Double-Effect Donation or Bodily Respect? A "Third Way" Response to Camosy and Vukov

Is it possible to donate unpaired vital organs, foreseeing but not intending one's own death? We argue that this is indeed psychologically possible, and thus far agree with Charles Camosy and Joseph Vukov in their recent paper on "double effect donation." Where we disagree with these authors is that we see double-effect donation not as a morally praiseworthy act akin to martyrdom but as a morally impermissible act that necessarily disrespects human bodily integrity. Respect for bodily integrity goes beyond avoiding the aim to kill: not all side effects of deliberate bodily interventions can be outweighed by intended benefits for another even if the subject fully consents. It is not any necessary intention to kill or harm another or oneself that makes lethal donation/harvesting illicit but the more immediate intention to accept or perform surgery on an (innocent) person combined with the foresight of lethal harm and no health-related good for him or her. Double-effect donation falls foul of the first condition of double-effect reasoning in that the immediate act is wrong in itself. We argue further that the wider effects of such donation would be socially disastrous and corrupting of the medical profession: doctors should retain a sense of nonnegotiable respect for bodily integrity even when they intervene on willing subjects for the benefit of others. Summary: Lethal organ donation (for example, donating one's heart) is not a praiseworthy but a morally impermissible act. This is not because such donation necessarily involves any aim to kill oneself (if one is the donor) or to kill the donor (if one is the surgeon). Respect for bodily integrity goes beyond avoiding any hypothetical aim to kill or harm oneself or another innocent person. 'Double effect donation' of unpaired vital organs, defended by Camosy and Vukov, is in our view a form of lethal bodily abuse and would also harm the transplant team, the medical profession and society at large.

Double-Effect Donation Disputed

In "Double Effect Donation," Camosy and Vukov argue that "there are circumstances in which it is morally permissible for a healthy individual to donate their organs even though their death is a foreseeable outcome". They propose that a living donor could ethically donate an entire, singular, vital organ while knowing that this act would result in death. In reply, I argue that it is not ethical for a living person to donate an entire, singular, vital organ. Moreover, mutatis mutandis, it is not ethical for surgeons and others to perform such a deadly operation. For to do so is "intentionally to cause the death of the donor in disposing of his organs". Such an act violates the dead donor rule which holds that an entire, singular, vital organ may be taken only from a corpse. Contrary to Camosy and Vukov's claims, double-effect reasoning does not endorse such organ donation.

Theravada Buddhism and Roman Catholicism on the Moral Permissibility of Palliative Sedation: A Blurred Demarcation Line

Although Theravada Buddhism and Roman Catholicism agree on the moral justification for palliative sedation, they differ on the premises underlying the justification. While Catholicism justifies palliative sedation on the ground of the Principle of Double Effect, Buddhism does so on the basis of the Third Noble Truth. Despite their theological differences, Buddhism and Catholicism both value the moral significance of the physician's intent to reduce suffering and both respect the sanctity of life. This blurs the demarcation line between Buddhism and Catholicism regarding the moral justification of palliative sedation.

Double Effect Donation

Double Effect Donation claims it is permissible for a person meeting brain death criteria to donate vital organs, even though such a person may be alive. The reason this act is permissible is that it does not aim at one's own death but rather at saving the lives of others and because saving the lives of others constitutes a proportionately serious reason for engaging in a behavior in which one foresees one's death as the outcome. Double Effect Donation, we argue, opens a novel position in debates surrounding brain death and organ donation and does so without compromising the sacredness and fundamental equality of human life.

SUMMARY

Recent cases and discussion have raised questions about whether brain death criteria successfully capture natural death. These questions are especially troubling since vital organs are often retrieved from individuals declared dead by brain death criteria. We therefore seem to be left with a choice: either salvage brain death criteria or else abandon current organ donation practices. In this article, we present a different way forward. In particular, we defend a view we call Double Effect Donation, according to which it is permissible for a person meeting brain death criteria to donate vital organs, even though such a person may be alive. Double Effect Donation, we argue, is not merely compatible with but grows out of a view that acknowledges the sacredness and fundamental equality of human life.

COVID-19 Policy-Making in a Country Divided: Catholic Social Teaching as a Path to Unity

Because no vaccines or specific treatments are available, governments around the globe have responded to the Coronavirus Virus Disease 2019 (COVID-19) pandemic with a variety of nonpharmaceutical interventions (NPIs) that include sheltering-in-place orders, social distancing, and school and business closures. While the actual and potential harm due to COVID-19 is far more severe than influenza, the harms due to the NPIs-that have clearly reduced mortality due to COVID-19-are also significant. With government-ordered "lockdowns" across the globe, many arguments for and against returning to normal social and economic activity have been reported, and in fact, Americans are divided about how and when to "open up." These arguments seem to fall into two major categories. Utilitarianism suggests that suspension of civil liberties and constitutional rights is a necessary response, while Libertarianism supports individual decision-making and greatly reduced government mandates. Protesters around the country have been vocal about one or the other points of view. First, we consider in detail the potential harms of severe acute respiratory syndrome virus-2 (SARS-CoV-2) if left unchecked by NPIs. Second, we look at harms due to restricted social and economic activity on human morbidity and mortality. Finally, we offer a framework based on the four pillars of Catholic Social Teaching and the principle of double effect that offers a more humane solution than Utilitarian or Libertarian principles alone.

