central place in the discourse about human suffering. Narrative—like suffering itself—has a unique epistemic value and the power to exert a humanizing influence in this discourse. This presentation, though neither strictly systematic nor exhaustive, illustrates narrative’s illuminative capacity in relation to the concepts and propositions that have been part of the discussion of redemptive suffering. Beginning with the present context, it provides justification for the use of narrative, discusses narrative’s place in the Catholic tradition, and then offers three narrative portraits accompanied by brief reflections on the various propositions that each narrative elucidates.

Difficulties in the moral assessment of embryo transfer and adoption include distinguishing it from illicit procedures like IVF and cryopreservation, determining the moral status of the human embryo, and reconciling embryo transfer and adoption with the procreative and unitive aspects of marriage. Many scholars who support embryo transfer and adoption limit their discussion to heterologous embryo transfer, the transfer of a genetically unrelated embryo into the uterus of a married woman. In this paper, the author focuses on homologous embryo transfer, the transfer of a genetically related embryo, as a viable option for married couples. It is the responsibility of the genetic mother to implant her embryos regardless of how they were created. When this option is not feasible, heterologous embryo transfer is possible in limited circumstances.