Non-sterilizing Hysterectomies? A Catholic Critique of the CDF

In 2019, the Congregation for the Doctrine of the Faith (CDF) issued a statement that a woman could morally undergo a hysterectomy to avoid serial miscarriages if her uterus were incapable of sustaining a child until viability because the procedure would not constitute a direct sterilization. We believe the CDF's conclusion and line of argumentation are both mistaken. Since the proposed hysterectomy seeks to make impossible what is presently possible-conceiving a child-it must therefore constitute a direct sterilization, which the Church has long taught is immoral. Using the Principle of Totality, we offer and defend a more straightforward interpretation of the case, arguing that while the woman's condition is both tragic and chronic, spiritual counseling and training in natural family planning should be recommended, as a hysterectomy is not medically indicated in this case.

Summary

The Congregation for the Doctrine of the Faith (CDF)'s recently issued a statement claiming that a woman could morally undergo a hysterectomy to avoid serial miscarriages if her uterus were incapable of sustaining a child until viability on the grounds that the procedure would not constitute a direct sterilization. We argue this is mistaken, and that the procedure would constitute a direct sterilization.

Targeting the Fetal Body and/or Mother-Child Connection: Vital Conflicts and Abortion

Is the "act itself" of separating a pregnant woman and her previable child neither good nor bad morally, considered in the abstract? Recently, Maureen Condic and Donna Harrison have argued that such separation is justified to protect the mother's life and that it does not constitute an abortion as the aim is not to kill the child. In our article on maternal-fetal conflicts, we agree there need be no such aim to kill (supplementing aims such as to remove). However, we argue that to understand "abortion" as performed only where the death of the child is intended is to define the term too narrowly. Respect for the mother, the fetus, and the bond between them goes well beyond avoiding any such aim. We distinguish between legitimate maternal treatments simply aimed at treating or removing a damaged part of the woman and illegitimate treatments that focus harmfully on the fetal body and its presence within the mother's body. In obstetrics as elsewhere, not all side effects for one subject of intervention can be outweighed by intended benefits for another. Certain side effects of certain intended interventions are morally conclusive.

Summary

How should one respond to "vital conflicts" in pregnancy where the mother's life or health is at risk? We argue that, in addition to avoiding any aim of ending life, one must avoid the similarly unacceptable aims of evicting the baby pre-viability and invading its body, including its placenta, in a lethally harmful way. Even at the cost of real and important benefits for the mother such as increased safety and protection of fertility, we must manage cases always in a way that respects the inviolable bodily rights of both mother and child and crucially, the unique bond between them.

Bioethical and Moral Perspectives in Human Reproductive Medicine

A reductive reading of Humanae vitae seeks to limit its appeal to a ban on contraception. In truth, however, it offers a vision of human sexuality and conjugal love with broad and enduring relevance. In setting forth the intrinsic complementarity and irreducibility of the unitive and procreative dimensions of the conjugal act, Paul VI has given us a hermeneutical key for assessing many contemporary ethical dilemmas in human reproductive medicine. From this perspective, this article seeks to apply the logic of Humanae vitae to several real-life scenarios confronted by medical practitioners, educators, and ethicists working in the field of fertility and reproductive health. These include a consideration of the ethics of prescribing hormonal contraceptives, the possibilities of investigating male infertility, issues of cooperation in counseling and assisting conception in same-sex relationships, the ethics pertaining to assisted reproductive technology (ART), the contested case of prenatal adoption, and the application of double-effect reasoning.

Summary

On the occasion of the fiftieth anniversary of the promulgation of Pope Paul VI's encyclical Humanae vitae, this article seeks to defend its enduring relevance to modern-day society, through application of its reasoning to contemporary dilemmas in reproductive medicine. It considers real cases of the ethics of prescribing hormonal contraceptives, of investigating male infertility, of cooperating in counseling and assisting conception in same-sex relationships, of ART, of prenatal adoption, and the application of double-effect reasoning.

Moral theological analysis of direct versus indirect abortion

Cases of a vital conflict, where the lives of both the mother and child are at risk during pregnancy, have been the subject of recent vigorous debate. The basic principles put forth in the Ethical and Religious Directives are reviewed, as is the principle of double effect. An illustrative case of severe cardiomyopathy in a pregnant woman is described and it is noted that the principle of double effect would not apply. Counter arguments are noted, focusing on Martin Rhonheimer who posits that in the case of vital conflicts, such as performing a craniotomy on a baby stuck in the birth canal, taking the baby's life does not constitute a direct abortion because moral norms do not apply in the extreme conflict situation where both mother and child will die. He states that the death of the fetus is not intentional in these cases. He overlooks "how the life is being saved" and that a choice has been made, which implies a moral act, not just a physical one. Rhonheimer wants to make his moral judgment solely on the basis of intention, prescinding from what actually occurs in the physical world of cause and effect. This is clearly against the teaching in Evangelium vitae. Ethics deal with the deliberate chosen actions in space and time of embodied human beings; it deals inescapably with material actions, with specifications of intentions. Rhonheimer states, "a killing or an abortion is 'direct,' not because the death of the fetus is caused in some physically direct way, but because it is willed as the means to an end." However the death of the child cannot be excluded from the act and is therefore of necessity included in it. What the acting person chooses includes what happens physically in this act. If the action theory proposed by Rhonheimer is accepted, it could be very difficult to avoid death-dealing actions from taking place in Catholic hospitals.

SUMMARY

This is a moral analysis of cases of "vital conflicts," where the lives of both the mother and child are at risk during a pregnancy. It is stated by some ethicists that directly killing the baby to save the life of the mother is morally justified, even when the direct action of the doctor is to kill the baby. Examples are provided to illustrate how Catholic moral principles apply. It is concluded that direct killing, regardless of the intention, is not justified. The doctor should always work to try and save the lives of both the mother and the child. One should never be directly killed even if the intention is to save the life of the other.